Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals.

Science.gov (United States)

Hayden, Melanie G; Hughes, Samuel; Hahn, Edward J; Aryan, Henry E; Levy, Michael L; Jandial, Rahul

2011-01-01

A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego. At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery. Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.

Neurosurgical robotic arm drilling navigation system.

Science.gov (United States)

Lin, Chung-Chih; Lin, Hsin-Cheng; Lee, Wen-Yo; Lee, Shih-Tseng; Wu, Chieh-Tsai

2017-09-01

The aim of this work was to develop a neurosurgical robotic arm drilling navigation system that provides assistance throughout the complete bone drilling process. The system comprised neurosurgical robotic arm navigation combining robotic and surgical navigation, 3D medical imaging based surgical planning that could identify lesion location and plan the surgical path on 3D images, and automatic bone drilling control that would stop drilling when the bone was to be drilled-through. Three kinds of experiment were designed. The average positioning error deduced from 3D images of the robotic arm was 0.502 ± 0.069 mm. The correlation between automatically and manually planned paths was 0.975. The average distance error between automatically planned paths and risky zones was 0.279 ± 0.401 mm. The drilling auto-stopping algorithm had 0.00% unstopped cases (26.32% in control group 1) and 70.53% non-drilled-through cases (8.42% and 4.21% in control groups 1 and 2). The system may be useful for neurosurgical robotic arm drilling navigation. Copyright © 2016 John Wiley & Sons, Ltd.

Neurosurgical Practice in Transition: A Review.

Science.gov (United States)

Kim, Dong H; Dagi, T Forcht; Bean, James R

2017-04-01

Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment. Copyright © 2016 by the Congress of Neurological Surgeons.

Pattern of Neurosurgical Procedures in Ethiopia: Experience from ...

African Journals Online (AJOL)

Background: In Ethiopia, the number of practicing neurosurgeons is very few and the pattern of neurosurgical diseases and operations is not well known.This study was aimed to define the patterns of neurosurgical diseases and the operative procedures commonly seen at two main neurosurgical hospitals in Ethiopia.

Disorders of water homeostasis in neurosurgical patients.

LENUS (Irish Health Repository)

Hannon, Mark J

2012-05-01

Context: Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery. Setting: We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies. Patients: The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation. Interventions: We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism. Main Outcome Measures: Morbidity and mortality associated with deranged salt and water balance were measured. Results: The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach. Conclusions: A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients.

Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback.

Science.gov (United States)

Lemole, G Michael; Banerjee, P Pat; Luciano, Cristian; Neckrysh, Sergey; Charbel, Fady T

2007-07-01

Mastery of the neurosurgical skill set involves many hours of supervised intraoperative training. Convergence of political, economic, and social forces has limited neurosurgical resident operative exposure. There is need to develop realistic neurosurgical simulations that reproduce the operative experience, unrestricted by time and patient safety constraints. Computer-based, virtual reality platforms offer just such a possibility. The combination of virtual reality with dynamic, three-dimensional stereoscopic visualization, and haptic feedback technologies makes realistic procedural simulation possible. Most neurosurgical procedures can be conceptualized and segmented into critical task components, which can be simulated independently or in conjunction with other modules to recreate the experience of a complex neurosurgical procedure. We use the ImmersiveTouch (ImmersiveTouch, Inc., Chicago, IL) virtual reality platform, developed at the University of Illinois at Chicago, to simulate the task of ventriculostomy catheter placement as a proof-of-concept. Computed tomographic data are used to create a virtual anatomic volume. Haptic feedback offers simulated resistance and relaxation with passage of a virtual three-dimensional ventriculostomy catheter through the brain parenchyma into the ventricle. A dynamic three-dimensional graphical interface renders changing visual perspective as the user's head moves. The simulation platform was found to have realistic visual, tactile, and handling characteristics, as assessed by neurosurgical faculty, residents, and medical students. We have developed a realistic, haptics-based virtual reality simulator for neurosurgical education. Our first module recreates a critical component of the ventriculostomy placement task. This approach to task simulation can be assembled in a modular manner to reproduce entire neurosurgical procedures.

Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees.

Science.gov (United States)

Zammar, Samer G; El Tecle, Najib E; El Ahmadieh, Tarek Y; Adelson, P David; Veznedaroglu, Erol; Surdell, Daniel L; Harrop, James S; Benes, Vladimir; Rezai, Ali R; Resnick, Daniel K; Bendok, Bernard R

2015-08-01

To assess microsurgical and diagnostic cerebral angiography modules and their corresponding objective assessment scales as educational tools for European neurosurgical residents at the European Association of Neurosurgical Societies Resident Vascular Neurosurgery course, which was held in Prague, Czech Republic, on September 2013. Microsurgical skills and cerebral angiography are fundamental skills in vascular neurosurgery. There is a need to develop a simulation-based curriculum focusing on these skills for neurosurgical trainees worldwide. The course consisted of 2 modules: microanastomosis and diagnostic cerebral angiography. In addition to an initial screening survey, each module was divided into 3 components: 1) a before didactic cognitive knowledge and technical skills testing, 2) a didactic lecture, and 3) an after didactic cognitive knowledge and technical skills testing. We compared the trainees' cognitive and technical scores from the before and after testing phases. Wilcoxon sum rank test was used to test statistical significance. The knowledge test median scores increased from 63% and 68% to 80% and 88% (P technical proficiency. Copyright © 2015. Published by Elsevier Inc.

Association of Prior Falls with Adverse Outcomes After Neurosurgical Operations in the Elderly.

Science.gov (United States)

Bekelis, Kimon; Rahmani, Redi; Kim-Hyung, Joon; Calnan, Daniel; MacKenzie, Todd A

2017-03-01

Despite the increasing number of elderly patients undergoing neurosurgical interventions, there are limited resources for preoperative assessment of frailty in this population. We investigated the association between recent history of falls and surgical outcomes for these patients. We performed a prospective cohort study of all patients, 65 years and older, undergoing elective neurosurgical procedures from 2014-2015 in a tertiary referral medical center. We examined the association of sustaining a fall in the 6 months before the operation with discharge to a facility, readmissions, and complications in the first 30 days after discharge. In order to control for confounding, we used multivariable regression models and propensity score conditioning. Mixed-effects models were used to control for clustering at the surgeon level. During the study period, 143 elderly patients underwent a neurosurgical procedure and met the inclusion criteria. Of these, 53.1% had a history of falls preoperatively. Mixed-effects multivariable logistic regression analysis demonstrated an association between preoperative falls and discharge to a facility (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.23-1.47), 30-day readmissions (OR, 1.57; 95% CI, 1.36-1.78), and 30-day complications (OR, 1.13; 95% CI, 1.03-1.23). Similar associations were present in propensity score-adjusted models and models stratified by cranial and spinal procedures. History of at least 1 fall in the 6 months before a neurosurgical operation was associated with increased risk of discharge to a facility, readmissions, and complications in the first 30 days after discharge. History of prior falls should be taken into account during the preoperative risk assessment of neurosurgical patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Model-Based Integration and Interpretation of Data

DEFF Research Database (Denmark)

Petersen, Johannes

2004-01-01

Data integration and interpretation plays a crucial role in supervisory control. The paper defines a set of generic inference steps for the data integration and interpretation process based on a three-layer model of system representations. The three-layer model is used to clarify the combination...... of constraint and object-centered representations of the work domain throwing new light on the basic principles underlying the data integration and interpretation process of Rasmussen's abstraction hierarchy as well as other model-based approaches combining constraint and object-centered representations. Based...

Evaluating the Effectiveness and the Impact of Donated Neurosurgical Equipment on Neurosurgical Units in Low- and Middle-Income Countries: The World Federation of Neurosurgical Societies Experience.

Science.gov (United States)

Venturini, Sara; Park, Kee B

2018-01-01

Surgical practice highly depends on the availability of surgical equipment; this is particularly relevant to low- and middle-income countries (LMICs), where resources are limited. A key part of the efforts to improve surgical provision globally include providing affordable equipment to LMICs; however, the effectiveness and the impact of these initiatives have not yet been assessed. We aimed to evaluate the World Federation of Neurosurgical Societies neurosurgical equipment program in this context. Recipients were identified from the World Federation of Neurosurgical Societies records; contact details were gathered. An online survey was used to collect data on equipment, including its current use, any malfunctioning issues, suitability, reliability, serviceability, and the impact it has had on the unit. Responses were received from 16 units, totaling 28 pieces of equipment. A total of 75% of the equipment is still in use; of this, 57% is fully functioning, and 43% is used despite some malfunction. We found that 25% of the equipment is broken and unusable; high-maintenance items, such as high-speed drills, feature in this category (100% broken, n = 3). Units reported an increase in number of operation performed in 74% cases, improved surgery quality in 78%, and breadth of operations in 44%. Satisfaction, equipment suitability, reliability, and serviceability scored highly, with median values of 9 for all fields on a 10-point scale. Equipment donation positively impacts neurosurgical units in LMICs by allowing expansion of neurosurgical practice, improved safety and quality, and affordability. Adequate follow-up, considerations regarding equipment durability and maintenance needs, and improved support for repairs should be prioritized to ensure maximal benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

Merging pathways: music therapy in neurosurgical rehabilitation.

Science.gov (United States)

Gilbertson, S; Ischebeck, W

2002-01-01

Relatively few departments of Music Therapy are found within neurosurgical rehabilitation clinics. In institutions where these departments exist, music therapy has become an integral part of multi-professional treatment and research activities (Gilbertson 1999). The diverse intervention strategies in Music Therapy focus upon auditory, motor, visual, cognitive and affective processing which are all involved in receptive and expressive musical behaviour and which affect related non-musical behaviour. A clear differentiation is made between primary and adjunct therapy roles. The related fields of neuromusicology, neuroanatomy, neuropsychology, music psychology and humanistic psychology are primary sources in the development of models of clinical application (Hodges 1996). Our main interests are focussed on the following issues and areas of clinical application: The initialisation of contact with patients in vegetative status Communicative interaction with patients who can not (initially) use verbal communication (aphasic disorders) Temporal motor organisation with patients with sensomotor disorders Cognitive organisation and mnemonic framework with patients with neuropsychological functional disorders (concentration, memory, perception) Treatment of spatial perception disorders (neglect) Enhancing personal and social integration following individual isolation, social withdrawal. These topics will be discussed and highlighted with clinical examples.

Machine Learning and Neurosurgical Outcome Prediction: A Systematic Review.

Science.gov (United States)

Senders, Joeky T; Staples, Patrick C; Karhade, Aditya V; Zaki, Mark M; Gormley, William B; Broekman, Marike L D; Smith, Timothy R; Arnaout, Omar

2018-01-01

Accurate measurement of surgical outcomes is highly desirable to optimize surgical decision-making. An important element of surgical decision making is identification of the patient cohort that will benefit from surgery before the intervention. Machine learning (ML) enables computers to learn from previous data to make accurate predictions on new data. In this systematic review, we evaluate the potential of ML for neurosurgical outcome prediction. A systematic search in the PubMed and Embase databases was performed to identify all potential relevant studies up to January 1, 2017. Thirty studies were identified that evaluated ML algorithms used as prediction models for survival, recurrence, symptom improvement, and adverse events in patients undergoing surgery for epilepsy, brain tumor, spinal lesions, neurovascular disease, movement disorders, traumatic brain injury, and hydrocephalus. Depending on the specific prediction task evaluated and the type of input features included, ML models predicted outcomes after neurosurgery with a median accuracy and area under the receiver operating curve of 94.5% and 0.83, respectively. Compared with logistic regression, ML models performed significantly better and showed a median absolute improvement in accuracy and area under the receiver operating curve of 15% and 0.06, respectively. Some studies also demonstrated a better performance in ML models compared with established prognostic indices and clinical experts. In the research setting, ML has been studied extensively, demonstrating an excellent performance in outcome prediction for a wide range of neurosurgical conditions. However, future studies should investigate how ML can be implemented as a practical tool supporting neurosurgical care. Copyright © 2017 Elsevier Inc. All rights reserved.

An Instrumented Glove to Assess Manual Dexterity in Simulation-Based Neurosurgical Education

Directory of Open Access Journals (Sweden)

Juan Diego Lemos

2017-04-01

Full Text Available The traditional neurosurgical apprenticeship scheme includes the assessment of trainee’s manual skills carried out by experienced surgeons. However, the introduction of surgical simulation technology presents a new paradigm where residents can refine surgical techniques on a simulator before putting them into practice in real patients. Unfortunately, in this new scheme, an experienced surgeon will not always be available to evaluate trainee’s performance. For this reason, it is necessary to develop automatic mechanisms to estimate metrics for assessing manual dexterity in a quantitative way. Authors have proposed some hardware-software approaches to evaluate manual dexterity on surgical simulators. This paper presents IGlove, a wearable device that uses inertial sensors embedded on an elastic glove to capture hand movements. Metrics to assess manual dexterity are estimated from sensors signals using data processing and information analysis algorithms. It has been designed to be used with a neurosurgical simulator called Daubara NS Trainer, but can be easily adapted to another benchtop- and manikin-based medical simulators. The system was tested with a sample of 14 volunteers who performed a test that was designed to simultaneously evaluate their fine motor skills and the IGlove’s functionalities. Metrics obtained by each of the participants are presented as results in this work; it is also shown how these metrics are used to automatically evaluate the level of manual dexterity of each volunteer.

Neurosurgical Hyponatremia

Directory of Open Access Journals (Sweden)

Mark J. Hannon

2014-10-01

Full Text Available Hyponatremia is a frequent electrolyte imbalance in hospital inpatients. Acute onset hyponatremia is particularly common in patients who have undergone any type of brain insult, including traumatic brain injury, subarachnoid hemorrhage and brain tumors, and is a frequent complication of intracranial procedures. Acute hyponatremia is more clinically dangerous than chronic hyponatremia, as it creates an osmotic gradient between the brain and the plasma, which promotes the movement of water from the plasma into brain cells, causing cerebral edema and neurological compromise. Unless acute hyponatremia is corrected promptly and effectively, cerebral edema may manifest through impaired consciousness level, seizures, elevated intracranial pressure, and, potentially, death due to cerebral herniation. The pathophysiology of hyponatremia in neurotrauma is multifactorial, but most cases appear to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH. Classical treatment of SIADH with fluid restriction is frequently ineffective, and in some circumstances, such as following subarachnoid hemorrhage, contraindicated. However, the recently developed vasopressin receptor antagonist class of drugs provides a very useful tool in the management of neurosurgical SIADH. In this review, we summarize the existing literature on the clinical features, causes, and management of hyponatremia in the neurosurgical patient.

Mentoring models in neurosurgical training: Review of literature.

Science.gov (United States)

Akhigbe, Taiwo; Zolnourian, Ardalan; Bulters, Diederik

2017-11-01

Effective mentoring is an invaluable element in the development of next generation of neurosurgeons. A mentor helps to develop professional core values, technical and non-technical skills, attitudes and disposition required to be qualified and competent neurosurgeon. Giving the invaluable significance of mentoring in neurosurgery, we undertook this literature review to identify mentoring models evaluating its success and relative benefit. Literature search identified using MeSH word 'mentor', mentoring, mentorship, mentoring model, neurosurgery' in MEDLINE, EMBASE and Scopus databases from 1990 to 2016. Literature reviewed to identify status of mentoring in neurosurgery, potential barriers, pitfalls and future framework for mentoring in neurosurgery. Additional articles identified through manual search of reference lists. A total of 247 studies were obtained from electronic databases, after removing duplicates, abstracts, letters to the editor and non-neurosurgery papers. Sixteen full text articles retrieved out of which five met the inclusion criteria. Generally, there is paucity of articles regarding mentoring in neurosurgery, all included papers were written in English Language, all of them described mentoring model used including simulation, distance, collaborative, facilitative tele-mentoring and peer mentoring. Mentoring in Neurosurgery is an important aspect of personal and professional development of neurosurgical trainees, currently there is decline in traditional apprenticeship due to increase demand for modern use of specialised technology, simulation and tele-medicine in neurosurgery practice. Effective and efficient mentoring will be an interplay of six mentoring models (collaborative, facilitative, distance, simulation, tele mentoring and peer mentoring) identified. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Coagulation management in patients undergoing neurosurgical procedures.

Science.gov (United States)

Robba, Chiara; Bertuetti, Rita; Rasulo, Frank; Bertuccio, Alessando; Matta, Basil

2017-10-01

Management of coagulation in neurosurgical procedures is challenging. In this contest, it is imperative to avoid further intracranial bleeding. Perioperative bleeding can be associated with a number of factors, including anticoagulant drugs and coagulation status but is also linked to the characteristic and the site of the intracranial disorder. The aim of this review will be to focus primarily on the new evidence regarding the management of coagulation in patients undergoing craniotomy for neurosurgical procedures. Antihemostatic and anticoagulant drugs have shown to be associated with perioperative bleeding. On the other hand, an increased risk of venous thromboembolism and hypercoagulative state after elective and emergency neurosurgery, in particular after brain tumor surgery, has been described in several patients. To balance the risk between thrombosis and bleeding, it is important to be familiar with the perioperative changes in coagulation and with the recent management guidelines for anticoagulated patients undergoing neurosurgical procedures, in particular for those taking new direct anticoagulants. We have considered the current clinical trials and literature regarding both safety and efficacy of deep venous thrombosis prophylaxis in the neurosurgical population. These were mainly trials concerning both elective surgical and intensive care patients with a poor grade intracranial bleed or multiple traumas with an associated severe traumatic brain injury (TBI). Coagulation management remains a major issue in patients undergoing neurosurgical procedures. However, in this field of research, literature quality is poor and further studies are necessary to identify the best strategies to minimize risks in this group of patients.

Neurosurgical In-Patient Profile: A Three-Year Audit in a Regional ...

African Journals Online (AJOL)

The burden of neurosurgical care in West Africa, compared with established facilities in Europe and America, is immense. The reasons include preventable neurotrauma, the dearth of specialists and a lack of a regional centre for neurosurgical care. The few unevenly spread established neurosurgical units can only meet ...

Neurosurgical procedures in Jehovah's Witnesses: the Tema experience.

Science.gov (United States)

Andrews, N B

2009-05-01

On account of religious reasons, Jehovah Witnesses do not accept blood or blood products; occasionally, they accept reinfusion of autologous blood via a cell saver during surgery. The aim of this study was to document the demographics of Jehovah Witnesses undergoing neurosurgical procedures, the neurosurgical procedures undertaken in Jehovah Witnesses and to evaluate the complications of the procedures. A retrospective audit of the medical records of all Jehovah's Witnesses who underwent neurosurgical procedures at our institution, from January 1st 2000 to December 31st 2006, was carried out. The parameters investigated included demographics, pre and post operative diagnosis, type of neurosurgical procedure and complications. Nineteen patients (fifteen male, four female; male/female 3.8:1) constituted the series. The mean age was 45.8 (range: 20-65) years. A total of 21 procedures were performed; intracranial surgery (33%), spinal surgery (67%). No autotransfusion of blood was given. Lumbar laminectomy for stenosis was the commonest spine procedure, ten (71.4%); craniotomy for tumor excision was the commonest intracranial procedure, six (85.7%). With respect to the whole series, the morbidity rate was 4.7% and the mortality rate was 4.7%; both were from intracranial surgery. It is possible to perform certain types of neurosurgical procedures in Jehovah's Witnesses without increasing the mortality and morbidity rate.

Risk of Venous Thromboembolism and Operative Duration in Patients Undergoing Neurosurgical Procedures.

Science.gov (United States)

Bekelis, Kimon; Labropoulos, Nicos; Coy, Shannon

2017-05-01

The association of operative duration with the risk of venous thromboembolism (VTE) has not been quantified in neurosurgery. To investigate the association of surgical duration for several neurosurgical procedures and the incidence of VTE. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. In order to control for confounding, we used multivariable regression models, and propensity score conditioning. During the study period, there were 94 747 patients, who underwent neurosurgical procedures, and met the inclusion criteria. Of these, 1358 (1.0%) developed VTE within 30 days postoperatively. Multivariable logistic regression demonstrated an association of longer operative duration with higher 30-day incidence of VTE (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19-1.25). Compared with procedures of moderate duration (third quintile, 40-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 3.15; 95% CI, 2.49-3.99) of developing VTE. The shortest procedures (<20th percentile) were associated with a decreased incidence of VTE (OR, 0.51; 95% CI, 0.27-0.76) in comparison to those of moderate duration. The same associations were present in propensity score-adjusted models, and models stratified by subgroups of cranial, spinal, peripheral nerve, and carotid procedures. In a cohort of patients from a national prospective surgical registry, increased operative duration was associated with increased incidence of VTE for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management, and to stratify patients with regard to VTE risk. Copyright © 2016 by the Congress of Neurological Surgeons

Evaluation of a completely robotized neurosurgical operating microscope.

Science.gov (United States)

Kantelhardt, Sven R; Finke, Markus; Schweikard, Achim; Giese, Alf

2013-01-01

Operating microscopes are essential for most neurosurgical procedures. Modern robot-assisted controls offer new possibilities, combining the advantages of conventional and automated systems. We evaluated the prototype of a completely robotized operating microscope with an integrated optical coherence tomography module. A standard operating microscope was fitted with motors and control instruments, with the manual control mode and balance preserved. In the robot mode, the microscope was steered by a remote control that could be fixed to a surgical instrument. External encoders and accelerometers tracked microscope movements. The microscope was additionally fitted with an optical coherence tomography-scanning module. The robotized microscope was tested on model systems. It could be freely positioned, without forcing the surgeon to take the hands from the instruments or avert the eyes from the oculars. Positioning error was about 1 mm, and vibration faded in 1 second. Tracking of microscope movements, combined with an autofocus function, allowed determination of the focus position within the 3-dimensional space. This constituted a second loop of navigation independent from conventional infrared reflector-based techniques. In the robot mode, automated optical coherence tomography scanning of large surface areas was feasible. The prototype of a robotized optical coherence tomography-integrated operating microscope combines the advantages of a conventional manually controlled operating microscope with a remote-controlled positioning aid and a self-navigating microscope system that performs automated positioning tasks such as surface scans. This demonstrates that, in the future, operating microscopes may be used to acquire intraoperative spatial data, volume changes, and structural data of brain or brain tumor tissue.

Three-dimensional spiral CT for neurosurgical planning.

Science.gov (United States)

Klein, H M; Bertalanffy, H; Mayfrank, L; Thron, A; Günther, R W; Gilsbach, J M

1994-08-01

We carried out 22 examinations to determine the value of three-dimensional (3D) volumetric CT (spiral CT) for planning neurosurgical procedures. All examinations were carried out on a of the first generation spiral CT. A tube model was used to investigate the influence of different parameter settings. Bolus injection of nonionic contrast medium was used when vessels or strongly enhancing tumours were to be delineated. 3D reconstructions were carried out using the integrated 3D software of the scanner. We found a table feed of 3 mm/s with a slice thickness of 2 mm and an increment of 1 mm to be suitable for most purposes. For larger regions of interest a table feed of 5 mm was the maximum which could be used without blurring of the 3D images. Particular advantages of 3D reconstructed spiral scanning were seen in the planning of approaches to the lower clivus, acquired or congenital bony abnormalities and when the relationship between vessels, tumour and bone was important.

Three-dimensional spiral CT for neurosurgical planning

International Nuclear Information System (INIS)

Klein, H.M.; Bertalanffy, H.; Mayfrank, L.; Thron, A.; Guenther, R.W.; Gilsbach, J.M.

1994-01-01

We carried out 22 examinations to determine the value of three-dimensional (3D) volumetric CT (spiral CT) for planning neurosurgical procedures. All examinations were carried out on a of the first generation spiral CT. A tube model was used to investigate the influence of different parameter settings. Bolus injection of nonionic contrast medium was used when vessels or strongly enhancing tumours were to be delineated. 3D reconstructions were carried out using the integrated 3D software of the scanner. We found a table feed of 3 mm/s with a slice thickness of 2 mm and an increment of 1 mm to be suitable for most purposes. For larger regions of interest a table feed of 5 mm was the maximum which could be used without blurring of the 3D images. Particular advantages of 3D reconstructed spiral scanning were seen in the planning of approaches to the lower clivus, acquired or congenital bony abnormalities and when the relationship between vessels, tumour and bone was important. (orig.)

Spine surgery training and competence of European Neurosurgical Trainees

NARCIS (Netherlands)

Boszczyk, Bronek Maximilian; Mooij, Jan Jakob; Schmitt, Natascha; Di Rocco, Concezio; Fakouri, Baroum Baroum; Lindsay, Kenneth W.

Little is known about the nature of spine surgery training received by European neurosurgical trainees during their residency and the level of competence they acquire in dealing with spinal disorders. A three-part questionnaire entailing 32 questions was devised and distributed to the neurosurgical

Synoptic philosophy in a neurosurgical residency: a book and cinema club.

Science.gov (United States)

Wadhwa, Rishi; Thakur, Jai Deep; Cardenas, Raul; Wright, Jeri; Nanda, Anil

2013-11-01

Introduction of a book and cinema club in a Department of Neurosurgery has helped combine an education in humanities with neurosurgical training. The authors believe the addition of teaching in humanities adds to the specialty and helps in fulfilling the six core competencies of the Accreditation Council for Graduate Medical Education. The goal is to encourage synoptic philosophy and impart creative ways of interacting with the world. Books and movies with a medical basis and nonmedical basis were selected and reviewed in an open forum. Efforts were made to integrate the Accreditation Council for Graduate Medical Education six core competencies into the discussions. Residents anonymously completed a questionnaire pertaining to the usefulness of the book club in residency. There were 13 residents who attended the sessions and responded to the questionnaire. Of residents, 61.5% believed the topics were pertinent to their everyday life, and 77% believed that the club had helped them somehow in residency. Most (7 of 13) believed the club should not be included as part of the curriculum in an 80-hour work week. Institution of a book and movie club seems to be an effective way of integrating humanities within a neurosurgical residency. Published by Elsevier Inc.

Readability and quality of wikipedia pages on neurosurgical topics.

Science.gov (United States)

Modiri, Omeed; Guha, Daipayan; Alotaibi, Naif M; Ibrahim, George M; Lipsman, Nir; Fallah, Aria

2018-03-01

Wikipedia is the largest online encyclopedia with over 40 million articles, and generating 500 million visits per month. The aim of this study is to assess the readability and quality of Wikipedia pages on neurosurgical related topics. We selected the neurosurgical related Wikipedia pages based on the series of online patient information articles that are published by the American Association of Neurological Surgeons (AANS). We assessed readability of Wikipedia pages using five different readability scales (Flesch Reading Ease, Flesch Kincaid Grade Level, Gunning Fog Index, SMOG) Grade level, and Coleman-Liau Index). We used the Center for Disease Control (CDC) Clear Communication Index as well as the DISCERN Instrument to evaluate the quality of each Wikipedia article. We identified a total of fifty-five Wikipedia articles that corresponded with patient information articles published by the AANS. This constitutes 77.46% of the AANS topics. The mean Flesch Kincaid reading ease score for all of the Wikipedia articles we analyzed is 31.10, which indicates that a college-level education is necessary to understand them. In comparison to the readability analysis for the AANS articles, the Wikipedia articles were more difficult to read across every scale. None of the Wikipedia articles meet the CDC criterion for clear communications. Our analyses demonstrated that Wikipedia articles related to neurosurgical topics are associated with higher grade levels for reading and also below the expected levels of clear communications for patients. Collaborative efforts from the neurosurgical community are needed to enhance the readability and quality of Wikipedia pages related to neurosurgery. Copyright © 2018 Elsevier B.V. All rights reserved.

New Directions in 3D Medical Modeling: 3D-Printing Anatomy and Functions in Neurosurgical Planning

OpenAIRE

Gargiulo, Paolo; ?rnad?ttir, ?ris; G?slason, Magn?s; Edmunds, Kyle; ?lafsson, Ingvar

2017-01-01

This paper illustrates the feasibility and utility of combining cranial anatomy and brain function on the same 3D-printed model, as evidenced by a neurosurgical planning case study of a 29-year-old female patient with a low-grade frontal-lobe glioma. We herein report the rapid prototyping methodology utilized in conjunction with surgical navigation to prepare and plan a complex neurosurgery. The method introduced here combines CT and MRI images with DTI tractography, while using various image...

Early years neurosurgical training in the era of the European Working Time Directive.

Science.gov (United States)

Kirkman, Matthew A; Watkins, Laurence D; Kitchen, Neil D; Sethi, Huma

2013-10-01

The past decade has seen significant changes to the face of neurosurgical training in the United Kingdom, driven in part by an increasing focus on patient safety and the introduction of Modernising Medical Careers and the European Working Time Directive (EWTD). Recent reforms to neurosurgical training over the past few years have resulted in creation of an 8-year 'run-through' training programme. In this programme, early years (ST1 and ST2) trainees often lack dedicated time for elective theatre lists and outpatient clinics. Further, any time spent in theatre and clinics is often with different teams. Here we describe a training model for early years trainees at the National Hospital for Neurology and Neurosurgery, who are given the responsibilities traditionally associated with a more senior trainee including dedicated weekly theatre and clinic time under the supervision of a single consultant, in addition to out of hours experience. The advantages and considerations for implementing this model are discussed, including the benefit of guidance under a single consultant in the early stages of training, along with key educational concepts necessary for understanding its utility. We feel that this is an effective model for junior neurosurgical training in the EWTD era, expediting the trainee's development of key technical and non-technical skills, with potentially significant rewards for patient, trainee and trainer. National implementation of this model should be considered.

21 CFR 882.4460 - Neurosurgical head holder (skull clamp).

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures. (b...

Pulmonary complications in neurosurgical patients

Directory of Open Access Journals (Sweden)

Randeep Guleria

2012-01-01

Full Text Available Pulmonary complications are a major cause of morbidity and mortality in neurosurgical patients. The common pulmonary complications in neurosurgical patients include pneumonia, postoperative atelectasis, respiratory failure, pulmonary embolism, and neurogenic pulmonary edema. Postoperative lung expansion strategies have been shown to be useful in prevention of the postoperative complications in surgical patients. Low tidal volume ventilation should be used in patients who develop acute respiratory distress syndrome. An antibiotic use policy should be put in practice depending on the local patterns of antimicrobial resistance in the hospital. Thromboprophylactic strategies should be used in nonambulatory patients. Meticulous attention should be paid to infection control with a special emphasis on hand-washing practices. Prevention and timely management of these complications can help to decrease the morbidity and mortality associated with pulmonary complications.

Bimanual Psychomotor Performance in Neurosurgical Resident Applicants Assessed Using NeuroTouch, a Virtual Reality Simulator.

Science.gov (United States)

Winkler-Schwartz, Alexander; Bajunaid, Khalid; Mullah, Muhammad A S; Marwa, Ibrahim; Alotaibi, Fahad E; Fares, Jawad; Baggiani, Marta; Azarnoush, Hamed; Zharni, Gmaan Al; Christie, Sommer; Sabbagh, Abdulrahman J; Werthner, Penny; Del Maestro, Rolando F

Current selection methods for neurosurgical residents fail to include objective measurements of bimanual psychomotor performance. Advancements in computer-based simulation provide opportunities to assess cognitive and psychomotor skills in surgically naive populations during complex simulated neurosurgical tasks in risk-free environments. This pilot study was designed to answer 3 questions: (1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using NeuroTouch? (2) Are there exceptionally skilled medical students in the applicant cohort? and (3) Is there an influence of previous surgical exposure on surgical performance? Participants were instructed to remove 3 simulated brain tumors with identical visual appearance, stiffness, and random bleeding points. Validated tier 1, tier 2, and advanced tier 2 metrics were used to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure. This pilot study was carried out at the McGill Neurosurgical Simulation Research and Training Center immediately following neurosurgical residency interviews at McGill University, Montreal, Canada. All 17 medical students interviewed were asked to participate, of which 16 agreed. Performances were clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increased applicant self-evaluated technical skills, high self-ratings of confidence, and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increased blood loss was seen in multivariate analysis. Simulation technology identifies neurosurgical residency applicants with differing levels of technical ability. These results provide information for studies being developed for longitudinal studies on the

The neurosurgical treatment of neuropathic facial pain.

Science.gov (United States)

Brown, Jeffrey A

2014-04-01

This article reviews the definition, etiology and evaluation, and medical and neurosurgical treatment of neuropathic facial pain. A neuropathic origin for facial pain should be considered when evaluating a patient for rhinologic surgery because of complaints of facial pain. Neuropathic facial pain is caused by vascular compression of the trigeminal nerve in the prepontine cistern and is characterized by an intermittent prickling or stabbing component or a constant burning, searing pain. Medical treatment consists of anticonvulsant medication. Neurosurgical treatment may require microvascular decompression of the trigeminal nerve. Copyright © 2014 Elsevier Inc. All rights reserved.

Modular Architecture for Integrated Model-Based Decision Support.

Science.gov (United States)

Gaebel, Jan; Schreiber, Erik; Oeser, Alexander; Oeltze-Jafra, Steffen

2018-01-01

Model-based decision support systems promise to be a valuable addition to oncological treatments and the implementation of personalized therapies. For the integration and sharing of decision models, the involved systems must be able to communicate with each other. In this paper, we propose a modularized architecture of dedicated systems for the integration of probabilistic decision models into existing hospital environments. These systems interconnect via web services and provide model sharing and processing capabilities for clinical information systems. Along the lines of IHE integration profiles from other disciplines and the meaningful reuse of routinely recorded patient data, our approach aims for the seamless integration of decision models into hospital infrastructure and the physicians' daily work.

Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay.

Science.gov (United States)

Missios, Symeon; Bekelis, Kimon

2018-03-01

The association of Magnet hospital status with improved surgical outcomes remains an issue of debate. To investigate whether hospitalization in a Magnet hospital is associated with improved outcomes for patients undergoing neurosurgical operations. A cohort study was executed using all patients undergoing neurosurgical operations in New York registered in the Statewide Planning and Research Cooperative System database from 2009 to 2013. We examined the association of Magnet status hospitalization after neurosurgical operations with inpatient case fatality and length of stay (LOS). We employed an instrumental variable analysis to simulate a randomized trial. Overall, 190 787 patients underwent neurosurgical operations. Of these, 68 046 (35.7%) were hospitalized in Magnet hospitals, and 122 741 (64.3%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with decreased case fatality (adjusted difference, -0.8%; -95% confidence interval, -0.7% to -0.6%), and LOS (adjusted difference, -1.9; 95% confidence interval, -2.2 to -1.5) in comparison to non-Magnet hospitals. These associations were also observed in propensity score adjusted mixed effects models. These associations persisted in prespecified subgroups of patients undergoing spine surgery, craniotomy for tumor resection, or neurovascular interventions. We identified an association of Magnet hospitals with lower case fatality, and shorter LOS in a comprehensive New York State patient cohort undergoing neurosurgical procedures. Copyright © 2017 by the Congress of Neurological Surgeons

Simulation-based interpersonal communication skills training for neurosurgical residents.

Science.gov (United States)

Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

2013-09-01

Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

Does famotidine induce thrombocytopenia in neurosurgical patients?

Science.gov (United States)

Ecker, Robert D; Wijdicks, Eelco F M; Wix, Kelly; McClelland, Robyn

2004-10-01

The incidence of thrombocytopenia in neurosurgical patients prescribed famotidine is unknown. Using hospital records of neurosurgery patients treated between July 2001 and July 2002, a retrospective cohort study was performed comparing platelet counts in patients treated with famotidine with a similar group of patients who were not prescribed an H2 antagonist. Patients were excluded if: 1) platelets were less than 150,000 prior to famotidine administration; 2) pre-drug and post-drug platelets were not drawn; 3) they were concurrently taking a potential thrombocytopenic inducing drug; or 4) disseminated intravascular coagulation, thrombocytopenic purpura, or any other confounding hematologic disorder developed. Seventeen of 50 (34%) patients on famotidine developed thrombocytopenia compared with 11 of 98 (11.2%) of those untreated (P = 0.002). In this retrospective study, neurosurgical patients on famotidine developed thrombocytopenia statistically significantly more often than those untreated. Although no clinically significant sequelae developed as a result of the thrombocytopenia, if these findings are confirmed by a prospective study, proton pump inhibitors and sucralfate, with their similar efficacy, may be a better choice for gastrointestinal prophylaxis in neurosurgical patients.

The Currarino triad: neurosurgical considerations

NARCIS (Netherlands)

Emans, P.J.; van Aalst, J.; van Heurn, L.W.E.; Marcelis, C.; Kootstra, G.; Beets-Tan, R.G.H.; Vles, J.S.; Beuls, E.A.

2006-01-01

OBJECTIVES: The Currarino triad, a relatively uncommon hereditary disorder, is often associated with tethered cord and anterior myelomeningocele. Little is known of the implications of these neuroanatomic malformations or of the neurosurgical attitude. The objective of this study is to identify the

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State.

Science.gov (United States)

Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A

2018-01-24

The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. We performed a cohort study of patients undergoing neurosurgical procedures from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

Point-of-View Recording Devices for Intraoperative Neurosurgical Video Capture

Directory of Open Access Journals (Sweden)

Jose Luis Porras

2016-10-01

Full Text Available AbstractIntroduction: The ability to record and stream neurosurgery is an unprecedented opportunity to further research, medical education, and quality improvement. Here, we appraise the ease of implementation of existing POV devices when capturing and sharing procedures from the neurosurgical operating room, and detail their potential utility in this context.Methods: Our neurosurgical team tested and critically evaluated features of the Google Glass and Panasonic HX-A500 cameras including ergonomics, media quality, and media sharing in both the operating theater and the angiography suite.Results: Existing devices boast several features that facilitate live recording and streaming of neurosurgical procedures. Given that their primary application is not intended for the surgical environment, we identified a number of concrete, yet improvable, limitations.Conclusion: The present study suggests that neurosurgical video capture and live streaming represents an opportunity to contribute to research, education, and quality improvement. Despite this promise, shortcomings render existing devices impractical for serious consideration. We describe the features that future recording platforms should possess to improve upon existing technology.

Integrating School-Based and Therapeutic Conflict Management Models at School.

Science.gov (United States)

D'Oosterlinck, Franky; Broekaert, Eric

2003-01-01

Explores the possibility of integrating school-based and therapeutic conflict management models, comparing two management models: a school-based conflict management program, "Teaching Students To Be Peacemakers"; and a therapeutic conflict management program, "Life Space Crisis Intervention." The paper concludes that integration might be possible…

Consequence Based Design. An approach for integrating computational collaborative models (Integrated Dynamic Models) in the building design phase

DEFF Research Database (Denmark)

Negendahl, Kristoffer

relies on various advancements in the area of integrated dynamic models. It also relies on the application and test of the approach in practice to evaluate the Consequence based design and the use of integrated dynamic models. As a result, the Consequence based design approach has been applied in five...... and define new ways to implement integrated dynamic models for the following project. In parallel, seven different developments of new methods, tools and algorithms have been performed to support the application of the approach. The developments concern: Decision diagrams – to clarify goals and the ability...... affect the design process and collaboration between building designers and simulationists. Within the limits of applying the approach of Consequence based design to five case studies, followed by documentation based on interviews, surveys and project related documentations derived from internal reports...

Infection Rate after Cranial Neurosurgical Procedures: A Prospective Single-Center Study.

Science.gov (United States)

Strahm, Carol; Albrich, Werner C; Zdravkovic, Vilijam; Schöbi, Barbara; Hildebrandt, Gerhard; Schlegel, Matthias

2018-03-01

To determine infection rate (IR) and to identify modifiable risk factors (RF) in cranial neurosurgery in a neurosurgical department for tertiary referral as part of an infection control surveillance to reduce surgical site infections (SSI). A prospective SSI incidence cohort study from February 2013 to January 2014 was performed in a tertiary-care neurosurgical teaching hospital and referral center. All consecutive adults undergoing any cranial neurosurgical procedure were included. Data were collected by a trained member of the infection control staff during the twice-weekly visits of the hospitalized patients. Follow-up was 30 days (procedures without implant) and 1 year (procedures involving permanent implants). SSI was diagnosed according to criteria of CDC. A total of 317 patients undergoing 333 index procedures were included. The median age was 61 years (range, 17-91 years) and 46% were female. Survival in patients with completed follow-up was 76% (196/258). Overall, IR was 7.2% (24/333 index procedures); in 96% (23/24), a neurosurgical implant was involved. The IR of extraventricular drainage (EVD) was 12.5% (13.1/1000 EVD days). The main causative pathogens were Staphylococcus aureus followed by coagulase-negative staphylococci and Propionibacterium acnes. Independent RF for neurosurgical SSI were EVD as part of the index operation and body mass index >25 kg/m 2 . IR was in accordance with recent prospective single-center studies (reported IR between 1.6% and 9%). EVD placement was identified as the strongest modifiable RF for SSI in cranial neurosurgical procedures. The need for standard infection control procedures for the insertion and maintenance of EVDs to avoid their contamination is reinforced. Copyright © 2017 Elsevier Inc. All rights reserved.

The Current State of Rural Neurosurgical Practice: An International Perspective.

Science.gov (United States)

Upadhyayula, Pavan S; Yue, John K; Yang, Jason; Birk, Harjus S; Ciacci, Joseph D

2018-01-01

Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. A comprehensive literature search was performed for English language manuscripts with keywords "rural" and "neurosurgery" using the National Library of Medicine PubMed database (01/1971-06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.

Telemedicine using an image transfer system in the treatment of neurosurgical emergent cases

International Nuclear Information System (INIS)

Saito, Atsushi; Numagami, Yoshihiro; Kamiyama, Hironaga; Furuno, Yuuichi; Nishimura, Shinjitsu; Nishijima, Michiharu

2007-01-01

Our department is located in the Tsugaru district, which is famous for heavy snow fall, and the small number of neurosurgeon centers in the urban areas leads to an inadequate distribution of neurosurgeons for patients in this region. Such geographical and social constraints have made it difficult to offer sufficient neurosurgical care to all patients in the region. We describe the usefulness of a telemedicine triage system using an image transfer system in the treatment of neurosurgical emergent cases. Image transfer systems have been installed at our hospital and 11 regional hospitals in the Tsugaru district, and have been utilized for teleconsultation regarding neurosurgical patients via transferred computed tomography images since 1989. Consultations regarding 2,858 cases were directed to our department between 1989 and 2006, including 1,615 cases of stroke, 869 cases of head trauma, 97 cases of brain tumor, and 277 cases with other disorders. 84% of subarachnoid hemorrhage cases and 22% of head trauma cases needed emergent transfer. The state of consciousness in intracerebral hemorrhage, and the state of consciousness and time of consultation in head trauma were statistically significant factors for emergent transfer. The presert telemedicine triage system was useful for ensuring correct diagnosis and appropriate primary neurosurgical care in the regional hospitals without neurosurgical units, resulting in a reinforcement of the relationships among the regional hospitals and the efficient transfer of emergent neurosurgical patients. (author)

Establishment of Next-Generation Neurosurgery Research and Training Laboratory with Integrated Human Performance Monitoring.

Science.gov (United States)

Bernardo, Antonio

2017-10-01

Quality of neurosurgical care and patient outcomes are inextricably linked to surgical and technical proficiency and a thorough working knowledge of microsurgical anatomy. Neurosurgical laboratory-based cadaveric training is essential for the development and refinement of technical skills before their use on a living patient. Recent biotechnological advances including 3-dimensional (3D) microscopy and endoscopy, 3D printing, virtual reality, surgical simulation, surgical robotics, and advanced neuroimaging have proved to reduce the learning curve, improve conceptual understanding of complex anatomy, and enhance visuospatial skills in neurosurgical training. Until recently, few means have allowed surgeons to obtain integrated surgical and technological training in an operating room setting. We report on a new model, currently in use at our institution, for technologically integrated surgical training and innovation using a next-generation microneurosurgery skull base laboratory designed to recreate the setting of a working operating room. Each workstation is equipped with a 3D surgical microscope, 3D endoscope, surgical drills, operating table with a Mayfield head holder, and a complete set of microsurgical tools. The laboratory also houses a neuronavigation system, a surgical robotic, a surgical planning system, 3D visualization, virtual reality, and computerized simulation for training of surgical procedures and visuospatial skills. In addition, the laboratory is equipped with neurophysiological monitoring equipment in order to conduct research into human factors in surgery and the respective roles of workload and fatigue on surgeons' performance. Copyright © 2017 Elsevier Inc. All rights reserved.

Neurosurgical Resident Training in Germany.

Science.gov (United States)

Stienen, Martin N; Gempt, Jens; Gautschi, Oliver P; Demetriades, Andreas K; Netuka, David; Kuhlen, Dominique E; Schaller, Karl; Ringel, Florian

2017-07-01

Introduction  Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany. Methods  An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time). Results  Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18-0.49; p  hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25-3.61; p  = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11-0.59; p  = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13-2.96; p  = 0.015). Conclusion  Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities. Georg Thieme Verlag KG Stuttgart · New York.

Generalization of the event-based Carnevale-Hines integration scheme for integrate-and-fire models

NARCIS (Netherlands)

van Elburg, R.A.J.; van Ooyen, A.

2009-01-01

An event-based integration scheme for an integrate-and-fire neuron model with exponentially decaying excitatory synaptic currents and double exponential inhibitory synaptic currents has been introduced by Carnevale and Hines. However, the integration scheme imposes nonphysiological constraints on

Generalization of the Event-Based Carnevale-Hines Integration Scheme for Integrate-and-Fire Models

NARCIS (Netherlands)

van Elburg, Ronald A. J.; van Ooyen, Arjen

An event-based integration scheme for an integrate-and-fire neuron model with exponentially decaying excitatory synaptic currents and double exponential inhibitory synaptic currents has been introduced by Carnevale and Hines. However, the integration scheme imposes nonphysiological constraints on

The current state of rural neurosurgical practice: An international perspective

Directory of Open Access Journals (Sweden)

Pavan S Upadhyayula

2018-01-01

Full Text Available Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017. Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and

The Current State of Rural Neurosurgical Practice: An International Perspective

Science.gov (United States)

Upadhyayula, Pavan S.; Yue, John K.; Yang, Jason; Birk, Harjus S.; Ciacci, Joseph D.

2018-01-01

Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to

Google Search Queries About Neurosurgical Topics: Are They a Suitable Guide for Neurosurgeons?

Science.gov (United States)

Lawson McLean, Anna C; Lawson McLean, Aaron; Kalff, Rolf; Walter, Jan

2016-06-01

Google is the most popular search engine, with about 100 billion searches per month. Google Trends is an integrated tool that allows users to obtain Google's search popularity statistics from the last decade. Our aim was to evaluate whether Google Trends is a useful tool to assess the public's interest in specific neurosurgical topics. We evaluated Google Trends statistics for the neurosurgical search topic areas "hydrocephalus," "spinal stenosis," "concussion," "vestibular schwannoma," and "cerebral arteriovenous malformation." We compared these with bibliometric data from PubMed and epidemiologic data from the German Federal Monitoring Agency. In addition, we assessed Google users' search behavior for the search terms "glioblastoma" and "meningioma." Over the last 10 years, there has been an increasing interest in the topic "concussion" from Internet users in general and scientists. "Spinal stenosis," "concussion," and "vestibular schwannoma" are topics that are of special interest in high-income countries (eg, Germany), whereas "hydrocephalus" is a popular topic in low- and middle-income countries. The Google-defined top searches within these topic areas revealed more detail about people's interests (eg, "normal pressure hydrocephalus" or "football concussion" ranked among the most popular search queries within the corresponding topics). There was a similar volume of queries for "glioblastoma" and "meningioma." Google Trends is a useful source to elicit information about general trends in peoples' health interests and the role of different diseases across the world. The Internet presence of neurosurgical units and surgeons can be guided by online users' interests to achieve high-quality, professional-endorsed patient education. Copyright © 2016 Elsevier Inc. All rights reserved.

The history of neurosurgical treatment of sports concussion.

Science.gov (United States)

Stone, James L; Patel, Vimal; Bailes, Julian E

2014-10-01

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion.

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

Science.gov (United States)

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Neurological and neurosurgical manifestations of human ...

African Journals Online (AJOL)

Neurological and neurosurgical manifestations of human immunodeficiency virus (HIV) infection in Mrica. Adelola Adeloye MS FRCS FRCP. Professor. Department of Surgery, College of Medicine. Blantyre, Malawi. Introduction. AIDS was first recognised in the United States of . America in the late 1970s among homosexual ...

The characteristics of post-neurosurgical bacterial meningitis in elective neurosurgery in 2012: A single institute study.

Science.gov (United States)

Tian, Runfa; Hao, Shuyu; Hou, Zonggang; Gao, Zhixian; Liu, Baiyun

2015-12-01

Most post-neurosurgical meningitis research has been focused on large cohorts with numerous cases followed over several years. However, the characteristics of post-neurosurgical meningitis in an entire single year are still unclear, and knowledge of these characteristics might influence the selection of appropriate antibiotics and therapeutic strategies for the successful management of this disease. Our aim is to obtain a better understanding of post-neurosurgical meningitis over a single entire year. Patients with positive meningitis cultures after neurosurgical operations in our hospital during the entire year of 2012 were included in the analysis. We report demographic characteristics, morbidity during different seasons, clinical and bacteriological profiles, sensitivity to antibiotics and causes of the post-neurosurgical meningitis infections in our cohort. Of the 6407 patients who underwent neurosurgical procedures during the study period, 146 developed post-neurosurgical meningitis and the overall incidence of meningitis was 2.28%. The incidence of meningitis was significantly higher in patients who underwent surgery in the autumn and winter than spring or summer (p=0.000). The most common organisms causing meningitis were Gram-positive bacteria, followed by the Klebsiella and Baumannii species. Compound sulfamethoxazole (52.6%) and vancomycin (10.5%) were the most active antibiotics against Gram-positive bacteria strains, whereas meropenem (43.8%) and polymyxin (18.8%) were active against Gram-negative bacillus strains. Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in our hospital. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China. Copyright © 2015 Elsevier B.V. All rights reserved.

Drug-resistant post-neurosurgical nosocomial Acinetobacter ...

African Journals Online (AJOL)

Drug-resistant post-neurosurgical nosocomial Acinetobacter baumannii meningitis in two Iranian hospitals. ... Vol 11, No 17 (2012) >. Log in or Register to get access to full text downloads. ... Acinetobacter baumannii may cause meningitis and ventriculitis, particularly after head trauma and/or neurosurgery. The rate of ...

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part II--concepts for future development, 2003 and beyond.

Science.gov (United States)

Liu, Charles Y; Spicer, Mark; Apuzzo, Michael L J

2003-01-01

The future development of the neurosurgical operative environment is driven principally by concurrent development in science and technology. In the new millennium, these developments are taking on a Jules Verne quality, with the ability to construct and manipulate the human organism and its surroundings at the level of atoms and molecules seemingly at hand. Thus, an examination of currents in technology advancement from the neurosurgical perspective can provide insight into the evolution of the neurosurgical operative environment. In the future, the optimal design solution for the operative environment requirements of specialized neurosurgery may take the form of composites of venues that are currently mutually distinct. Advances in microfabrication technology and laser optical manipulators are expanding the scope and role of robotics, with novel opportunities for bionic integration. Assimilation of biosensor technology into the operative environment promises to provide neurosurgeons of the future with a vastly expanded set of physiological data, which will require concurrent simplification and optimization of analysis and presentation schemes to facilitate practical usefulness. Nanotechnology derivatives are shattering the maximum limits of resolution and magnification allowed by conventional microscopes. Furthermore, quantum computing and molecular electronics promise to greatly enhance computational power, allowing the emerging reality of simulation and virtual neurosurgery for rehearsal and training purposes. Progressive minimalism is evident throughout, leading ultimately to a paradigm shift as the nanoscale is approached. At the interface between the old and new technological paradigms, issues related to integration may dictate the ultimate emergence of the products of the new paradigm. Once initiated, however, history suggests that the process of change will proceed rapidly and dramatically, with the ultimate neurosurgical operative environment of the future

Main neurosurgical pathologies in Benin Republic

Directory of Open Access Journals (Sweden)

Hugues Jean Thierry Gandaho

2016-01-01

Full Text Available Background: Benin republic is a very low-income French-speaking country in West Africa The development of Neurosurgery in the Republic of Benin took off with the arrival of the first Beninese neurosurgeons in the year 2003. Aims: This study aims to evaluate patients' attendance in a public neurosurgical center, and appreciate populations' affordability to a new specialty. Settings and Design: In the year 2004, the Benin Armed Forces established the first Department of Neurosurgery in the Nation's Military Teaching Hospital. From the public authorities, that was a proof of motivation to develop this specialty in the Benin Republic. Materials and Methods: A retrospective cross-sectional survey (September 2003 to December 2009 of the total neurosurgical patient population managed in a public pioneer hospital in a developing country. Statistical Analysis Used: Data were captured and analyzed with the SPSS software (SPSS Inc., Chicago, IL, USA and presented in descriptive statistics such as frequencies and proportions. Results: 2908 new patients, civilians, and militaries were registered. The surgical treatment was offered adult (86% as well as pediatric (14% patients. Spinal degenerative diseases (52.1% were the most common pathology; neurotraumatology emergency cases (8.4% appeared low in representation. Three-quarters of patients experienced financial difficulties to procure the required radiologic investigations and although 609 (20.94% benefited from surgery, most patients could not pay for the surgical operations as well as the perioperative care. Conclusions: In spite of the great constraints of this country's privately-funded health-care delivery system on the affordability of neurosurgical treatment for the average Beninese, this study demonstrates a globally increasing attendance of the department.

Skull base tumor model.

Science.gov (United States)

Gragnaniello, Cristian; Nader, Remi; van Doormaal, Tristan; Kamel, Mahmoud; Voormolen, Eduard H J; Lasio, Giovanni; Aboud, Emad; Regli, Luca; Tulleken, Cornelius A F; Al-Mefty, Ossama

2010-11-01

Resident duty-hours restrictions have now been instituted in many countries worldwide. Shortened training times and increased public scrutiny of surgical competency have led to a move away from the traditional apprenticeship model of training. The development of educational models for brain anatomy is a fascinating innovation allowing neurosurgeons to train without the need to practice on real patients and it may be a solution to achieve competency within a shortened training period. The authors describe the use of Stratathane resin ST-504 polymer (SRSP), which is inserted at different intracranial locations to closely mimic meningiomas and other pathological entities of the skull base, in a cadaveric model, for use in neurosurgical training. Silicone-injected and pressurized cadaveric heads were used for studying the SRSP model. The SRSP presents unique intrinsic metamorphic characteristics: liquid at first, it expands and foams when injected into the desired area of the brain, forming a solid tumorlike structure. The authors injected SRSP via different passages that did not influence routes used for the surgical approach for resection of the simulated lesion. For example, SRSP injection routes included endonasal transsphenoidal or transoral approaches if lesions were to be removed through standard skull base approach, or, alternatively, SRSP was injected via a cranial approach if the removal was planned to be via the transsphenoidal or transoral route. The model was set in place in 3 countries (US, Italy, and The Netherlands), and a pool of 13 physicians from 4 different institutions (all surgeons and surgeons in training) participated in evaluating it and provided feedback. All 13 evaluating physicians had overall positive impressions of the model. The overall score on 9 components evaluated--including comparison between the tumor model and real tumor cases, perioperative requirements, general impression, and applicability--was 88% (100% being the best possible

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents.

Science.gov (United States)

Sundar, Swetha J; Healy, Andrew T; Kshettry, Varun R; Mroz, Thomas E; Schlenk, Richard; Benzel, Edward C

2016-05-01

OBJECTIVE Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy. METHODS This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models. RESULTS A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively). CONCLUSIONS Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a

Integrating school-based and therapeutic conflict management models at schools.

Science.gov (United States)

D'Oosterlinck, Franky; Broekaert, Eric

2003-08-01

Including children with emotional and behavioral needs in mainstream school systems leads to growing concern about the increasing number of violent and nonviolent conflicts. Schools must adapt to this evolution and adopt a more therapeutic dimension. This paper explores the possibility of integrating school-based and therapeutic conflict management models and compares two management models: a school-based conflict management program. Teaching Students To Be Peacemakers; and a therapeutic conflict management program, Life Space Crisis Intervention. The authors conclude that integration might be possible, but depends on establishing a positive school atmosphere, the central position of the teacher, and collaborative and social learning for pupils. Further implementation of integrated conflict management models can be considered but must be underpinned by appropriate scientific research.

Integrated community-based dementia care: the Geriant model

Directory of Open Access Journals (Sweden)

Ludo Glimmerveen

2015-09-01

Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

A DSM-based framework for integrated function modelling

DEFF Research Database (Denmark)

Eisenbart, Boris; Gericke, Kilian; Blessing, Lucienne T. M.

2017-01-01

an integrated function modelling framework, which specifically aims at relating between the different function modelling perspectives prominently addressed in different disciplines. It uses interlinked matrices based on the concept of DSM and MDM in order to facilitate cross-disciplinary modelling and analysis...... of the functionality of a system. The article further presents the application of the framework based on a product example. Finally, an empirical study in industry is presented. Therein, feedback on the potential of the proposed framework to support interdisciplinary design practice as well as on areas of further...

Congenital malformations in paediatric and neurosurgical practices ...

African Journals Online (AJOL)

Congenital malformations in paediatric and neurosurgical practices: problems and pattern (A preliminary report) ... Open Access DOWNLOAD FULL TEXT ... over a 5-year period (1998 to 2002) with congenital anomalies to the Paediatric Surgery and Neurosurgery units of the University Teaching Hospital, Ilorin, Nigeria.

Functional magnetic resonance imaging for neurosurgical planning in neurooncology

International Nuclear Information System (INIS)

Vlieger, Erik-Jan; Majoie, Charles B.; Heeten, Gerard J. den; Leenstra, Sieger

2004-01-01

Functional magnetic resonance imaging (fMRI) is a non-invasive technique that is widely available and can be used to determine the spatial relationships between tumor tissue and eloquent brain areas. Within certain limits, this functional information can be applied in the field of neurosurgery as a pre-operative mapping tool to minimize damage to eloquent brain areas. In this article, we review the literature on the use of fMRI for neurosurgical planning. The issues addressed are: (1) stimulation paradigms, (2) the influence of tumors on the blood oxygenation level-dependent (BOLD) signal, (3) post-processing the fMRI time course, (4) integration of fMRI results into neuronavigation systems, (5) the accuracy of fMRI and (6) fMRI compared to intra-operative mapping (IOM). (orig.)

Social Media Metrics and Bibliometric Profiles of Neurosurgical Departments and Journals: Is There a Relationship?

Science.gov (United States)

Alotaibi, Naif M; Guha, Daipayan; Fallah, Aria; Aldakkan, Abdulrahman; Nassiri, Farshad; Badhiwala, Jetan H; Ibrahim, George M; Shamji, Mohammed F; Macdonald, R Loch; Lozano, Andres M

2016-06-01

Social media plays an increasingly important role in dissemination of knowledge and raising awareness of selected topics among the general public and the academic community. To investigate the relationship between social media metrics and academic indices of neurosurgical programs and journals. A 2-step online search was performed to identify official social media accounts of neurosurgical departments that were accredited by the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada. Dedicated neurosurgery and spine journals' social media accounts also were identified through an online search on SCImago Journal and Country Rank portal. Nonparametric tests were performed with bootstrapping to compare groups and to look for correlations between social media and academic metrics. We identified 36 social media accounts officially affiliated with academic neurosurgical institutions. These accounts represented 22 of 119 neurosurgical programs in North America (18.4%). The presence of a social media account for neurosurgical departments was associated with statistically significant higher values of academic impact metrics (P social media metrics for neurosurgical department accounts, however, did not correlate with any values of academic indices. For journals, there were 11 journals present on social media and had greater academic metrics compared with journals without social media presence (P Social media presence is associated with stronger academic bibliometrics profiles for both neurosurgical departments and journals. The impact of social media metrics on indices of scientific impact in neurosurgery is not known. Copyright © 2016 Elsevier Inc. All rights reserved.

Integration of supervisory control synthesis in model-based systems engineering

NARCIS (Netherlands)

Baeten, J.C.M.; van de Mortel - Fronczak, J.M.; Rooda, J.E.

2016-01-01

Increasing system complexity, time to market and development costs reduction place higher demands on engineering processes. Formal models play an important role here because they enable the use of various model-based analyses and early integration techniques and tools. Engineering processes based on

Neurosurgical Procedures in Jehovah's Witnesses: The Tema ...

African Journals Online (AJOL)

BACKGROUND: On account of religious reasons, Jehovah Witnesses do not accept blood or blood products; occasionally, they accept reinfusion of autologous blood via a cell saver during surgery. OBJECTIVE: The aim of this study was to document the demographics of Jehovah Witnesses undergoing neurosurgical ...

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

NARCIS (Netherlands)

Lindert, E.J. van; Delye, H.H.; Leonardo, J.

2014-01-01

OBJECT: The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care.

Research on Multi - Person Parallel Modeling Method Based on Integrated Model Persistent Storage

Science.gov (United States)

Qu, MingCheng; Wu, XiangHu; Tao, YongChao; Liu, Ying

2018-03-01

This paper mainly studies the multi-person parallel modeling method based on the integrated model persistence storage. The integrated model refers to a set of MDDT modeling graphics system, which can carry out multi-angle, multi-level and multi-stage description of aerospace general embedded software. Persistent storage refers to converting the data model in memory into a storage model and converting the storage model into a data model in memory, where the data model refers to the object model and the storage model is a binary stream. And multi-person parallel modeling refers to the need for multi-person collaboration, the role of separation, and even real-time remote synchronization modeling.

[Development method of healthcare information system integration based on business collaboration model].

Science.gov (United States)

Li, Shasha; Nie, Hongchao; Lu, Xudong; Duan, Huilong

2015-02-01

Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.

Virtual reality simulator: demonstrated use in neurosurgical oncology.

Science.gov (United States)

Clarke, David B; D'Arcy, Ryan C N; Delorme, Sebastien; Laroche, Denis; Godin, Guy; Hajra, Sujoy Ghosh; Brooks, Rupert; DiRaddo, Robert

2013-04-01

The overriding importance of patient safety, the complexity of surgical techniques, and the challenges associated with teaching surgical trainees in the operating room are all factors driving the need for innovative surgical simulation technologies. Despite these issues, widespread use of virtual reality simulation technology in surgery has not been fully implemented, largely because of the technical complexities in developing clinically relevant and useful models. This article describes the successful use of the NeuroTouch neurosurgical simulator in the resection of a left frontal meningioma. The widespread application of surgical simulation technology has the potential to decrease surgical risk, improve operating room efficiency, and fundamentally change surgical training.

fMRI for mapping language networks in neurosurgical cases

International Nuclear Information System (INIS)

Gupta, Santosh S

2014-01-01

Evaluating language has been a long-standing application in functional magnetic resonance imaging (fMRI) studies, both in research and clinical circumstances, and still provides challenges. Localization of eloquent areas is important in neurosurgical cases, so that there is least possible damage to these areas during surgery, maintaining their function postoperatively, therefore providing good quality of life to the patient. Preoperative fMRI study is a non-invasive tool to localize the eloquent areas, including language, with other traditional methods generally used being invasive and at times perilous. In this article, we describe methods and various paradigms to study the language areas, in clinical neurosurgical cases, along with illustrations of cases from our institute

Spectrum of neurosurgical complications following medical tourism ...

African Journals Online (AJOL)

Background and objectives: The cost of medical care and availability of resources (human and facilities) which differs from nation to nation are amongst others, factors driving medical tourism (MT) despite its potential drawbacks. The aim of the study was to analyse all patients that presented with neurosurgical complications ...

The "proactive" model of learning: Integrative framework for model-free and model-based reinforcement learning utilizing the associative learning-based proactive brain concept.

Science.gov (United States)

Zsuga, Judit; Biro, Klara; Papp, Csaba; Tajti, Gabor; Gesztelyi, Rudolf

2016-02-01

Reinforcement learning (RL) is a powerful concept underlying forms of associative learning governed by the use of a scalar reward signal, with learning taking place if expectations are violated. RL may be assessed using model-based and model-free approaches. Model-based reinforcement learning involves the amygdala, the hippocampus, and the orbitofrontal cortex (OFC). The model-free system involves the pedunculopontine-tegmental nucleus (PPTgN), the ventral tegmental area (VTA) and the ventral striatum (VS). Based on the functional connectivity of VS, model-free and model based RL systems center on the VS that by integrating model-free signals (received as reward prediction error) and model-based reward related input computes value. Using the concept of reinforcement learning agent we propose that the VS serves as the value function component of the RL agent. Regarding the model utilized for model-based computations we turned to the proactive brain concept, which offers an ubiquitous function for the default network based on its great functional overlap with contextual associative areas. Hence, by means of the default network the brain continuously organizes its environment into context frames enabling the formulation of analogy-based association that are turned into predictions of what to expect. The OFC integrates reward-related information into context frames upon computing reward expectation by compiling stimulus-reward and context-reward information offered by the amygdala and hippocampus, respectively. Furthermore we suggest that the integration of model-based expectations regarding reward into the value signal is further supported by the efferent of the OFC that reach structures canonical for model-free learning (e.g., the PPTgN, VTA, and VS). (c) 2016 APA, all rights reserved).

Medical negligence. An overview of legal theory and neurosurgical practice: causation.

Science.gov (United States)

Todd, Nicholas V

2014-06-01

This article discusses the principles of the law in relation to legal causation as applied to neurosurgical practice. Causation is a causal link between a breach of duty of care and the final harm. The fundamental "but-for" test for causation will be discussed, together with Chester v Afshar modified causation, prospective and retrospective probabilities of harm, loss of a chance, causation following breach of duty of care by omission, breaking the chain of causation, material contribution and the law in relation to multiple defendants, with neurosurgical examples.

Integration of Simulink Models with Component-based Software Models

Directory of Open Access Journals (Sweden)

MARIAN, N.

2008-06-01

Full Text Available Model based development aims to facilitate the development of embedded control systems by emphasizing the separation of the design level from the implementation level. Model based design involves the use of multiple models that represent different views of a system, having different semantics of abstract system descriptions. Usually, in mechatronics systems, design proceeds by iterating model construction, model analysis, and model transformation. Constructing a MATLAB/Simulink model, a plant and controller behavior is simulated using graphical blocks to represent mathematical and logical constructs and process flow, then software code is generated. A Simulink model is a representation of the design or implementation of a physical system that satisfies a set of requirements. A software component-based system aims to organize system architecture and behavior as a means of computation, communication and constraints, using computational blocks and aggregates for both discrete and continuous behavior, different interconnection and execution disciplines for event-based and time-based controllers, and so on, to encompass the demands to more functionality, at even lower prices, and with opposite constraints. COMDES (Component-based Design of Software for Distributed Embedded Systems is such a component-based system framework developed by the software engineering group of Mads Clausen Institute for Product Innovation (MCI, University of Southern Denmark. Once specified, the software model has to be analyzed. One way of doing that is to integrate in wrapper files the model back into Simulink S-functions, and use its extensive simulation features, thus allowing an early exploration of the possible design choices over multiple disciplines. The paper describes a safe translation of a restricted set of MATLAB/Simulink blocks to COMDES software components, both for continuous and discrete behavior, and the transformation of the software system into the S

Integration agent-based models and GIS as a virtual urban dynamic laboratory

Science.gov (United States)

Chen, Peng; Liu, Miaolong

2007-06-01

Based on the Agent-based Model and spatial data model, a tight-coupling integrating method of GIS and Agent-based Model (ABM) is to be discussed in this paper. The use of object-orientation for both spatial data and spatial process models facilitates their integration, which can allow exploration and explanation of spatial-temporal phenomena such as urban dynamic. In order to better understand how tight coupling might proceed and to evaluate the possible functional and efficiency gains from such a tight coupling, the agent-based model and spatial data model are discussed, and then the relationships affecting spatial data model and agent-based process models interaction. After that, a realistic crowd flow simulation experiment is presented. Using some tools provided by general GIS systems and a few specific programming languages, a new software system integrating GIS and MAS as a virtual laboratory applicable for simulating pedestrian flows in a crowd activity centre has been developed successfully. Under the environment supported by the software system, as an applicable case, a dynamic evolution process of the pedestrian's flows (dispersed process for the spectators) in a crowds' activity center - The Shanghai Stadium has been simulated successfully. At the end of the paper, some new research problems have been pointed out for the future.

Brevibacterium otitidis: an elusive cause of neurosurgical infection.

LENUS (Irish Health Repository)

Fe Talento, Alida

2013-03-01

Coryneform bacteria are usually considered as non-pathogenic when isolated from clinical specimens. We present a case of Brevibacterium otitidis neurosurgical infection in an immunocompetent patient, and highlight the difficulty with identification and interpretation of antimicrobial susceptibility results for this unusual pathogen.

Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis.

Science.gov (United States)

Zhang, Yang; Xiao, Xiong; Zhang, Junting; Gao, Zhixian; Ji, Nan; Zhang, Liwei

2017-06-01

To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients. The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC -ROC ) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases. The diagnostic accuracy of routine blood examinations was relatively low (AUC -ROC CSF lactate level achieved rather high diagnostic accuracy (AUC -ROC =0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC -ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively. The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Program for lowering the incidence of pressure sores in neurosurgical patients].

Science.gov (United States)

Chang, Chau-Hui; Chen, Hui-Ling; Chen, Hsiang-Chi

2007-12-01

Pressure sores are one of the well known problems that occur in hospitals. As the literature on the subject indicates, a lot of money is expended in managing this problem every year, and 12-66% of pressure sores are caused during surgery. Patients who undergo neurosurgical procedures are susceptible to pressure sores because of lengthy operations. We collected data on patients with pressure sores who underwent surgery between May 2004 and August 2004, and found that the incidence of pressure sore in neurosurgical patients was 9.5%, which was the highest among all surgical patients. This project was developed to solve the problem of pressure sores by setting up standard preventive procedures, a nursing follow up system and continuing education courses, and utilizing cotton rolls to pad sites of pressure sores. The incidence of pressure sore in neurosurgical patients was reduced from 9.5% to 7% after the improvement project was carried out. The more concerned nurses are about pressure sores, the better the quality of operative nursing care.

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound-based study in children 12 years of age or younger.

Science.gov (United States)

Scherer, Andrea G; White, Ian K; Shaikh, Kashif A; Smith, Jodi L; Ackerman, Laurie L; Fulkerson, Daniel H

2017-07-01

OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery. METHODS A total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year. RESULTS There was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol. CONCLUSIONS In this

Massive cerebellar infarction: a neurosurgical approach

Directory of Open Access Journals (Sweden)

Salazar Luis Rafael Moscote

2015-12-01

Full Text Available Cerebellar infarction is a challenge for the neurosurgeon. The rapid recognition will crucial to avoid devastating consequences. The massive cerebellar infarction has pseudotumoral behavior, should affect at least one third of the volume of the cerebellum. The irrigation of the cerebellum presents anatomical diversity, favoring the appearance of atypical infarcts. The neurosurgical management is critical for massive cerebellar infarction. We present a review of the literature.

A web GIS based integrated flood assessment modeling tool for coastal urban watersheds

Science.gov (United States)

Kulkarni, A. T.; Mohanty, J.; Eldho, T. I.; Rao, E. P.; Mohan, B. K.

2014-03-01

Urban flooding has become an increasingly important issue in many parts of the world. In this study, an integrated flood assessment model (IFAM) is presented for the coastal urban flood simulation. A web based GIS framework has been adopted to organize the spatial datasets for the study area considered and to run the model within this framework. The integrated flood model consists of a mass balance based 1-D overland flow model, 1-D finite element based channel flow model based on diffusion wave approximation and a quasi 2-D raster flood inundation model based on the continuity equation. The model code is written in MATLAB and the application is integrated within a web GIS server product viz: Web Gram Server™ (WGS), developed at IIT Bombay, using Java, JSP and JQuery technologies. Its user interface is developed using open layers and the attribute data are stored in MySQL open source DBMS. The model is integrated within WGS and is called via Java script. The application has been demonstrated for two coastal urban watersheds of Navi Mumbai, India. Simulated flood extents for extreme rainfall event of 26 July, 2005 in the two urban watersheds of Navi Mumbai city are presented and discussed. The study demonstrates the effectiveness of the flood simulation tool in a web GIS environment to facilitate data access and visualization of GIS datasets and simulation results.

Model Integrated Problem Solving Based Learning pada Perkuliahan Dasar-dasar Kimia Analitik

Directory of Open Access Journals (Sweden)

Indarini Dwi Pursitasari

2013-07-01

Full Text Available Abstract: Integrated Problem Solving Based Learning Model on Foundation of Analytical Chemistry. This study was conducted to know the effects of Integrated Problem Solving Based Learning (IPSBL model on problem solving skills and cognitive ability of pre-service teachers. The subjects of the study were 41 pre- service teachers, 21 in the experimental group and 20 in the control group. The data were collected through a test on problem solving skills, a test on cognitive ability, and a questionnaire on the students’opinions on the use of IPSBL model. The quantitative data were analyzed using t-test and one-way ANOVA, and the qualitative data were analyzed by counting the percentage. The results of the study show that the implementation of IPSBL model increased the problem solving skills and cognitive ability of the pre-service teachers . The model was also responded positively by the research subjects. Abstrak: Model Integrated Problem Solving Based learning pada Perkuliahan Dasar-dasar Kimia Analitik. Penelitian ini bertujuan menentukan pengaruh model Integrated Problem Solving Based Learning(IPSBL terhadap peningkatan kemampuan problem solving dan kemampuan kognitif mahasiswa calon guru. Subjek penelitian terdiri dari 21 mahasiswa kelas eksperimen dan 20 mahasiswa kelas kontrol. Data dikumpulkan menggunakan tes kemampuan problem solving, tes kemampuan kognitif, dan angket untuk menjaring pendapat mahasiswa terhadap penggunaan model IPSBL . Data kuantitatif dianalisis denga n uji- t dan Anava dengan bantuan program SPSS 16.0. Data kualitatif dihitung persentasenya. Hasil penelitian menunjukkan bahwa model IPSBL dapat meningkatkan kemampuan problem solving dan kemampuan kognitif serta mendapat tanggapan yang positif dari mahasiswa.

Massive pediatric neurosurgical injuries and lessons learned following a tornado disaster in Alabama.

Science.gov (United States)

Chern, Joshua J; Miller, Joseph H; Tubbs, R Shane; Whisenhunt, Thomas R; Johnston, James M; Wellons, John C; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry

2011-12-01

A large volume of patients presented to a Level I pediatric trauma center during and after a recent tornado disaster. Injuries of the central and peripheral nervous systems and the medical responses of a pediatric neurosurgical team are reviewed. The clinical courses of patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornado storm are reported. The clinical actions taken by the neurosurgical team during and after the event are reviewed and the lessons learned are discussed. The tornado storm system moved through the Tuscaloosa and Birmingham metropolitan areas on the early evening hours of April 27, 2011. Twenty-four patients received care from the neurosurgical team. A total of 11 cranial (including placement of an external ventricular drain), 2 spine, and 2 peripheral procedures were performed for the victims. Nine procedures were performed within the first 12 hours of the event, and an additional 6 surgeries were performed in the following 24 hours. Injuries of the peripheral nervous system often presented in a delayed fashion. Several key components were identified that enabled adequate neurosurgical care for a large influx of acute patients. Massive casualties due to tornados are rare. A well-organized physician team working with the hospital administration may decrease the mortality and morbidity of such events.

Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.

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Chidambaram, Swathi; Nair, M Nathan; Krishnan, Shyam Sundar; Cai, Ling; Gu, Weiling; Vasudevan, Madabushi Chakravarthy

2015-12-01

Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included. Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038). This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis. Copyright © 2015 Elsevier Inc. All rights reserved.

Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results.

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Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L

2010-08-01

Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.

Value-based choice: An integrative, neuroscience-informed model of health goals.

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Berkman, Elliot T

2018-01-01

Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour. I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating. Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.

The Integrated Model of Sustainability Perspective in Spermatophyta Learning Based on Local Wisdom

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Hartadiyati, E.; Rizqiyah, K.; Wiyanto; Rusilowati, A.; Prasetia, A. P. B.

2017-09-01

In present condition, culture is diminished, the change of social order toward the generation that has no policy and pro-sustainability; As well as the advancement of science and technology are often treated unwisely so as to excite local wisdom. It is therefore necessary to explore intra-curricular local wisdom in schools. This study aims to produce an integration model of sustainability perspectives based on local wisdom on spermatophyta material that is feasible and effective. This research uses define, design and develop stages to an integration model of sustainability perspectives based on local wisdom on spermatophyta material. The resulting product is an integration model of socio-cultural, economic and environmental sustainability perspective and formulated with preventive, preserve and build action on spermatophyta material consisting of identification and classification, metagenesis and the role of spermatophyta for human life. The integration model of sustainability perspective in learning spermatophyta based on local wisdom is considered proven to be effective in raising sustainability’s awareness of high school students.

Effects of Transcranial Direct-Current Stimulation on Neurosurgical Skill Acquisition: A Randomized Controlled Trial.

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Ciechanski, Patrick; Cheng, Adam; Lopushinsky, Steven; Hecker, Kent; Gan, Liu Shi; Lang, Stefan; Zareinia, Kourosh; Kirton, Adam

2017-12-01

Recent changes in surgical training environments may have limited opportunities for trainees to gain proficiency in skill. Complex skills such as neurosurgery require extended periods of training. Methods to enhance surgical training are required to overcome duty-hour restrictions, to ensure the acquisition of skill proficiency. Transcranial direct-current stimulation (tDCS) can enhance motor skill learning, but is untested in surgical procedural training. We aimed to determine the effects of tDCS on simulation-based neurosurgical skill acquisition. Medical students were trained to acquire tumor resection skills using a virtual reality neurosurgical simulator. The primary outcome of change in tumor resection was scored at baseline, over 8 repetitions, post-training, and again at 6 weeks. Participants received anodal tDCS or sham over the primary motor cortex. Secondary outcomes included changes in brain resected, resection effectiveness, duration of excessive forces (EF) applied, and resection efficiency. Additional outcomes included tDCS tolerability. Twenty-two students consented to participate, with no dropouts over the course of the trial. Participants receiving tDCS intervention increased the amount of tumor resected, increased the effectiveness of resection, reduced the duration of EF applied, and improved resection efficiency. Little or no decay was observed at 6 weeks in both groups. No adverse events were documented, and sensation severity did not differ between stimulation groups. The addition of tDCS to neurosurgical training may enhance skill acquisition in a simulation-based environment. Trials of additional skills in high-skill residents, and translation to nonsimulated performance are needed to determine the potential utility of tDCS in surgical training. Copyright © 2017 Elsevier Inc. All rights reserved.

A Framework for Sharing and Integrating Remote Sensing and GIS Models Based on Web Service

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Chen, Zeqiang; Lin, Hui; Chen, Min; Liu, Deer; Bao, Ying; Ding, Yulin

2014-01-01

Sharing and integrating Remote Sensing (RS) and Geographic Information System/Science (GIS) models are critical for developing practical application systems. Facilitating model sharing and model integration is a problem for model publishers and model users, respectively. To address this problem, a framework based on a Web service for sharing and integrating RS and GIS models is proposed in this paper. The fundamental idea of the framework is to publish heterogeneous RS and GIS models into standard Web services for sharing and interoperation and then to integrate the RS and GIS models using Web services. For the former, a “black box” and a visual method are employed to facilitate the publishing of the models as Web services. For the latter, model integration based on the geospatial workflow and semantic supported marching method is introduced. Under this framework, model sharing and integration is applied for developing the Pearl River Delta water environment monitoring system. The results show that the framework can facilitate model sharing and model integration for model publishers and model users. PMID:24901016

A framework for sharing and integrating remote sensing and GIS models based on Web service.

Science.gov (United States)

Chen, Zeqiang; Lin, Hui; Chen, Min; Liu, Deer; Bao, Ying; Ding, Yulin

2014-01-01

Sharing and integrating Remote Sensing (RS) and Geographic Information System/Science (GIS) models are critical for developing practical application systems. Facilitating model sharing and model integration is a problem for model publishers and model users, respectively. To address this problem, a framework based on a Web service for sharing and integrating RS and GIS models is proposed in this paper. The fundamental idea of the framework is to publish heterogeneous RS and GIS models into standard Web services for sharing and interoperation and then to integrate the RS and GIS models using Web services. For the former, a "black box" and a visual method are employed to facilitate the publishing of the models as Web services. For the latter, model integration based on the geospatial workflow and semantic supported marching method is introduced. Under this framework, model sharing and integration is applied for developing the Pearl River Delta water environment monitoring system. The results show that the framework can facilitate model sharing and model integration for model publishers and model users.

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective.

Science.gov (United States)

Dewan, Michael C; Rattani, Abbas; Baticulon, Ronnie E; Faruque, Serena; Johnson, Walter D; Dempsey, Robert J; Haglund, Michael M; Alkire, Blake C; Park, Kee B; Warf, Benjamin C; Shrime, Mark G

2018-05-11

OBJECTIVE The global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload. METHODS An electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics-including case volume and perceived workload-were also captured. RESULTS Eighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon's perceived workload (0-not busy, 100-overworked), respondents selected a

Hybrid Microscopic-Endoscopic Surgery for Craniopharyngioma in Neurosurgical Suite: Technical Notes.

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Ichikawa, Tomotsugu; Otani, Yoshihiro; Ishida, Joji; Fujii, Kentaro; Kurozumi, Kazuhiko; Ono, Shigeki; Date, Isao

2016-01-01

The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite. Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously. Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery. Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.

Model Integrated Problem Solving Based Learning pada Perkuliahan Dasar-dasar Kimia Analitik

OpenAIRE

Indarini Dwi Pursitasari; Anna Permanasari

2013-01-01

Abstract: Integrated Problem Solving Based Learning Model on Foundation of Analytical Chemistry. This study was conducted to know the effects of Integrated Problem Solving Based Learning (IPSBL) model on problem solving skills and cognitive ability of pre-service teachers. The subjects of the study were 41 pre- service teachers, 21 in the experimental group and 20 in the control group. The data were collected through a test on problem solving skills, a test on cognitive ability, and a questio...

Model Integrated Problem Solving Based Learning Pada Perkuliahan Dasar-dasar Kimia Analitik

OpenAIRE

Pursitasari, Indarini Dwi; Permanasari, Anna

2012-01-01

: Integrated Problem Solving Based Learning Model on Foundation of Analytical Chemistry. This study was conducted to know the effects of Integrated Problem Solving Based Learning (IPSBL) model on problem solving skills and cognitive ability of pre-service teachers. The subjects of the study were 41 pre- service teachers, 21 in the experimental group and 20 in the control group. The data were collected through a test on problem solving skills, a test on cognitive ability, and a questionnaire o...

Pain in neurosurgically treated patients: A prospective observational study

NARCIS (Netherlands)

M. Klimek (Markus); J.F. Ubben (Johannes); J. Ammann (Jan); K. Borner (Katy); J. Klein (Jan); S.J.C. Verbrugge (Serge)

2006-01-01

textabstractObject. This is the first observational study to compare perioperative pain character and intensity in patients undergoing different types of elective neurosurgical procedures. Methods. A structured questionnaire was used to inquire about pain intensity, character, and management during

Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.

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Fuller, Anthony T; Haglund, Michael M; Lim, Stephanie; Mukasa, John; Muhumuza, Michael; Kiryabwire, Joel; Ssenyonjo, Hussein; Smith, Emily R

2016-11-01

Pediatric neurosurgical cases have been identified as an important target for impacting health disparities in Uganda, with over 50% of the population being less than 15 years of age. The objective of the present study was to evaluate the effects of the Duke-Mulago collaboration on pediatric neurosurgical outcomes in Mulago National Referral Hospital. We performed retrospective analysis of all pediatric neurosurgical cases who presented at Mulago National Referral Hospital in Kampala, Uganda, to examine overall, preprogram (2005-2007), and postprogram (2008-2013) outcomes. We analyzed mortality, presurgical infections, postsurgical infections, length of stay, types of procedures, and significant predictors of mortality. Data on neurosurgical cases was collected from surgical logbooks, patient charts, and Mulago National Referral Hospital's yearly death registry. Of 820 pediatric neurosurgical cases, outcome data were complete for 374 children. Among children who died within 30 days of a surgical procedure, the largest group was less than a year old (45%). Postinitiation of the Duke-Mulago collaboration, we identified an overall increase in procedures, with the greatest increase in cases with complex diagnoses. Although children ages 6-18 years of age were 6.66 times more likely to die than their younger counterparts preprogram, age was no longer a predictive variable postprogram. When comparing pre- and postprogram outcomes, mortality among pediatric patients within 30 days after a neurosurgical procedure increased from 4.3% to 10.0%, mortality after 30 days increased slightly from 4.9% to 5.0%, presurgical infections decreased by 4.6%, and postsurgery infections decreased slightly by 0.7%. Our data show the provision of more complex neurological procedures does not necessitate improved outcomes. Rather, combining these higher-level procedures with essential pre- and postoperative care and continued efforts in health system strengthening for pediatric neurosurgical

An analysis of the citation climate in neurosurgical literature and description of an interfield citation metric.

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Madhugiri, Venkatesh S; Sasidharan, Gopalakrishnan M; Subeikshanan, Venkatesan; Dutt, Akshat; Ambekar, Sudheer; Strom, Shane F

2015-05-01

The citation climate in neurosurgical literature is largely undefined. To study the patterns of citation of articles in neurosurgery as a scientific field and to evaluate the performance of neurosurgery journals vis-à-vis journals in other fields. References cited in articles published in neurosurgery journals during a specified time period were analyzed to determine the age of articles cited in neurosurgical literature. In the next analysis, articles published in neurosurgical journals were followed up for 13 years after publication. The postpublication citation patterns were analyzed to determine the time taken to reach the maximally cited state and the time when articles stopped being cited. The final part of the study dealt with the evolution of a new interfield citation metric, which was then compared with other standardized citation indexes. The mean ± SD age of articles cited in neurosurgical literature was 11.6 ± 11.7 years (median, 8 years). Citations received by articles gradually increased to a peak (at 6.25 years after publication in neurosurgery) and then reached a steady state; articles were still cited well into the late postpublication period. Neurosurgical articles published in nonneurosurgical high-impact journals were cited more highly than those in neurosurgical journals, although they took approximately the same time to reach the maximally cited state (7.2 years). The most cited pure neurosurgery journal was Neurosurgery. The citation climate for neurosurgery was adequately described. The interfield citation metric was able to ensure cross-field comparability of journal performance. G1, group 1G2, group 2G3, group 3G4, group 4IFCM, interfield citation metric.

Epidemiology of Mild Traumatic Brain Injury with Intracranial Hemorrhage: Focusing Predictive Models for Neurosurgical Intervention.

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Orlando, Alessandro; Levy, A Stewart; Carrick, Matthew M; Tanner, Allen; Mains, Charles W; Bar-Or, David

2017-11-01

To outline differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries and help identify which ICH types are most likely to benefit from creation of predictive models for NI. A multicenter retrospective study of adult patients spanning 3 years at 4 U.S. trauma centers was performed. Patients were included if they presented with mild traumatic brain injury (Glasgow Coma Scale score 13-15) with head CT scan positive for ICH. Patients were excluded for skull fractures, "unspecified hemorrhage," or coagulopathy. Primary outcome was NI. Stepwise multivariable logistic regression models were built to analyze the independent association between ICH variables and outcome measures. The study comprised 1876 patients. NI rate was 6.7%. There was a significant difference in rate of NI by ICH type. Subdural hematomas had the highest rate of NI (15.5%) and accounted for 78% of all NIs. Isolated subarachnoid hemorrhages had the lowest, nonzero, NI rate (0.19%). Logistic regression models identified ICH type as the most influential independent variable when examining NI. A model predicting NI for isolated subarachnoid hemorrhages would require 26,928 patients, but a model predicting NI for isolated subdural hematomas would require only 328 patients. This study highlighted disparate NI rates among ICH types in patients with mild traumatic brain injury and identified mild, isolated subdural hematomas as most appropriate for construction of predictive NI models. Increased health care efficiency will be driven by accurate understanding of risk, which can come only from accurate predictive models. Copyright © 2017 Elsevier Inc. All rights reserved.

Post-operative shampoo effects in neurosurgical patients: a pilot experimental study.

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Palese, Alvisa; Moreale, Renzo; Noacco, Massimo; Pistrino, Flavia; Mastrolia, Irene; Sartor, Assunta; Scarparo, Claudio; Skrap, Miran

2015-04-01

Neurosurgical site infections are an important issue. Among the acknowledged preventive tactics, the non-shaving technique is well established in the neurosurgical setting. However, given that patient's hair around the surgical site may retain biologic material that emerges during the surgical procedure or that may simply become dirty, which may increase the risk of surgical site infections, if and when shampooing should be offered remains under debate. A pilot experimental study was undertaken from 2011 to 2012. A series of neurosurgical patients not affected by conditions that would increase the risk of post-operative infection were assigned randomly to the exposed group (receiving shampoo 72 h after surgical procedure) or control group (receiving standard dressing surveillance without shampooing). Comfort, surgical site contamination (measured as the number of colony-forming units [CFU]), and SSIs at 30 d after surgery were the main study outcomes. A total of 53 patients were included: 25 (47.2%) received a shampoo after 72 h whereas 28 (52.8%) received standard care. Patients who received a shampoo reported a similar level of comfort (average=8.04; standard deviation [SD] 1.05) compared with those receiving standard care (average 7.3; SD 3.2) although this was not statistically significant (p=0.345). No statistically significant difference emerged in the occurrence of surgical site contamination between the groups, and no SSIs were detected within 30 d. In our pilot study, the results of which are not generalizable because of the limited sample of patients involved, a gentle shampoo offered 72 h after the surgical procedure did not increase the SSIs occurrence or the contamination of the surgical site, although it may increase the perception of comfort by patients. Further studies are strongly recommended involving a larger sample size and designed to include more diversified neurosurgical patients undergoing surgical procedures in different centers.

Red blood cell transfusion probability and associated costs in neurosurgical procedures.

Science.gov (United States)

Barth, Martin; Weiss, Christel; Schmieder, Kirsten

2018-03-20

The extent of red blood cell units (RBC) needed for different neurosurgical procedures and the time point of their administration are widely unknown, which results in generously cross-matching prior to surgery. However, RBC are increasingly requested in the aging western populations, and blood donations are significantly reduced. Therefore, the knowledge of the extent and time point of administration of RBC is of major importance. This is a retrospective single center analysis. The incidence of RBC transfusion during surgery or within 48 h after surgery was analyzed for all neurosurgical patients within 3 years. Costs for cross-matched and transfused RBC were calculated and risk factors for RBC transfusion analyzed. The risk of intraoperative RBC administration was low for spinal and intracranial tumor resections (1.87%) and exceeded 10% only in spinal fusion procedures. This was dependent on the number of fused segments with an intraoperative transfusion risk of > 12.5% with fusion of more than three levels. Multiple logistic regression analysis showed a significantly increased risk for RBC transfusion for female gender (p = 0.006; OR 1.655), higher age (N = 4812; p < 0.0001; OR 1.028), and number of fused segments (N = 737; p < 0.0001; OR 1.433). Annual costs for cross-matching were 783,820.88 USD and for intraoperative RBC administration 121,322.13 USD. Neurosurgical procedures are associated with a low number of RBC needed intraoperatively. Only elective spine fusion procedures with ≥ 3 levels involved and AVM resections seem to require cross-matching of RBC. The present data may allow changing the preoperative algorithm of RBC cross-matching in neurosurgical procedures and help to save resources and costs.

Application of Model Project Based Learning on Integrated Science in Water Pollution

Science.gov (United States)

Yamin, Y.; Permanasari, A.; Redjeki, S.; Sopandi, W.

2017-09-01

The function of this research was to analyze the influence model Project Based Learning (PjBl) on integrated science about the concept mastery for junior high school students. Method used for this research constitutes the quasi of experiment method. Population and sample for this research are the students junior high school in Bandung as many as two classes to be experiment and control class. The instrument that used for this research is the test concept mastery, assessment questionnaire of product and the questionnaire responses of the student about learning integrated science. Based on the result of this research get some data that with accomplishment the model of PjBl. Learning authority of integrated science can increase the concept mastery for junior high school students. The highest increase in the theme of pollution water is in the concept of mixtures and the separation method. The students give a positive response in learning of integrated science for the theme of pollution of the water used model PjBL with questionnaire of the opinion aspect in amount of 83.5%, the anxiety of the students in amount of 95.5%, the profit learning model of PjBL in amount of 96.25% and profit learning of integrated science in amount of 95.75%.

Integration of a Three-Dimensional Process-Based Hydrological Model into the Object Modeling System

Directory of Open Access Journals (Sweden)

Giuseppe Formetta

2016-01-01

Full Text Available The integration of a spatial process model into an environmental modeling framework can enhance the model’s capabilities. This paper describes a general methodology for integrating environmental models into the Object Modeling System (OMS regardless of the model’s complexity, the programming language, and the operating system used. We present the integration of the GEOtop model into the OMS version 3.0 and illustrate its application in a small watershed. OMS is an environmental modeling framework that facilitates model development, calibration, evaluation, and maintenance. It provides innovative techniques in software design such as multithreading, implicit parallelism, calibration and sensitivity analysis algorithms, and cloud-services. GEOtop is a physically based, spatially distributed rainfall-runoff model that performs three-dimensional finite volume calculations of water and energy budgets. Executing GEOtop as an OMS model component allows it to: (1 interact directly with the open-source geographical information system (GIS uDig-JGrass to access geo-processing, visualization, and other modeling components; and (2 use OMS components for automatic calibration, sensitivity analysis, or meteorological data interpolation. A case study of the model in a semi-arid agricultural catchment is presented for illustration and proof-of-concept. Simulated soil water content and soil temperature results are compared with measured data, and model performance is evaluated using goodness-of-fit indices. This study serves as a template for future integration of process models into OMS.

The Value of Neurosurgical and Intraoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography in Clinically Integrated Neuroanatomy Modules: A Cross-Sectional Study

Science.gov (United States)

Familiari, Giuseppe; Relucenti, Michela; Heyn, Rosemarie; Baldini, Rossella; D'Andrea, Giancarlo; Familiari, Pietro; Bozzao, Alessandro; Raco, Antonino

2013-01-01

Neuroanatomy is considered to be one of the most difficult anatomical subjects for students. To provide motivation and improve learning outcomes in this area, clinical cases and neurosurgical images from diffusion tensor imaging (DTI) tractographies produced using an intraoperative magnetic resonance imaging apparatus (MRI/DTI) were presented and…

Virtual Reality and Simulation in Neurosurgical Training.

Science.gov (United States)

Bernardo, Antonio

2017-10-01

Recent biotechnological advances, including three-dimensional microscopy and endoscopy, virtual reality, surgical simulation, surgical robotics, and advanced neuroimaging, have continued to mold the surgeon-computer relationship. For developing neurosurgeons, such tools can reduce the learning curve, improve conceptual understanding of complex anatomy, and enhance visuospatial skills. We explore the current and future roles and application of virtual reality and simulation in neurosurgical training. Copyright © 2017 Elsevier Inc. All rights reserved.

Endoscopic and keyhole endoscope-assisted neurosurgical approaches: a qualitative survey on technical challenges and technological solutions.

Science.gov (United States)

Marcus, Hani J; Cundy, Thomas P; Hughes-Hallett, Archie; Yang, Guang-Zhong; Darzi, Ara; Nandi, Dipankar

2014-10-01

The literature reflects a resurgence of interest in endoscopic and keyhole endoscope-assisted neurosurgical approaches as alternatives to conventional microsurgical approaches in carefully selected cases. The aim of this study was to assess the technical challenges of neuroendoscopy, and the scope for technological innovations to overcome these barriers. All full members of the Society of British Neurosurgeons (SBNS) were electronically invited to participate in an online survey. The open-ended structured survey asked three questions; firstly, whether the surgeon presently utilises or has experience with endoscopic or endoscope-assisted approaches; secondly, what they consider to be the major technical barriers to adopting such approaches; and thirdly, what technological advances they foresee improving safety and efficacy in the field. Responses were subjected to a qualitative research method of multi-rater emergent theme analysis. Three clear themes emerged: 1) surgical approach and better integration with image-guidance systems (20%), 2) intra-operative visualisation and improvements in neuroendoscopy (49%), and 3) surgical manipulation and improvements in instruments (74%). The analysis of responses to our open-ended survey revealed that although opinion was varied three major themes could be identified. Emerging technological advances such as augmented reality, high-definition stereo-endoscopy, and robotic joint-wristed instruments may help overcome the technical difficulties associated with neuroendoscopic approaches. Results of this qualitative survey provide consensus amongst the technology end-user community such that unambiguous goals and priorities may be defined. Systems integrating these advances could improve the safety and efficacy of endoscopic and endoscope-assisted neurosurgical approaches.

Development of an Integrated Education/Training based Nuclear Outreach Model

International Nuclear Information System (INIS)

Han, Kyongwon; Nam, Youngmi; Hwang, Ina; Lee, Jisuk; Ko, Hansuk; Lee, Taejoon

2013-01-01

The Korean nuclear community also recognizes the importance of outreach from its experience with rad waste and nuclear power programs. Accordingly, nationwide programs dealing with public information, support for local community development, and HRD are implemented continuously involving a number of organizations concerned. The Nuclear Training and Education Center (NTC) of the Korea Atomic Energy Research Institute (KAERI), with its unique function and capability as a national research organization, has needs for the enhancement of public acceptance for KAERI programs, a better contribution to the national effort, and addressing the emerging needs for international education/training on nuclear outreach. This paper presents an integrated education/training based nuclear outreach model with a set of reference program, which is developed for NTC. An integrated education/training based nuclear outreach model for NTC is developed addressing the increasing needs for public acceptance on the peaceful use of nuclear energy, in terms of supporting KAERI activities, contributing to the national nuclear outreach efforts, and promoting international education and training on nuclear outreach. The model, harmonized with the national nuclear outreach system, consists of objectives, target audiences, a set of reference program supported by infrastructure and networking, and an evaluation system. The program is further specified into sub-programs with detailed design for the respective audiences. The developed model with a reference program is characterized by its integrity in terms of encompassing the whole outreach process cycle, and setting up of a target audience based total program structure with existing and new sub-programs. Also, it intends to be sustainable by addressing future generations' needs as well as innovative in the program delivery. The model will be continuously upgraded and applied addressing respective needs of the audiences

Development of an Integrated Education/Training based Nuclear Outreach Model

Energy Technology Data Exchange (ETDEWEB)

Han, Kyongwon; Nam, Youngmi; Hwang, Ina; Lee, Jisuk; Ko, Hansuk; Lee, Taejoon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2013-05-15

The Korean nuclear community also recognizes the importance of outreach from its experience with rad waste and nuclear power programs. Accordingly, nationwide programs dealing with public information, support for local community development, and HRD are implemented continuously involving a number of organizations concerned. The Nuclear Training and Education Center (NTC) of the Korea Atomic Energy Research Institute (KAERI), with its unique function and capability as a national research organization, has needs for the enhancement of public acceptance for KAERI programs, a better contribution to the national effort, and addressing the emerging needs for international education/training on nuclear outreach. This paper presents an integrated education/training based nuclear outreach model with a set of reference program, which is developed for NTC. An integrated education/training based nuclear outreach model for NTC is developed addressing the increasing needs for public acceptance on the peaceful use of nuclear energy, in terms of supporting KAERI activities, contributing to the national nuclear outreach efforts, and promoting international education and training on nuclear outreach. The model, harmonized with the national nuclear outreach system, consists of objectives, target audiences, a set of reference program supported by infrastructure and networking, and an evaluation system. The program is further specified into sub-programs with detailed design for the respective audiences. The developed model with a reference program is characterized by its integrity in terms of encompassing the whole outreach process cycle, and setting up of a target audience based total program structure with existing and new sub-programs. Also, it intends to be sustainable by addressing future generations' needs as well as innovative in the program delivery. The model will be continuously upgraded and applied addressing respective needs of the audiences.

An Integrated Intrusion Detection Model of Cluster-Based Wireless Sensor Network.

Science.gov (United States)

Sun, Xuemei; Yan, Bo; Zhang, Xinzhong; Rong, Chuitian

2015-01-01

Considering wireless sensor network characteristics, this paper combines anomaly and mis-use detection and proposes an integrated detection model of cluster-based wireless sensor network, aiming at enhancing detection rate and reducing false rate. Adaboost algorithm with hierarchical structures is used for anomaly detection of sensor nodes, cluster-head nodes and Sink nodes. Cultural-Algorithm and Artificial-Fish-Swarm-Algorithm optimized Back Propagation is applied to mis-use detection of Sink node. Plenty of simulation demonstrates that this integrated model has a strong performance of intrusion detection.

Methodological Bases for Describing Risks of the Enterprise Business Model in Integrated Reporting

Directory of Open Access Journals (Sweden)

Nesterenko Oksana O.

2017-12-01

Full Text Available The aim of the article is to substantiate the methodological bases for describing the business and accounting risks of an enterprise business model in integrated reporting for their timely detection and assessment, and develop methods for their leveling or minimizing and possible prevention. It is proposed to consider risks in the process of forming integrated reporting from two sides: first, risks that arise in the business model of an organization and should be disclosed in its integrated report; second, accounting risks of integrated reporting, which should be taken into account by members of the cross-sectoral working group and management personnel in the process of forming and promulgating integrated reporting. To develop an adequate accounting and analytical tool for disclosure of information about the risks of the business model and integrated reporting, their leveling or minimization, in the article a terminological analysis of the essence of entrepreneurial and accounting risks is carried out. The entrepreneurial risk is defined as an objective-subjective economic category that characterizes the probability of negative or positive consequences of economic-social-ecological activity within the framework of the business model of an enterprise under uncertainty. The accounting risk is suggested to be understood as the probability of unfavorable consequences as a result of organizational, methodological errors in the integrated accounting system, which present threat to the quality, accuracy and reliability of the reporting information on economic, social and environmental activities in integrated reporting as well as threat of inappropriate decision-making by stakeholders based on the integrated report. For the timely identification of business risks and maximum leveling of the influence of accounting risks on the process of formation and publication of integrated reporting, in the study the place of entrepreneurial and accounting risks in

Teleconferencing using multimedia messaging service (MMS) for long-range consultation of patients with neurosurgical problems in an acute situation.

Science.gov (United States)

Waran, Vicknes; Selladurai, Benedict M; Bahuri, Nor Faizal Ahmad; George, George John K Thomas; Lim, Grace P S; Khine, Myo

2008-02-01

: We present our initial experience using a simple and relatively cost effective system using existing mobile phone network services and conventional handphones with built in cameras to capture carefully selected images from hard copies of scan images and transferring these images from a hospital without neurosurgical services to a university hospital with tertiary neurosurgical service for consultation and management plan. : A total of 14 patients with acute neurosurgical problems admitted to a general hospital in a 6 months period had their images photographed and transferred in JPEG format to a university neurosurgical unit. This was accompanied by a phone conference to discuss the scan and the patients' condition between the neurosurgeon and the referring physician. All images were also reviewed by a second independent neurosurgeon on a separate occasion to asses the agreement on the diagnosis and the management plan. : There were nine patients with acute head injury and five patients with acute nontraumatic neurosurgical problems. In all cases both neurosurgeons were in agreement that a diagnosis could be made on the basis of the images that were transferred. With respect to the management advice there were differences in opinion on three of the patients but these were considered to be minor. : Accurate diagnosis can be made on images of acute neurosurgical problems transferred using a conventional camera phone and meaningful decisions can be made on these images. This method of consultation also proved to be highly convenient and cost effective.

Integration of Simulink Models with Component-based Software Models

DEFF Research Database (Denmark)

Marian, Nicolae; Top, Søren

2008-01-01

, communication and constraints, using computational blocks and aggregates for both discrete and continuous behaviour, different interconnection and execution disciplines for event-based and time-based controllers, and so on, to encompass the demands to more functionality, at even lower prices, and with opposite...... to be analyzed. One way of doing that is to integrate in wrapper files the model back into Simulink S-functions, and use its extensive simulation features, thus allowing an early exploration of the possible design choices over multiple disciplines. The paper describes a safe translation of a restricted set...... of MATLAB/Simulink blocks to COMDES software components, both for continuous and discrete behaviour, and the transformation of the software system into the S-functions. The general aim of this work is the improvement of multi-disciplinary development of embedded systems with the focus on the relation...

Neurosurgical hand-held optical coherence tomography (OCT) forward-viewing probe

Science.gov (United States)

Sun, Cuiru; Lee, Kenneth K. C.; Vuong, Barry; Cusimano, Michael; Brukson, Alexander; Mariampillai, Adrian; Standish, Beau A.; Yang, Victor X. D.

2012-02-01

A prototype neurosurgical hand-held optical coherence tomography (OCT) imaging probe has been developed to provide micron resolution cross-sectional images of subsurface tissue during open surgery. This new ergonomic hand-held probe has been designed based on our group's previous work on electrostatically driven optical fibers. It has been packaged into a catheter probe in the familiar form factor of the clinically accepted Bayonet shaped neurosurgical non-imaging Doppler ultrasound probes. The optical design was optimized using ZEMAX simulation. Optical properties of the probe were tested to yield an ~20 um spot size, 5 mm working distance and a 3.5 mm field of view. The scan frequency can be increased or decreased by changing the applied voltage. Typically a scan frequency of less than 60Hz is chosen to keep the applied voltage to less than 2000V. The axial resolution of the probe was ~15 um (in air) as determined by the OCT system. A custom-triggering methodology has been developed to provide continuous stable imaging, which is crucial for clinical utility. Feasibility of this probe, in combination with a 1310 nm swept source OCT system was tested and images are presented to highlight the usefulness of such a forward viewing handheld OCT imaging probe. Knowledge gained from this research will lay the foundation for developing new OCT technologies for endovascular management of cerebral aneurysms and transsphenoidal neuroendoscopic treatment of pituitary tumors.

An Integrated Model of Co-ordinated Community-Based Care.

Science.gov (United States)

Scharlach, Andrew E; Graham, Carrie L; Berridge, Clara

2015-08-01

Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Integrating model checking with HiP-HOPS in model-based safety analysis

International Nuclear Information System (INIS)

Sharvia, Septavera; Papadopoulos, Yiannis

2015-01-01

The ability to perform an effective and robust safety analysis on the design of modern safety–critical systems is crucial. Model-based safety analysis (MBSA) has been introduced in recent years to support the assessment of complex system design by focusing on the system model as the central artefact, and by automating the synthesis and analysis of failure-extended models. Model checking and failure logic synthesis and analysis (FLSA) are two prominent MBSA paradigms. Extensive research has placed emphasis on the development of these techniques, but discussion on their integration remains limited. In this paper, we propose a technique in which model checking and Hierarchically Performed Hazard Origin and Propagation Studies (HiP-HOPS) – an advanced FLSA technique – can be applied synergistically with benefit for the MBSA process. The application of the technique is illustrated through an example of a brake-by-wire system. - Highlights: • We propose technique to integrate HiP-HOPS and model checking. • State machines can be systematically constructed from HiP-HOPS. • The strengths of different MBSA techniques are combined. • Demonstrated through modeling and analysis of brake-by-wire system. • Root cause analysis is automated and system dynamic behaviors analyzed and verified

Impact of Operating Room Environment on Postoperative Central Nervous System Infection in a Resource-Limited Neurosurgical Center in South Asia.

Science.gov (United States)

Chidambaram, Swathi; Vasudevan, Madabushi Chakravarthy; Nair, Mani Nathan; Joyce, Cara; Germanwala, Anand V

2018-02-01

Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system. This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013. All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections. Copyright © 2017 Elsevier Inc. All rights reserved.

Infection Rate in 1033 Elective Neurosurgical Procedures at a University Hospital in South China.

Science.gov (United States)

Zhu, Hongwei; Liu, Xiyao; Wang, Zhanxiang

2017-09-01

Objective  Infection following surgery is a serious complication, especially in neurosurgery. The aim of the study is to report the change of incidence rates of infection in patients undergoing elective neurosurgical procedures at a university hospital in South China as well as the risk factors. Material and Methods  The medical records and postoperative courses for patients undergoing 1,033 neurosurgical procedures from 2008 to 2014 were reviewed retrospectively to determine the incidence of neurosurgical infection, the identity of the offending organisms, and the factors associated with infection. Results  A total of 33 patients (40 cases) experienced postoperative infection representing 3.19% of the study population. Twenty cases were incision infections (1.94%), and 20 were cranial/spinal infections (1.94%) including 15 intracranial infections and 5 intraspinal infections. The 2.4-fold greater incidence of postoperative infection in 2008 to 2010 was compared with that in 2011 to 2014 with perioperative antibiotic prophylaxis ( p neurosurgery (1.08%). The most common offending organism was Staphylococcus aureus (27.5%). Foreign body implantation, operative time > 4 hours, and cerebrospinal fluid (CSF) leak (13 infections in 158 patients; p <0.001) were risk factors for infections ( p <0.05). Conclusion  The neurosurgical infection rate is usually low with perioperative antibiotic prophylaxis even in developing countries. Less foreign body implantation, shorter operative times, and controlling CSF leak could reduce infection rates. Georg Thieme Verlag KG Stuttgart · New York.

Ventriculostomy infections at the paediatric neurosurgical unit at Dr ...

African Journals Online (AJOL)

of patients admitted to the paediatric neurosurgical unit at the hospital between January 2010 and December 2013, who had had an EVD inserted as part of their treatment, and if all records were accurate, legible and complete. Patients were excluded from the study if they were older than 12 years. Information was sourced ...

Neurosurgery contact handheld probe based on sapphire shaped crystal

Science.gov (United States)

Shikunova, I. A.; Stryukov, D. O.; Rossolenko, S. N.; Kiselev, A. M.; Kurlov, V. N.

2017-01-01

A handheld contact probe based on sapphire shaped crystal is developed for intraoperative spectrally-resolved optical diagnostics, laser coagulation and aspiration of malignant brain tissue. The technology was integrated into the neurosurgical workflow for intraoperative real-time identification and removing of invasive brain cancer.

Russian and Foreign Experience of Integration of Agent-Based Models and Geographic Information Systems

Directory of Open Access Journals (Sweden)

Konstantin Anatol’evich Gulin

2016-11-01

Full Text Available The article provides an overview of the mechanisms of integration of agent-based models and GIS technology developed by Russian and foreign researchers. The basic framework of the article is based on critical analysis of domestic and foreign literature (monographs, scientific articles. The study is based on the application of universal scientific research methods: system approach, analysis and synthesis, classification, systematization and grouping, generalization and comparison. The article presents theoretical and methodological bases of integration of agent-based models and geographic information systems. The concept and essence of agent-based models are explained; their main advantages (compared to other modeling methods are identified. The paper characterizes the operating environment of agents as a key concept in the theory of agent-based modeling. It is shown that geographic information systems have a wide range of information resources for calculations, searching, modeling of the real world in various aspects, acting as an effective tool for displaying the agents’ operating environment and allowing to bring the model as close as possible to the real conditions. The authors also focus on a wide range of possibilities for various researches in different spatial and temporal contexts. Comparative analysis of platforms supporting the integration of agent-based models and geographic information systems has been carried out. The authors give examples of complex socio-economic models: the model of a creative city, humanitarian assistance model. In the absence of standards for research results description, the authors focus on the models’ elements such as the characteristics of the agents and their operation environment, agents’ behavior, rules of interaction between the agents and the external environment. The paper describes the possibilities and prospects of implementing these models

Academic impact and rankings of American and Canadian neurosurgical departments as assessed using the h index.

Science.gov (United States)

Ponce, Francisco A; Lozano, Andres M

2010-09-01

The authors undertook a study to estimate the relative academic impact of neurosurgical departments in Canada and the US using the h index, a measure of the number of citations received by a collection of work. The study included 99 departments of neurosurgery with residency programs participating in the US National Residency Matching Program, and the 14 analogous Canadian programs. Three types of h indices were determined-one reflecting the cumulative work attributed to a neurosurgical department, h(c); one restricted to the cumulative work published over the past 10 years, h(10); and one limited to work published in 2 major North American neurosurgical journals, h(NS)(10). For an article to be included, attribution to a neurosurgical department had to appear in the address field in the database Thomson's ISI Web of Science. The three h indices were compared with each other, and their relation to other measures such as size of the department, degrees held by the faculty, and research funding was examined. Significant correlations were found between the citation indices and faculty size, number of publications and the types of degrees held by the faculty, and funding by the US NIH. Three types of authorship were identified: neurosurgeon, nonclinician researcher, and nonneurosurgeon clinical affiliate. The degree to which the latter 2 nonneurosurgeon categories contributed to the departmental h index varied among departments and can confound interdepartmental comparison. Limiting articles to those published in neurosurgical journals appeared to correct for the influence of nonneurosurgeons in departmental impact and reflect neurosurgeon-driven scholarship. The h index may be useful in evaluating output across neurosurgery departments.

Shape memory alloys: metallurgy, biocompatibility, and biomechanics for neurosurgical applications.

Science.gov (United States)

Hoh, Daniel J; Hoh, Brian L; Amar, Arun P; Wang, Michael Y

2009-05-01

SHAPE MEMORY ALLOYS possess distinct dynamic properties with particular applications in neurosurgery. Because of their unique physical characteristics, these materials are finding increasing application where resiliency, conformation, and actuation are needed. Nitinol, the most frequently manufactured shape memory alloy, responds to thermal and mechanical stimuli with remarkable mechanical properties such as shape memory effect, super-elasticity, and high damping capacity. Nitinol has found particular use in the biomedical community because of its excellent fatigue resistance and biocompatibility, with special interest in neurosurgical applications. The properties of nitinol and its diffusionless phase transformations contribute to these unique mechanical capabilities. The features of nitinol, particularly its shape memory effect, super-elasticity, damping capacity, as well as its biocompatibility and biomechanics are discussed herein. Current and future applications of nitinol and other shape memory alloys in endovascular, spinal, and minimally invasive neurosurgery are introduced. An understanding of the metallurgic properties of nitinol provides a foundation for further exploration of its use in neurosurgical implant design.

An agent-based model for integrated emotion regulation and contagion in socially affected decision making

OpenAIRE

Manzoor, A.; Treur, J.

2015-01-01

This paper addresses an agent-based computational social agent model for the integration of emotion regulation, emotion contagion and decision making in a social context. The model integrates emotion-related valuing, in order to analyse the role of emotions in socially affected decision making. The agent-based model is illustrated for the interaction between two persons. Simulation experiments for different kinds of scenarios help to understand how decisions can be affected by regulating the ...

Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform.

Science.gov (United States)

Matloob, Samir A; Hyam, Jonathan A; Thorne, Lewis; Bradford, Robert

2016-01-01

Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.

Use of neurosurgical decision-making and damage-control neurosurgery courses in the Iraq and Afghanistan conflicts: a surgeon's experience.

Science.gov (United States)

Teff, Richard J

2010-05-01

A shortage of Coalition neurological surgeons in the Iraq conflict prompted a creative approach to standardized neurosurgical care in 2007. After formulation of theater-wide clinical pathway guidelines, a need for standardized triage and neurological resuscitation was identified. The object was to establish a simple, reproducible course for medics, forward surgical and emergency room personnel, and other critical care providers to quickly standardize the ability of all deployed health care personnel to provide state-of-the-art neurosurgical triage and damage-control interventions. The methods applied were Microsoft PowerPoint presentations and hands-on learning. The year-long project resulted in more than 100 individuals being trained in neurosurgical decision making and in more than 15 surgeons being trained in damage-control neurosurgery. At the year's conclusion, hundreds of individuals received exceptional neurosurgical care from nonneurosurgical providers and a legacy course was left for future deployed providers to receive ongoing education at their own pace.

Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes.

Science.gov (United States)

Holland, Christopher M; Lovasik, Brendan P; Howard, Brian M; McClure, Evan W; Samuels, Owen B; Barrow, Daniel L

2017-09-01

Interhospital transfer of neurosurgical patients is common; however, little is known about the impact of transfer parameters on clinical outcomes. Lower survival rates have been reported for patients admitted at night and on weekends in other specialties. Whether time or day of admission affects neurosurgical patient outcomes, specifically those transferred from other facilities, is unknown. To examine the impact of the timing of interhospital transfer on the hospital course and clinical outcomes of neurosurgical patients. All consecutive admissions of patients transferred to our adult neurosurgical service were retrospectively analyzed for a 1-year study period using data from a central transfer database and the electronic health record. Patients arrived more often at night (70.8%) despite an even distribution of transfer requests. The lack of transfer imaging did not affect length of stay, intervention times, or patient outcomes. Daytime arrivals had shorter total transfer time, but longer intenstive care unit and overall length of stay (8.7 and 11.6 days, respectively), worse modified Rankin Scale scores, lower rates of functional independence, and almost twice the mortality rate. Weekend admissions had significantly worse modified Rankin Scale scores and lower rates of functional independence. The timing of transfer arrivals, both by hour or day of the week, is correlated with the time to intervention, hospital course, and overall patient outcomes. Patients admitted during the weekend suffered worse functional outcomes and a trend towards increased mortality. While transfer logistics clearly impact patient outcomes, further work is needed to understand these complex relationships. Copyright © 2017 by the Congress of Neurological Surgeons.

The Johns Hopkins Hunterian Laboratory Philosophy: Mentoring Students in a Scientific Neurosurgical Research Laboratory.

Science.gov (United States)

Tyler, Betty M; Liu, Ann; Sankey, Eric W; Mangraviti, Antonella; Barone, Michael A; Brem, Henry

2016-06-01

After over 50 years of scientific contribution under the leadership of Harvey Cushing and later Walter Dandy, the Johns Hopkins Hunterian Laboratory entered a period of dormancy between the 1960s and early 1980s. In 1984, Henry Brem reinstituted the Hunterian Neurosurgical Laboratory, with a new focus on localized delivery of therapies for brain tumors, leading to several discoveries such as new antiangiogenic agents and Gliadel chemotherapy wafers for the treatment of malignant gliomas. Since that time, it has been the training ground for 310 trainees who have dedicated their time to scientific exploration in the lab, resulting in numerous discoveries in the area of neurosurgical research. The Hunterian Neurosurgical Laboratory has been a unique example of successful mentoring in a translational research environment. The laboratory's philosophy emphasizes mentorship, independence, self-directed learning, creativity, and people-centered collaboration, while maintaining productivity with a focus on improving clinical outcomes. This focus has been served by the diverse backgrounds of its trainees, both in regard to educational status as well as culturally. Through this philosophy and strong legacy of scientific contribution, the Hunterian Laboratory has maintained a positive and productive research environment that supports highly motivated students and trainees. In this article, the authors discuss the laboratory's training philosophy, linked to the principles of adult learning (andragogy), as well as the successes and the limitations of including a wide educational range of students in a neurosurgical translational laboratory and the phenomenon of combining clinical expertise with rigorous scientific training.

Virtual Cerebral Aneurysm Clipping with Real-Time Haptic Force Feedback in Neurosurgical Education.

Science.gov (United States)

Gmeiner, Matthias; Dirnberger, Johannes; Fenz, Wolfgang; Gollwitzer, Maria; Wurm, Gabriele; Trenkler, Johannes; Gruber, Andreas

2018-04-01

Realistic, safe, and efficient modalities for simulation-based training are highly warranted to enhance the quality of surgical education, and they should be incorporated in resident training. The aim of this study was to develop a patient-specific virtual cerebral aneurysm-clipping simulator with haptic force feedback and real-time deformation of the aneurysm and vessels. A prototype simulator was developed from 2012 to 2016. Evaluation of virtual clipping by blood flow simulation was integrated in this software, and the prototype was evaluated by 18 neurosurgeons. In 4 patients with different medial cerebral artery aneurysms, virtual clipping was performed after real-life surgery, and surgical results were compared regarding clip application, surgical trajectory, and blood flow. After head positioning and craniotomy, bimanual virtual aneurysm clipping with an original forceps was performed. Blood flow simulation demonstrated residual aneurysm filling or branch stenosis. The simulator improved anatomic understanding for 89% of neurosurgeons. Simulation of head positioning and craniotomy was considered realistic by 89% and 94% of users, respectively. Most participants agreed that this simulator should be integrated into neurosurgical education (94%). Our illustrative cases demonstrated that virtual aneurysm surgery was possible using the same trajectory as in real-life cases. Both virtual clipping and blood flow simulation were realistic in broad-based but not calcified aneurysms. Virtual clipping of a calcified aneurysm could be performed using the same surgical trajectory, but not the same clip type. We have successfully developed a virtual aneurysm-clipping simulator. Next, we will prospectively evaluate this device for surgical procedure planning and education. Copyright © 2018 Elsevier Inc. All rights reserved.

Knowledge-based inspection:modelling complex processes with the integrated Safeguards Modelling Method (iSMM)

International Nuclear Information System (INIS)

Abazi, F.

2011-01-01

Increased level of complexity in almost every discipline and operation today raises the demand for knowledge in order to successfully run an organization whether to generate profit or to attain a non-profit mission. Traditional way of transferring knowledge to information systems rich in data structures and complex algorithms continue to hinder the ability to swiftly turnover concepts into operations. Diagrammatic modelling commonly applied in engineering in order to represent concepts or reality remains to be an excellent way of converging knowledge from domain experts. The nuclear verification domain represents ever more a matter which has great importance to the World safety and security. Demand for knowledge about nuclear processes and verification activities used to offset potential misuse of nuclear technology will intensify with the growth of the subject technology. This Doctoral thesis contributes with a model-based approach for representing complex process such as nuclear inspections. The work presented contributes to other domains characterized with knowledge intensive and complex processes. Based on characteristics of a complex process a conceptual framework was established as the theoretical basis for creating a number of modelling languages to represent the domain. The integrated Safeguards Modelling Method (iSMM) is formalized through an integrated meta-model. The diagrammatic modelling languages represent the verification domain and relevant nuclear verification aspects. Such a meta-model conceptualizes the relation between practices of process management, knowledge management and domain specific verification principles. This fusion is considered as necessary in order to create quality processes. The study also extends the formalization achieved through a meta-model by contributing with a formalization language based on Pattern Theory. Through the use of graphical and mathematical constructs of the theory, process structures are formalized enhancing

An anatomical study of the different neurosurgical approaches of the ...

African Journals Online (AJOL)

Objective: This study was done to study the feasibility of the various neurosurgical approaches of the cervical spinal cord. Methods: Ten cadaveric specimens obtained from the dissecting room of the Faculty of Medicine, University of Alexandria were dissected both anteriorly and posteriorly in the cervical region to compare ...

Design and implementation of space physics multi-model application integration based on web

Science.gov (United States)

Jiang, Wenping; Zou, Ziming

With the development of research on space environment and space science, how to develop network online computing environment of space weather, space environment and space physics models for Chinese scientific community is becoming more and more important in recent years. Currently, There are two software modes on space physics multi-model application integrated system (SPMAIS) such as C/S and B/S. the C/S mode which is traditional and stand-alone, demands a team or workshop from many disciplines and specialties to build their own multi-model application integrated system, that requires the client must be deployed in different physical regions when user visits the integrated system. Thus, this requirement brings two shortcomings: reducing the efficiency of researchers who use the models to compute; inconvenience of accessing the data. Therefore, it is necessary to create a shared network resource access environment which could help users to visit the computing resources of space physics models through the terminal quickly for conducting space science research and forecasting spatial environment. The SPMAIS develops high-performance, first-principles in B/S mode based on computational models of the space environment and uses these models to predict "Space Weather", to understand space mission data and to further our understanding of the solar system. the main goal of space physics multi-model application integration system (SPMAIS) is to provide an easily and convenient user-driven online models operating environment. up to now, the SPMAIS have contained dozens of space environment models , including international AP8/AE8 IGRF T96 models and solar proton prediction model geomagnetic transmission model etc. which are developed by Chinese scientists. another function of SPMAIS is to integrate space observation data sets which offers input data for models online high-speed computing. In this paper, service-oriented architecture (SOA) concept that divides system into

Integrated Debugging of Modelica Models

Directory of Open Access Journals (Sweden)

Adrian Pop

2014-04-01

Full Text Available The high abstraction level of equation-based object-oriented (EOO languages such as Modelica has the drawback that programming and modeling errors are often hard to find. In this paper we present integrated static and dynamic debugging methods for Modelica models and a debugger prototype that addresses several of those problems. The goal is an integrated debugging framework that combines classical debugging techniques with special techniques for equation-based languages partly based on graph visualization and interaction. To our knowledge, this is the first Modelica debugger that supports both equation-based transformational and algorithmic code debugging in an integrated fashion.

The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

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Kwon, Woo-Keun; Kim, Joo Han; Moon, Hong Joo; Park, Youn-Kwan

2017-01-01

Objectives The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. Methods We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. Results During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. Conclusion More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement. PMID:28061492

An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America.

Science.gov (United States)

Khan, Nickalus R; Saad, Hassan; Oravec, Chesney S; Norrdahl, Sebastian P; Fraser, Brittany; Wallace, David; Lillard, Jock C; Motiwala, Mustafa; Nguyen, Vincent N; Lee, Siang Liao; Jones, Anna V; Ajmera, Sonia; Kalakoti, Piyush; Dave, Pooja; Moore, Kenneth A; Akinduro, Olutomi; Nyenwe, Emmanuel; Vaughn, Brandy; Michael, L Madison; Klimo, Paul

2018-05-30

Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P productivity. This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.

Use of Tranexamic Acid Is Associated with Reduced Blood Product Transfusion in Complex Skull Base Neurosurgical Procedures: A Retrospective Cohort Study.

Science.gov (United States)

Mebel, Dmitry; Akagami, Ryojo; Flexman, Alana M

2016-02-01

Compared with other procedures, complex skull base neurosurgery has the potential for increased intraoperative blood loss yet coagulation near eloquent cranial structures should be minimized. The safety and efficacy of the antifibrinolytic, tranexamic acid in elective neurosurgical procedures is not known. Our primary objective was to determine the relationship between the use of tranexamic acid and transfusion at our institution. Our secondary objective was to determine the incidence of adverse events associated with the use of tranexamic acid. In this retrospective cohort study, we included all patients who underwent complex skull base neurosurgical procedures at our institution between 2001 and 2013. Tranexamic acid was introduced during these procedures in 2006. Patient and surgical variables, transfusion data, and adverse events in the perioperative period were abstracted from the medical record. The rates of transfusion and adverse events were compared between patients who did and did not receive tranexamic acid. Multivariate regression was used to identify independent predictors of perioperative transfusion. We compared 245 patients who received tranexamic acid with 274 patients who did not receive the drug during the study period. The 2 groups were similar, with the exception that patients who received tranexamic acid had larger tumors (mean, 3.5 vs 2.9 cm; P tranexamic acid was lower (7% vs 13%, P = 0.04). After adjusting for preoperative hemoglobin, tumor diameter, and surgical procedure category, the use of tranexamic acid was independently predictive of perioperative transfusion (adjusted odds ratio, 0.32; 95% confidence interval, 0.15-0.65, P = 0.002). The rates of thromboembolic events and seizure were similar between the 2 groups. Our results demonstrate that tranexamic acid use is associated with reduced transfusion rates in our study population, with no apparent increase in seizure or thrombotic complications. Our data support the need for further

Current neurosurgical trainees' perception of the European Working Time Directive and shift work.

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Tait, M J; Fellows, G A; Pushpananthan, S; Sergides, Y; Papadopoulos, M C; Bell, B A

2008-02-01

The introduction of the shift system in response to the European Working Time Directive has had an enormous impact on the running of neurosurgical units in the UK. This study seeks to establish what provisions are currently in place for out of hours cover and what has been the effect of the introduction of shifts in three main areas: patient safety, training and 'work/life balance'. The on-call registrar at each UK neurosurgical unit was contacted by telephone. Data regarding current emergency provision were sought. Registrars who had worked both on-calls and the shift system during their career as a neurosurgical registrar were asked to make a comparison. Data were collected from all 33 UK units. Twenty-two still use a traditional 24-h on-call system. Twenty-one on-call rotas were classed as non-resident although 12/21 of those officially on non-resident rotas were in fact resident whilst on call. Twenty-two registrars had worked both systems as a neurosurgical registrar. Twenty-one (95.45%) felt that traditional on-calls gave better clinical exposure. Twenty-one (95.45%) felt that on-calls allowed the provision of better patient care. Nineteen (86.36%) felt that on-calls were safer. Thirteen (59.09%) reported that they were more tired when doing shift work than on-calls. Fourteen (63.63%) found that the on-call system gives more useful spare time and more time to deal with family commitments. Current neurosurgery registrars feel the shift system is less safe, harmful to training and worse in terms of work/life balance. More than one-third of units are claiming to have non-resident on-call systems in order to appear compliant with EWTD when registrars are in fact resident.

Attitudes of young neurosurgeons and neurosurgical residents towards euthanasia and physician-assisted suicide.

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Broekman, M L D; Verlooy, J S A

2013-11-01

Euthanasia and physician assisted suicide (PAS) are two controversial topics in neurosurgical practice. Personal attitudes and opinions on these important issues may vary between professionals, and may also depend on their location since current legislation differs between European countries. As these issues may have significant impact on clinical practice, the goal of the present study was to survey the opinions of neurosurgical residents and young neurosurgeons across Europe with respect to euthanasia and physician assisted suicide. We performed a survey among the participants of the European Association of Neurosurgical Societies (EANS) training courses (2011-2012), asking residents and young neurosurgeons nine questions on euthanasia and PAS. For the analysis of this survey, we divided all 295 participants into four European regions (North, South, East, West). We found that even though most residents are aware of regulations about euthanasia or PAS in their country or hospital, a substantial number were not aware of the regulations. We observed no significant differences in terms of their opinions on euthanasia and PAS among the four European regions. While most are actually in favor of euthanasia or PAS, if legally allowed, under appropriate circumstances, very few neurosurgeons would be willing to actively participate in these end-of-life practices. The results of this first survey on neurosurgical residents' attitudes towards euthanasia and PAS show that a significant number of residents is not familiar with national and/or local regulations regarding euthanasia and PAS. If legally allowed, most residents would be in favor of euthanasia and PAS, but only a minority would be willing to actively participate in these practices. We did not observe a difference in stances on euthanasia and PAS among residents from different regions in Europe.

Safety of Running Two Rooms: A Systematic Review and Meta-Analysis of Overlapping Neurosurgical Procedures.

Science.gov (United States)

Self, D Mitchell; Ilyas, Adeel; Stetler, William R

2018-04-27

Overlapping surgery, a long-standing practice within academic neurosurgery centers nationwide, has recently come under scrutiny from the government and media as potentially harmful to patients. Therefore, the objective of this systematic review and meta-analysis is to determine the safety of overlapping neurosurgical procedures. The authors performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A review of PubMed and Medline databases was undertaken with the search phrase "overlapping surgery AND neurosurgery AND outcomes." Data regarding patient demographics, type of neurosurgical procedure, and outcomes and complications were extracted from each study. The principle summary measure was odds ratio (OR) of the association of overlapping versus non-overlapping surgery with outcomes. The literature search yielded a total of 36 studies, of which 5 studies met inclusion criteria and were included in this study. These studies included a total of 25,764 patients undergoing neurosurgical procedures. Overlapping surgery was associated with an increased likelihood of being discharged home (OR = 1.32; 95% CI 1.20 to 1.44; P < 0.001) and a reduced 30-day unexpected return to the operating room (OR = 0.79; 95% CI 0.72 to 0.87; P < 0.001). Overlapping surgery did not significantly affect OR of length of surgery, 30-day mortality, or 30-day readmission. Overlapping neurosurgical procedures were not associated with worse patient outcomes. Additional, prospective studies are needed to further assess the safety overlapping procedures. Copyright © 2018. Published by Elsevier Inc.

A Retrospective Propensity Score-Matched Early Thromboembolic Event Analysis of Prothrombin Complex Concentrate vs Fresh Frozen Plasma for Warfarin Reversal Prior to Emergency Neurosurgical Procedures.

Science.gov (United States)

Agarwal, Prateek; Abdullah, Kalil G; Ramayya, Ashwin G; Nayak, Nikhil R; Lucas, Timothy H

2017-06-29

Reversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP). To compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center. Sixty-three consecutive patients on warfarin therapy presenting with intracranial hemorrhage who received anticoagulation reversal prior to emergency neurosurgical procedures were retrospectively identified between 2007 and 2016. They were divided into 2 cohorts based on reversal agent, either PCC (n = 28) or FFP (n = 35). The thrombotic complications rates within 72 h of reversal were compared using the χ 2 test. A multivariate propensity score matching analysis was used to limit the threat to interval validity from selection bias arising from differences in demographics, laboratory values, history, and clinical status. Thrombotic complications were uncommon in this neurosurgical population, occurring in 1.59% (1/63) of treated patients. There was no significant difference in the thrombotic complication rate between groups, 3.57% (1/28; PCC group) vs 0% (0/35; FFP group). Propensity score matching analysis validated this finding after controlling for any selection bias. In this limited sample, thrombotic complication rates were similar between use of PCC and FFP for anticoagulation reversal in the management of intracranial hemorrhage prior to emergency neurosurgical procedures. Copyright © 2017 by the Congress of Neurological Surgeons

The British Neurosurgical Trainee Research Collaborative: Five years on.

Science.gov (United States)

Chari, Aswin; Jamjoom, Aimun A; Edlmann, Ellie; Ahmed, Aminul I; Coulter, Ian C; Ma, Ruichong; May, Paul; Brennan, Paul M; Hutchinson, Peter J A; Kolias, Angelos G

2018-01-01

Since its inception in 2012, the British Neurosurgical Trainee Research Collaborative (BNTRC) has established itself as a robust example of a trainee-led research collaborative. This article summarises the work of the collaborative over its first 5 years of existence, outlining the structure, its research projects, impact and future directions.

Predicting Resident Performance from Preresidency Factors: A Systematic Review and Applicability to Neurosurgical Training.

Science.gov (United States)

Zuckerman, Scott L; Kelly, Patrick D; Dewan, Michael C; Morone, Peter J; Yengo-Kahn, Aaron M; Magarik, Jordan A; Baticulon, Ronnie E; Zusman, Edie E; Solomon, Gary S; Wellons, John C

2018-02-01

Neurosurgical educators strive to identify the best applicants, yet formal study of resident selection has proved difficult. We conducted a systematic review to answer the following question: What objective and subjective preresidency factors predict resident success? PubMed, ProQuest, Embase, and the CINAHL databases were queried from 1952 to 2015 for literature reporting the impact of preresidency factors (PRFs) on outcomes of residency success (RS), among neurosurgery and all surgical subspecialties. Due to heterogeneity of specialties and outcomes, a qualitative summary and heat map of significant findings were constructed. From 1489 studies, 21 articles met inclusion criteria, which evaluated 1276 resident applicants across five surgical subspecialties. No neurosurgical studies met the inclusion criteria. Common objective PRFs included standardized testing (76%), medical school performance (48%), and Alpha Omega Alpha (43%). Common subjective PRFs included aggregate rank scores (57%), letters of recommendation (38%), research (33%), interviews (19%), and athletic or musical talent (19%). Outcomes of RS included faculty evaluations, in-training/board exams, chief resident status, and research productivity. Among objective factors, standardized test scores correlated well with in-training/board examinations but poorly correlated with faculty evaluations. Among subjective factors, aggregate rank scores, letters of recommendation, and athletic or musical talent demonstrated moderate correlation with faculty evaluations. Standardized testing most strongly correlated with future examination performance but correlated poorly with faculty evaluations. Moderate predictors of faculty evaluations were aggregate rank scores, letters of recommendation, and athletic or musical talent. The ability to predict success of neurosurgical residents using an evidence-based approach is limited, and few factors have correlated with future resident performance. Given the importance of

Evaluation of a mobile augmented reality application for image guidance of neurosurgical interventions.

Science.gov (United States)

Kramers, Matthew; Armstrong, Ryan; Bakhshmand, Saeed M; Fenster, Aaron; de Ribaupierre, Sandrine; Eagleson, Roy

2014-01-01

Image guidance can provide surgeons with valuable contextual information during a medical intervention. Often, image guidance systems require considerable infrastructure, setup-time, and operator experience to be utilized. Certain procedures performed at bedside are susceptible to navigational errors that can lead to complications. We present an application for mobile devices that can provide image guidance using augmented reality to assist in performing neurosurgical tasks. A methodology is outlined that evaluates this mode of visualization from the standpoint of perceptual localization, depth estimation, and pointing performance, in scenarios derived from a neurosurgical targeting task. By measuring user variability and speed we can report objective metrics of performance for our augmented reality guidance system.

An agent-based model for integrated emotion regulation and contagion in socially affected decision making

NARCIS (Netherlands)

Manzoor, A.; Treur, J.

2015-01-01

This paper addresses an agent-based computational social agent model for the integration of emotion regulation, emotion contagion and decision making in a social context. The model integrates emotion-related valuing, in order to analyse the role of emotions in socially affected decision making. The

Effect of mobile laminar airflow units on airborne bacterial contamination during neurosurgical procedures.

Science.gov (United States)

von Vogelsang, A-C; Förander, P; Arvidsson, M; Löwenhielm, P

2018-03-24

Surgical site infections (SSIs) after neurosurgery are potentially life-threatening and entail great costs. SSIs may occur from airborne bacteria in the operating room, and ultraclean air is desired during infection-prone cleaning procedures. Door openings and the number of persons present in the operating room affect the air quality. Mobile laminar airflow (MLAF) units, with horizontal laminar airflow, have previously been shown to reduce airborne bacterial contamination. To assess the effect of MLAF units on airborne bacterial contamination during neurosurgical procedures. In a quasi-experimental design, bacteria-carrying particles (colony-forming units: cfu) during neurosurgical procedures were measured with active air-sampling in operating rooms with conventional turbulent ventilation, and with additional MLAF units. The MLAF units were shifted between operating rooms monthly. Colony-forming unit count and bacterial species detection were conducted after incubation. Data was collected for a period of 18 months. A total of 233 samples were collected during 45 neurosurgical procedures. The use of MLAF units significantly reduced the numbers of cfu in the surgical site area (P neurosurgery to ultraclean air levels. MLAF units are valuable when the main operating room ventilation system is unable to produce ultraclean air in infection-prone clean neurosurgery. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Neurosurgical strategies for Gilles de la Tourette’s syndrome

Directory of Open Access Journals (Sweden)

Karim Mukhida

2008-09-01

Full Text Available Karim Mukhida1,2, Matthew Bishop2, Murray Hong2, Ivar Mendez21Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; 2Departments, of Anatomy and Neurobiology and Surgery (Neurosurgery, Dalhousie University, Halifax, Nova Scotia, CanadaAbstract: Tourette’s syndrome (TS is a neurological disorder characterized by motor and vocal tics that typically begin in childhood and often are accompanied by psychiatric comorbidities. Symptoms of TS may be socially disabling and cause secondary medical complications. Pharmacological therapies remain the mainstay of symptom management. For the subset of patients in whom TS symptoms are medically recalcitrant and do not dissipate by adulthood, neurosurgery may offer an alternative treatment strategy. Greater understanding of the neuroanatomic and pathophysiologic basis of TS has facilitated the development of surgical procedures that aim to ameliorate TS symptoms by lesions or deep brain stimulation of cerebral structures. Herein, the rationale for the surgical management of TS is discussed and neurosurgical experiences since the 1960s are reviewed. The necessity for neurosurgical strategies to be performed with appropriate ethical considerations is highlighted.Keywords: tourette’s syndrome, neurosurgery, deep brain stimulation, thalamus

Application of an aviation model of incident reporting and investigation to the neurosurgical scenario: method and preliminary data.

Science.gov (United States)

Ferroli, Paolo; Caldiroli, Dario; Acerbi, Francesco; Scholtze, Maurizio; Piro, Alfonso; Schiariti, Marco; Orena, Eleonora F; Castiglione, Melina; Broggi, Morgan; Perin, Alessandro; DiMeco, Francesco

2012-11-01

Incident reporting systems are universally recognized as important tools for quality improvement in all complex adaptive systems, including the operating room. Nevertheless, introducing a safety culture among neurosurgeons is a slow process, and few studies are available in the literature regarding the implementation of an incident reporting system within a neurosurgical department. The authors describe the institution of an aviation model of incident reporting and investigation in neurosurgery, focusing on the method they have used and presenting some preliminary results. In 2010, the Inpatient Safety On-Board project was developed through cooperation between a team of human factor and safety specialists with aviation backgrounds (DgSky team) and the general manager of the Fondazione Istituto Neurologico Carlo Besta. In 2011, after specific training in safety culture, the authors implemented an aviation-derived prototype of incident reporting within the Department of Neurosurgery. They then developed an experimental protocol to track, analyze, and categorize any near misses that happened in the operating room. This project officially started in January 2012, when a dedicated team of assessors was established. All members of the neurosurgical department were asked to report near misses on a voluntary, confidential, and protected form (Patient Incident Reporting System form, Besta Safety Management Programme). Reports were entered into an online database and analyzed by a dedicated team of assessors with the help of a facilitator, and an aviation-derived root cause analysis was performed. Since January 2012, 14 near misses were analyzed and classified. The near-miss contributing factors were mainly related to human factors (9 of 14 cases), technology (1 of 14 cases), organizational factors (3 of 14 cases), or procedural factors (1 of 14 cases). Implementing an incident reporting system is quite demanding; the process should involve all of the people who work within

Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.

Science.gov (United States)

Jagannathan, Jay; Vates, G Edward; Pouratian, Nader; Sheehan, Jason P; Patrie, James; Grady, M Sean; Jane, John A

2009-05-01

taking the exam for self-assessment decreased from 310 in 2002 to 259 in 2006 (16% decrease, p quality care (82% of program directors and 87% of chief residents). When asked about the effects of a 56-hour workweek, all program directors and 98% of the chief residents indicated that resident training and surgical education would be further compromised. Most respondents (95% of program directors and 84% of chief residents) also believed that additional work-hour restrictions would jeopardize patient care. Neurological surgery continues to attract top-quality resident applicants. Test scores and levels of participation in national conferences, however, indicate that the 80-hour workweek may adversely affect resident training. Subjectively, neurosurgical program directors and chief residents believe that the 80-hour workweek makes neurosurgical training and the care of patients more difficult. Based on experience with the 80-hour workweek, educators think that a 56-hour workweek would further compromise neurosurgical training and patient care in the US.

The use of IV-tubing as a closed-suction drainage system during neurosurgical cases in Tanzania.

Science.gov (United States)

Bonfield, Christopher M; Shabani, Hamisi K; Kanumba, Emmanuel S; Ellegala, Dilantha B; Nicholas, Joyce

2013-01-01

Commercial closed-suctions drainage systems are commonly used in the United States and many other countries for use in neurosurgical cases. However, in Tanzania and other developing nations with fewer resources, these are not available. This report explores another option for a closed-system drainage system utilizing inexpensive supplies found commonly in hospitals around the world. Sterile IV-tubing is cut, inserted into the wound, and brought out through an adjacent puncture incision. For suction, an empty plastic bottle can be attached to the tubing. The IV-tubing closed-suction drainage system was applied in both cranial and spinal neurosurgical procedures, including as subdural, subgaleal, epidural, and suprafacial drains. It maintained suction and was an adequate substitute when commercial drains are unavailable. This report illustrates how sterile IV-tubing can be adapted for use as a closed-drainage system. It utilizes inexpensive supplies commonly found in many hospitals throughout the world and can be applied to both cranial and spinal neurosurgical procedures.

Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

Science.gov (United States)

Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Crimmins, Darach; Caird, John

2018-01-01

OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.

Fast integration-based prediction bands for ordinary differential equation models.

Science.gov (United States)

Hass, Helge; Kreutz, Clemens; Timmer, Jens; Kaschek, Daniel

2016-04-15

To gain a deeper understanding of biological processes and their relevance in disease, mathematical models are built upon experimental data. Uncertainty in the data leads to uncertainties of the model's parameters and in turn to uncertainties of predictions. Mechanistic dynamic models of biochemical networks are frequently based on nonlinear differential equation systems and feature a large number of parameters, sparse observations of the model components and lack of information in the available data. Due to the curse of dimensionality, classical and sampling approaches propagating parameter uncertainties to predictions are hardly feasible and insufficient. However, for experimental design and to discriminate between competing models, prediction and confidence bands are essential. To circumvent the hurdles of the former methods, an approach to calculate a profile likelihood on arbitrary observations for a specific time point has been introduced, which provides accurate confidence and prediction intervals for nonlinear models and is computationally feasible for high-dimensional models. In this article, reliable and smooth point-wise prediction and confidence bands to assess the model's uncertainty on the whole time-course are achieved via explicit integration with elaborate correction mechanisms. The corresponding system of ordinary differential equations is derived and tested on three established models for cellular signalling. An efficiency analysis is performed to illustrate the computational benefit compared with repeated profile likelihood calculations at multiple time points. The integration framework and the examples used in this article are provided with the software package Data2Dynamics, which is based on MATLAB and freely available at http://www.data2dynamics.org helge.hass@fdm.uni-freiburg.de Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e

Development of neurosurgery in Germany: comparison of data collected by polls for 1997, 2003, and 2008 among providers of neurosurgical care.

Science.gov (United States)

Steiger, Hans J; Krämer, Michael; Reulen, Hans J

2012-01-01

To deduce structural trends in neurosurgery in Germany by comparison of data derived from polls conducted by the Deutsche Gesellschaft für Neurochirurgie (DGNC) in 1997, 2003 and 2008. The questionnaires of the different polls probed a comparable set of issues. The data from the responding sample were extrapolated to the nationwide average or sum and compared between the different time periods. The number of identified neurosurgical departments increased from 146 to 201 during the years 1997-2008 largely as a result of the new foundation of numerous private groups. Nationwide total neurosurgical bed capacity and intensive care unit bed capacity increased modestly over the time period. The extrapolated total number of neurosurgical operations increased from 196,341 to 319,295. Although cranial and spinal neurosurgery remain the dominant subspecialties, the number of functional neurosurgical procedures and operations for pain increased more than proportionally. Outpatient procedures were established during the time period and corresponded in 2008 to a substantial proportion of the surgical volume. The total number of residents and board-certified neurosurgeons increased during the period 1997-2008 from 1513 to 1961. The proportion of residents decreased during 1997-2003 and then increased again. The number of neurosurgical operations increased in Germany proportionally to the economic growth of other service branches over the time period. Private organizations developed more than neurosurgical departments at university and other general hospitals. Work density measured as operations per physician increased during the period 1997-2008. Copyright © 2012 Elsevier Inc. All rights reserved.

Qualitative Analysis of Integration Adapter Modeling

OpenAIRE

Ritter, Daniel; Holzleitner, Manuel

2015-01-01

Integration Adapters are a fundamental part of an integration system, since they provide (business) applications access to its messaging channel. However, their modeling and configuration remain under-represented. In previous work, the integration control and data flow syntax and semantics have been expressed in the Business Process Model and Notation (BPMN) as a semantic model for message-based integration, while adapter and the related quality of service modeling were left for further studi...

Resident away rotations allow adaptive neurosurgical training.

Science.gov (United States)

Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

2015-04-01

Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

Clinical characteristics of post-neurosurgical Klebsiella pneumoniae meningitis in adults and a clinical comparison to the spontaneous form in a Taiwanese population.

Science.gov (United States)

Chang, Wen-Neng; Lu, Chen-Hsien; Huang, Chi-Ren; Chuang, Yao-Chung; Tsai, Nai-Wen; Chang, Chiung-Chih; Chen, Shu-Fang; Wang, Hung-Chen; Yang, Tzu-Ming; Hsieh, Mei-Jen; Chien, Chun-Chih

2010-03-01

A total of 46 patients (nine post-neurosurgical, 37 spontaneous) with adult bacterial meningitis (ABM) caused by Klebsiellapneumoniae infection were included in this study. The nine patients in the post-neurosurgical K. pneumoniae ABM group (seven male, two female) had a mean age of 48.9 years. Two patients in this group also had diabetes mellitus (DM) and one had liver disease. The most common presentation of patients in post-neurosurgical K. pneumoniae ABM group was fever (nine patients), followed by altered consciousness (seven patients) and hydrocephalus (six patients). With medical and/or surgical treatment, a mortality of 22.2% (2/9) occurred. Compared to patients who had spontaneous K. pneumoniae ABM, those with the post-neurosurgical form had a lower incidence of community-acquired infection, seizure and DM, but had a higher incidence of leukocytosis, hydrocephalus, cerebrospinal fluid leak and bacterial strains with extended-spectrum beta-lactamase. Univariate analysis found these clinical differences to be statistically significant, however they were not significant on multivariate analysis. This study reveals that there are clinical differences between the post-neurosurgical and spontaneous presentations of K. pneumoniae ABM. Copyright 2009 Elsevier Ltd. All rights reserved.

Integration of an Evidence Base into a Probabilistic Risk Assessment Model. The Integrated Medical Model Database: An Organized Evidence Base for Assessing In-Flight Crew Health Risk and System Design

Science.gov (United States)

Saile, Lynn; Lopez, Vilma; Bickham, Grandin; FreiredeCarvalho, Mary; Kerstman, Eric; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.

Knowledge-based immunosuppressive therapy for kidney transplant patients--from theoretical model to clinical integration.

Science.gov (United States)

Seeling, Walter; Plischke, Max; de Bruin, Jeroen S; Schuh, Christian

2015-01-01

Immunosuppressive therapy is a risky necessity after a patient received a kidney transplant. To reduce risks, a knowledge-based system was developed that determines the right dosage of the immunosuppresive agent Tacrolimus. A theoretical model, to classify medication blood levels as well as medication adaptions, was created using data from almost 500 patients, and over 13.000 examinations. This model was then translated into an Arden Syntax knowledge base, and integrated directly into the hospital information system of the Vienna General Hospital. In this paper we give an overview of the construction and integration of such a system.

Advanced approach for intraoperative MRI guidance and potential benefit for neurosurgical applications.

Science.gov (United States)

Busse, Harald; Schmitgen, Arno; Trantakis, Christos; Schober, Ralf; Kahn, Thomas; Moche, Michael

2006-07-01

To present an advanced approach for intraoperative image guidance in an open 0.5 T MRI and to evaluate its effectiveness for neurosurgical interventions by comparison with a dynamic scan-guided localization technique. The built-in scan guidance mode relied on successive interactive MRI scans. The additional advanced mode provided real-time navigation based on reformatted high-quality, intraoperatively acquired MR reference data, allowed multimodal image fusion, and used the successive scans of the built-in mode for quick verification of the position only. Analysis involved tumor resections and biopsies in either scan guidance (N = 36) or advanced mode (N = 59) by the same three neurosurgeons. Technical, surgical, and workflow aspects were compared. The image quality and hand-eye coordination of the advanced approach were improved. While the average extent of resection, neurologic outcome after functional MRI (fMRI) integration, and diagnostic yield appeared to be slightly better under advanced guidance, particularly for the main surgeon, statistical analysis revealed no significant differences. Resection times were comparable, while biopsies took around 30 minutes longer. The presented approach is safe and provides more detailed images and higher navigation speed at the expense of actuality. The surgical outcome achieved with advanced guidance is (at least) as good as that obtained with dynamic scan guidance. (c) 2006 Wiley-Liss, Inc.

First Steps Towards AN Integrated Citygml-Based 3d Model of Vienna

Science.gov (United States)

Agugiaro, G.

2016-06-01

This paper presents and discusses the results regarding the initial steps (selection, analysis, preparation and eventual integration of a number of datasets) for the creation of an integrated, semantic, three-dimensional, and CityGML-based virtual model of the city of Vienna. CityGML is an international standard conceived specifically as information and data model for semantic city models at urban and territorial scale. It is being adopted by more and more cities all over the world. The work described in this paper is embedded within the European Marie-Curie ITN project "Ci-nergy, Smart cities with sustainable energy systems", which aims, among the rest, at developing urban decision making and operational optimisation software tools to minimise non-renewable energy use in cities. Given the scope and scale of the project, it is therefore vital to set up a common, unique and spatio-semantically coherent urban model to be used as information hub for all applications being developed. This paper reports about the experiences done so far, it describes the test area and the available data sources, it shows and exemplifies the data integration issues, the strategies developed to solve them in order to obtain the integrated 3D city model. The first results as well as some comments about their quality and limitations are presented, together with the discussion regarding the next steps and some planned improvements.

Neurosurgical conditions and procedures in infancy are associated with mortality and academic performances in adolescence

DEFF Research Database (Denmark)

Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen W

2015-01-01

at assessing the impact of specific neurosurgical conditions and procedures in infancy on mortality and academic achievements in adolescence. METHODS: A nationwide unselected register-based follow-up study of the Danish birth cohorts 1986-1990 compared academic performances of all children having undergone.......00001, P = 0.000077, and P = 0.000064). CONCLUSION: Neurosurgery in infancy was associated with high mortality and significantly impaired academic achievements in adolescence. When studying anesthesia-related neurotoxicity and the developing brain, focus on specific surgeries/conditions is important...

Environmental and Clinical Risk Factors for Delirium in a Neurosurgical Center: A Prospective Study.

Science.gov (United States)

Matano, Fumihiro; Mizunari, Takayuki; Yamada, Keiko; Kobayashi, Shiro; Murai, Yasuo; Morita, Akio

2017-07-01

Few reports of delirium-related risk factors have focused on environmental risk factors and clinical risk factors, such as white matter signal abnormalities on magnetic resonance imaging fluid attenuated inversion recovery images. We prospectively enrolled 253 patients admitted to our neurosurgical center between December 2014 and June 2015 and analyzed 220 patients (100 male patients; mean age, 64.1 years; age range, 17-92 years). An Intensive Care Delirium Screening Checklist score ≥4 points indicated delirium. We evaluated patient factors consisting of baseline characteristics and related factors, such as white matter lesions (WMLs), as well as the surrounding environment. Delirium occurred in 29/220 cases (13.2%). Regarding baseline characteristics, there were significant statistical correlations between delirium and age (P = 0.0187), Hasegawa Dementia Scale-Revised score (P = 0.0022) on admission, and WMLs (P delirium and stay in a neurosurgical care unit (P = 0.0245). Multivariate logistic regression analyses showed statistically significant correlations of delirium with WMLs (P delirium (P = 0.026). WMLs in patients and the surrounding environment are risk factors for delirium in a neurosurgical center. To prevent delirium, clinicians must recognize risk factors, such as high-grade WMLs, and manage environmental factors. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating functional MRI procedures for assessing hemispheric language dominance in neurosurgical patients

Energy Technology Data Exchange (ETDEWEB)

Baciu, M.V. [Pierre Mendes-France University, Laboratory of Psychology and Neurocognition, Grenoble (France); Watson, J.M.; Maccotta, L.; McDermott, K.B. [Washington University, Department of Psychology, St. Louis (United States); Buckner, R.L. [Washington University, Department of Psychology, St. Louis (United States); Howard Hughes Medical Institute, Washington University, St. Louis (United States); Gilliam, F.G. [Washington University School of Medicine, Department of Neurology, St. Louis (United States); Ojemann, J.G. [Washington University School of Medicine, Department of Neurological Surgery, St. Louis (United States)

2005-11-01

Two methods of quantifying hemispheric language dominance (HLD) in neurosurgical patients are compared: (1) an average magnitudes (AM) method, which is a calculation of the average signal intensity variation in regions of interest for each patient that were predefined in a group analysis for each task, and (2) a lateralization indices (LI) method, which is based on the number of activated pixels in regions of interest predefined in each individual patient. Four language tasks [a living/nonliving (LNL) judgment, word stem completion (WSC), semantic associate (SA) and a phonological associate (PA) task] were compared with ''gold standard'' measures such as the Wada test or electrocortical stimulation. Results showed that the LI method was more accurate (73% agreement with gold standard methods) than the AM method (only 40% agreement) across tasks and subjects. Furthermore, by varying the threshold used for determining laterality, the ability of functional magnetic resonance imaging (fMRI) to predict HLD was influenced for the AM method, whereas the LI method was relatively unaffected by changing the threshold. Using the LI method, the SA task was the most accurate for quantifying HLD (100% agreement with gold standard methods) with respect to the other three language tasks (80% accuracy for WSC, 65% for the LNL and 63% for phonological task). Depending on the method and the task, fMRI may be a promising tool for assessing HLD in neurosurgical patients. (orig.)

Evaluating functional MRI procedures for assessing hemispheric language dominance in neurosurgical patients

International Nuclear Information System (INIS)

Baciu, M.V.; Watson, J.M.; Maccotta, L.; McDermott, K.B.; Buckner, R.L.; Gilliam, F.G.; Ojemann, J.G.

2005-01-01

Two methods of quantifying hemispheric language dominance (HLD) in neurosurgical patients are compared: (1) an average magnitudes (AM) method, which is a calculation of the average signal intensity variation in regions of interest for each patient that were predefined in a group analysis for each task, and (2) a lateralization indices (LI) method, which is based on the number of activated pixels in regions of interest predefined in each individual patient. Four language tasks [a living/nonliving (LNL) judgment, word stem completion (WSC), semantic associate (SA) and a phonological associate (PA) task] were compared with ''gold standard'' measures such as the Wada test or electrocortical stimulation. Results showed that the LI method was more accurate (73% agreement with gold standard methods) than the AM method (only 40% agreement) across tasks and subjects. Furthermore, by varying the threshold used for determining laterality, the ability of functional magnetic resonance imaging (fMRI) to predict HLD was influenced for the AM method, whereas the LI method was relatively unaffected by changing the threshold. Using the LI method, the SA task was the most accurate for quantifying HLD (100% agreement with gold standard methods) with respect to the other three language tasks (80% accuracy for WSC, 65% for the LNL and 63% for phonological task). Depending on the method and the task, fMRI may be a promising tool for assessing HLD in neurosurgical patients. (orig.)

Survey of biomedical and environental data bases, models, and integrated computer systems at Argonne National Laboratory

International Nuclear Information System (INIS)

Murarka, I.P.; Bodeau, D.J.; Scott, J.M.; Huebner, R.H.

1978-08-01

This document contains an inventory (index) of information resources pertaining to biomedical and environmental projects at Argonne National Laboratory--the information resources include a data base, model, or integrated computer system. Entries are categorized as models, numeric data bases, bibliographic data bases, or integrated hardware/software systems. Descriptions of the Information Coordination Focal Point (ICFP) program, the system for compiling this inventory, and the plans for continuing and expanding it are given, and suggestions for utilizing the services of the ICFP are outlined

Survey of biomedical and environental data bases, models, and integrated computer systems at Argonne National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Murarka, I.P.; Bodeau, D.J.; Scott, J.M.; Huebner, R.H.

1978-08-01

This document contains an inventory (index) of information resources pertaining to biomedical and environmental projects at Argonne National Laboratory--the information resources include a data base, model, or integrated computer system. Entries are categorized as models, numeric data bases, bibliographic data bases, or integrated hardware/software systems. Descriptions of the Information Coordination Focal Point (ICFP) program, the system for compiling this inventory, and the plans for continuing and expanding it are given, and suggestions for utilizing the services of the ICFP are outlined.

Neurosurgical targets for compulsivity: what can we learn from acquired brain lesions?

NARCIS (Netherlands)

Figee, Martijn; Wielaard, Ilse; Mazaheri, Ali; Denys, Damiaan

2013-01-01

Treatment efficacy of deep brain stimulation (DBS) and other neurosurgical techniques in refractory obsessive-compulsive disorder (OCD) is greatly dependent on the targeting of relevant brain regions. Over the years, several case reports have been published on either the emergence or resolution of

Accelerating progress on the road to safer sports: based on remarks of NFL Commissioner Roger Goodell in the Neurosurgical Society of America (NSA) medal lecture.

Science.gov (United States)

Goodell, Roger; Batjer, H Hunt; Ellenbogen, Richard G

2014-10-01

Roger Goodell was invited by the Neurosurgical Society of America (NSA) to give the keynote speech as the NSA Medalist 2013. As President of the NSA, and Co-Chairs of the National Football league's Head Neck and Spine Committee, we provided the introduction for Goodell. He was cited for his tireless advocacy on behalf of professional and student athletes. We noted that the National Football League has been a world leader in funding traumatic brain injury research and a catalyst for safety in youth and professional sports. Mr Goodell's national leadership in thinking and acting boldly on the subject of traumatic brain injury prevention and treatment was the primary motivation for awarding him the NSA medal. What follows is a transcript of his NSA Medal Lecture to the Neurosurgical Society of America.

Integrating 3D geological information with a national physically-based hydrological modelling system

Science.gov (United States)

Lewis, Elizabeth; Parkin, Geoff; Kessler, Holger; Whiteman, Mark

2016-04-01

Robust numerical models are an essential tool for informing flood and water management and policy around the world. Physically-based hydrological models have traditionally not been used for such applications due to prohibitively large data, time and computational resource requirements. Given recent advances in computing power and data availability, a robust, physically-based hydrological modelling system for Great Britain using the SHETRAN model and national datasets has been created. Such a model has several advantages over less complex systems. Firstly, compared with conceptual models, a national physically-based model is more readily applicable to ungauged catchments, in which hydrological predictions are also required. Secondly, the results of a physically-based system may be more robust under changing conditions such as climate and land cover, as physical processes and relationships are explicitly accounted for. Finally, a fully integrated surface and subsurface model such as SHETRAN offers a wider range of applications compared with simpler schemes, such as assessments of groundwater resources, sediment and nutrient transport and flooding from multiple sources. As such, SHETRAN provides a robust means of simulating numerous terrestrial system processes which will add physical realism when coupled to the JULES land surface model. 306 catchments spanning Great Britain have been modelled using this system. The standard configuration of this system performs satisfactorily (NSE > 0.5) for 72% of catchments and well (NSE > 0.7) for 48%. Many of the remaining 28% of catchments that performed relatively poorly (NSE land cover change studies and integrated assessments of groundwater and surface water resources.

Neuro-critical care: a valuable placement during foundation and early neurosurgical training.

Science.gov (United States)

Dyson, Edward W; Kolias, Angelos G; Burnstein, Rowan M; Hutchinson, Peter J A; Garnett, Matthew R; Menon, David K; Trivedi, Rikin A

2014-10-01

Neurosciences critical care units (NCCUs) present a unique opportunity to junior trainees in neurosurgery as well as foundation trainees looking to gain experience in the management of critically ill patients with neurological conditions. Placements in NCCUs are undertaken in the early years of neurosurgical training or during neurosciences themed foundation programmes. We sought to quantify the educational benefits of such placements from the trainee perspective. Thirty-two trainees who had undertaken placements at Foundation Year 2 (FY2) to Specialty Trainee Year 3 (ST3) level between August 2009 and April 2013 were invited to take part in an online questionnaire survey. Competence in individual skills was self-rated on a ranked scale from one (never observed) to five (performed unsupervised) both before and after the placement. Trainees were also asked a series of questions pertaining to their ability to manage common neurosurgical conditions, as well as the perceived educational rigour of their placement. Twenty-three responses were received. Eighteen responses were from FY2s and seven were from ST1-3 level trainees. Following their placements, 100% of respondents felt better equipped to deal with neurosurgical and neurological emergencies and cranial trauma. Most felt better equipped to manage hydrocephalus (95.7%), polytrauma patients (95.7%), spontaneous intracranial haemorrhage (91.3%) and spinal trauma (82.6%). Significant increases were seen in experience in all practical skills assessed. These included central venous catheterisation (p training programme as well as in the Foundation Programme. This supports the incorporation of a four- to six-month NCCU rotation in early years training as educationally valuable.

Pilot Use of a Novel Tool to Assess Neurosurgical Capacity in Uganda.

Science.gov (United States)

Ploss, Brittany; Abdelgadir, Jihad; Smith, Emily R; Fuller, Anthony; Nickenig Vissoci, Joao Ricardo; Muhindo, Alex; Galukande, Moses; Haglund, Michael M

2017-12-01

There is a significant burden of unmet surgical need in many low- and middle-income countries (>80% in parts of Africa). This need is even larger for specialties such as neurosurgery. Surgical capacity tools have been developed and used to assess needs and plan for resource allocation. This study piloted a new tool to assess neurosurgical capacity and describes its use. A surgical capacity tool was adapted to assess neurosurgical capacity. An expert panel of neurosurgeons and researchers reviewed the Surgeons OverSeas PIPES (personnel, infrastructure, procedures, equipment, and supplies) assessment and added additional items essential to perform common neurosurgery procedures. This tool was then piloted at 3 public hospitals in Uganda and each hospital was given a score of neurosurgical capacity. At 1 hospital, 3 respondents were asked to answer the survey to assess reliability. The hospital with the largest neurosurgery caseload and 5 neurosurgeons scored the highest on our survey, followed by a regional hospital with 1 practicing neurosurgeon. The third hospital, without a neurosurgeon, scored the lowest on the scale. At the hospital that completed the reliability assessment, scores were varied between respondents. NeuroPIPES survey scores were in keeping with the number of neurosurgeons and respective caseloads of each hospital. However, the variation in scores between respondents at the same hospital suggests that adaptations could be made to the tool that may improve reliability and validity. The methodology used to create NeuroPIPES may be successfully applied to a variety of other surgical subspecialties for similar assessments. Copyright © 2017 Elsevier Inc. All rights reserved.

Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

Science.gov (United States)

Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

2010-01-01

This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

Lotus Base: An integrated information portal for the model legume Lotus japonicus.

Science.gov (United States)

Mun, Terry; Bachmann, Asger; Gupta, Vikas; Stougaard, Jens; Andersen, Stig U

2016-12-23

Lotus japonicus is a well-characterized model legume widely used in the study of plant-microbe interactions. However, datasets from various Lotus studies are poorly integrated and lack interoperability. We recognize the need for a comprehensive repository that allows comprehensive and dynamic exploration of Lotus genomic and transcriptomic data. Equally important are user-friendly in-browser tools designed for data visualization and interpretation. Here, we present Lotus Base, which opens to the research community a large, established LORE1 insertion mutant population containing an excess of 120,000 lines, and serves the end-user tightly integrated data from Lotus, such as the reference genome, annotated proteins, and expression profiling data. We report the integration of expression data from the L. japonicus gene expression atlas project, and the development of tools to cluster and export such data, allowing users to construct, visualize, and annotate co-expression gene networks. Lotus Base takes advantage of modern advances in browser technology to deliver powerful data interpretation for biologists. Its modular construction and publicly available application programming interface enable developers to tap into the wealth of integrated Lotus data. Lotus Base is freely accessible at: https://lotus.au.dk.

Integrating statistical and process-based models to produce probabilistic landslide hazard at regional scale

Science.gov (United States)

Strauch, R. L.; Istanbulluoglu, E.

2017-12-01

We develop a landslide hazard modeling approach that integrates a data-driven statistical model and a probabilistic process-based shallow landslide model for mapping probability of landslide initiation, transport, and deposition at regional scales. The empirical model integrates the influence of seven site attribute (SA) classes: elevation, slope, curvature, aspect, land use-land cover, lithology, and topographic wetness index, on over 1,600 observed landslides using a frequency ratio (FR) approach. A susceptibility index is calculated by adding FRs for each SA on a grid-cell basis. Using landslide observations we relate susceptibility index to an empirically-derived probability of landslide impact. This probability is combined with results from a physically-based model to produce an integrated probabilistic map. Slope was key in landslide initiation while deposition was linked to lithology and elevation. Vegetation transition from forest to alpine vegetation and barren land cover with lower root cohesion leads to higher frequency of initiation. Aspect effects are likely linked to differences in root cohesion and moisture controlled by solar insulation and snow. We demonstrate the model in the North Cascades of Washington, USA and identify locations of high and low probability of landslide impacts that can be used by land managers in their design, planning, and maintenance.

Shadow of Buddhism and Shintoism in neurosurgical practice in Japan.

Science.gov (United States)

Ohta, T

2006-01-01

In Japan, almost all culture and civilization were introduced from abroad; in the past from China and now from U.S. and European countries, owing to her geographical features circumscribed by oceans and separated from the continents. Neurosurgical science and practice have been received in the same way as other activities. However, there are some exceptions such as organ transplantation from the brain dead and brain-dock, which means a brain check-up system of asymptomatic brain diseases. Reasons why these are practised or not in Japan are considered from the viewpoint of Buddhism and Shintoism. If our special practises could appeal to people in other countries, our neurosurgical philosophy might become widespread and welcome worldwide. Organ transplantations from brain dead have routinely been performed in many countries, while only 37 cases have been executed in Japan, after the Japanese government accepted its application in 1997. In contrast, brain-dock is widely practised without any national insurance systems, while this is rarely practised in other countries. It seems to me that Buddhism and Shintoism have influenced on these special situations, due to extreme fear and impurity of the dead body and a way of comprehending the oneness of body and mind, and also deep concern for the impact of their diseases to their families rather than for themselves. We neurosurgeons should realize that our profession is directly related to ultimate human sufferings such as aging, disease, and death, as pointed out by Gautama Buddha. We are in fact in a position to study the real way for resolution of the human sufferings, mentally and physically. Based on our experiences, the foundation of a new academic discipline like "cultural medical science" should urgently be considered in all parts of the world and in light of individual cultural, economical, geographical, and population problems.

Computational Modeling for Enhancing Soft Tissue Image Guided Surgery: An Application in Neurosurgery.

Science.gov (United States)

Miga, Michael I

2016-01-01

With the recent advances in computing, the opportunities to translate computational models to more integrated roles in patient treatment are expanding at an exciting rate. One area of considerable development has been directed towards correcting soft tissue deformation within image guided neurosurgery applications. This review captures the efforts that have been undertaken towards enhancing neuronavigation by the integration of soft tissue biomechanical models, imaging and sensing technologies, and algorithmic developments. In addition, the review speaks to the evolving role of modeling frameworks within surgery and concludes with some future directions beyond neurosurgical applications.

Risk of cataract among medical staff in neurosurgical department occupationally exposed to radiation

International Nuclear Information System (INIS)

Stankova-Mileva, I.; Vassileva, J.; Djounova, J.

2012-01-01

In this study we present the risk of cataract among medical staff in neurosurgical department occupationally exposed to radiation compared to those of non-radiation workers. Cataract is the most common degenerative opacity of the crystalline lens developing with aging. Other risk factors for cataract are: infrared and ultraviolet radiation, systemic diseases (diabetes, hypertonic disease), eye diseases (glaucoma, high myopia), drugs (steroids), etc. High risk of developing cataract we find among staff occupationally exposed to radiation during operations - interventional cardiologists and neurosurgeons. This study includes 30 people between 33 and 60 years of age working in neurosurgical department and control group (the same amount and age of people not exposed to radiation in their work). After visual acuity measurement, the lens was examined by retroillumination method (red reflex) and using a bio microscope. The patients were asked for presence of ocular and systemic diseases, eye trauma, drug, alcohol and tobacco abuse and for how many years they work in this department. There was one case with cataract among neurosurgeons. The doctor doesn't have eye or systemic diseases, doesn't take any drugs and is not alcohol or tobacco abuser. In the control group there were two persons with subcapsular cataract but they have diabetes. Radiation is one of the risk factors for cataract. Continuing of this epidemiological survey will provide further knowledge on the potential risk of occupational radiation-induced cataract among neurosurgical staff and will contribute for optimization of radiation protection. (authors)

Image fusion of MRI and fMRI with intraoperative MRI data: methods and clinical relevance for neurosurgical interventions; Fusion von MRT-, fMRT- und intraoperativen MRT-Daten. Methode und klinische Bedeutung am Beispiel neurochirurgischer Interventionen

Energy Technology Data Exchange (ETDEWEB)

Moche, M.; Busse, H.; Dannenberg, C.; Schulz, T.; Schmidt, F.; Kahn, T. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie; Schmitgen, A. [GMD Forschungszentrum Informationstechnik GmbH-FIT, Sankt Augustin (Germany); Trantakis, C.; Winkler, D. [Klinik und Poliklinik fuer Neurochirurgie, Universitaetsklinikum Leipzig (Germany)

2001-11-01

The aim of this work was to realize and clinically evaluate an image fusion platform for the integration of preoperative MRI and fMRI data into the intraoperative images of an interventional MRI system with a focus on neurosurgical procedures. A vertically open 0.5 T MRI scanner was equipped with a dedicated navigation system enabling the registration of additional imaging modalities (MRI, fMRI, CT) with the intraoperatively acquired data sets. These merged image data served as the basis for interventional planning and multimodal navigation. So far, the system has been used in 70 neurosurgical interventions (13 of which involved image data fusion - requiring 15 minutes extra time). The augmented navigation system is characterized by a higher frame rate and a higher image quality as compared to the system-integrated navigation based on continuously acquired (near) real time images. Patient movement and tissue shifts can be immediately detected by monitoring the morphological differences between both navigation scenes. The multimodal image fusion allowed a refined navigation planning especially for the resection of deeply seated brain lesions or pathologies close to eloquent areas. Augmented intraoperative orientation and instrument guidance improve the safety and accuracy of neurosurgical interventions. (orig.) [German] Ziel dieser Arbeit waren die Realisierung und klinische Bewertung einer Bildfusion praeoperativer MRT- und fMRT-Bilder mit intraoperativen Datensaetzen eines interventionellen MRT-Systems am Beispiel neurochirurgischer Eingriffe. Ein vertikal offenes 0,5-T-MRT-System wurde mit einem erweiterten Navigationssystem ausgestattet, welches eine Integration zusaetzlicher Bildinformationen (Hochfeld-MRT, fMRT, CT) in die intraoperativ akquirierten Datensaetze erlaubt. Diese fusionierten Bilddaten wurden zur Interventionsplanung und multimodalen Navigation verwendet. Bisher wurde das System bei insgesamt 70 neurochirurgischen Eingriffen eingesetzt, davon 13

Tensor Product Model Transformation Based Adaptive Integral-Sliding Mode Controller: Equivalent Control Method

Directory of Open Access Journals (Sweden)

Guoliang Zhao

2013-01-01

Full Text Available This paper proposes new methodologies for the design of adaptive integral-sliding mode control. A tensor product model transformation based adaptive integral-sliding mode control law with respect to uncertainties and perturbations is studied, while upper bounds on the perturbations and uncertainties are assumed to be unknown. The advantage of proposed controllers consists in having a dynamical adaptive control gain to establish a sliding mode right at the beginning of the process. Gain dynamics ensure a reasonable adaptive gain with respect to the uncertainties. Finally, efficacy of the proposed controller is verified by simulations on an uncertain nonlinear system model.

Long-term outcome of neurosurgical untethering on neurosegmental motor and ambulation levels

NARCIS (Netherlands)

Schoenmakers, M. A. G. C.; Gooskens, R. H. J. M.; Gulmans, V. A. M.; Hanlo, P. W.; Vandertop, W. P.; Uiterwaal, C. S. P. M.; Helders, P. J. M.

2003-01-01

The aim of this study was to determine the long-term outcome of neurosurgical untethering on neurosegmental motor level and ambulation level in children with tethered spinal cord syndrome. Forty-four children were operated on (17 males, 27 females; mean age at operation 6 years 2 months, SD 5

Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit

Directory of Open Access Journals (Sweden)

Manish Singh Sharma

2012-01-01

Full Text Available Objectives: The routine use of prophylactic antibiotics in neurosurgery has been shown to significantly reduce surgical site infection rates. The documentation of non-surgical site, nosocomial infections in neurosurgical patients remains limited, despite this being a stimulus for prolific antibiotic usage. The actual quantum of antibiotic use in neurosurgery and its role in infection control remain both undocumented and controversial. The authors address this issue with a cost-effectiveness study using historical controls. Materials and Methods: Bacteriologically positive body fluid samples were used to quantify infection rates in the year 2006 and compared with those in the year 1997. Itemized drug lists obtained from dedicated neurosurgical intensive care units and wards were used to quantify antibiotic usage and calculate their costs. Results were compared using both historical and internal controls. The monetary conversion factor used was INR 40=US$1. Results: A total of 3114 consecutive elective and emergency neurosurgical procedures were performed during the study period. 329 patients (10.6% were recorded to have bacteriologically positive body fluid samples, and 100,250 units of antibiotics were consumed costing Rs. 14,378,227.5 ($359,455.7. On an average, an operated patient received 32.2 units of antibiotics valued at Rs. 4,617 ($115.4. The crude infection rates were recorded to have reduced significantly in comparison to 1997, but did not differ between mirror intra-departmental units with significantly different antibiotic usage. Conclusions: Antibiotics accounted for 31% of the per capita cost of consumables for performing a craniotomy in the year 2006. This estimate should be factored into projecting future package costs.

Risk-to-Benefit Ratio of Venous Thromboembolism Prophylaxis for Neurosurgical Procedures at a Quaternary Referral Center.

Science.gov (United States)

Agarwal, Nitin; Zenonos, Georgios A; Agarwal, Prateek; Walch, Frank J; Roach, Eileen; Stokes, Sandra J; Friedlander, Robert M; Gerszten, Peter C

2018-03-09

Pharmacological prophylaxis for venous thromboembolism (VTE) in the neurosurgical population is still a matter of debate, as the risk-to-benefit ratio is not well defined. To further evaluate the risk-to-benefit ratio of VTE prophylaxis (VTEP) for all neurosurgical procedures. A prospective evaluation was performed after the initiation of a VTEP protocol for 11 436 patients undergoing neurosurgical procedures over 24 mo. Unless a bleeding complication was present, 5000 international units of subcutaneous heparin every 8 h was ordered on postoperative day (POD) 1 for spine, POD2 for cranial, and by POD4 for subdural, intracerebral, and epidural hematoma cases. Incidence of VTE and any subsequent bleeding complications were noted. A total of 70 VTEs (0.6% overall) were documented (28 deep vein thrombosis, 42 pulmonary embnolism). The highest rates of VTE were associated with deformity (6.7%); open cerebrovascular (6.5%); subdural, intracerebral, and epidural hematoma (3.2%); spinal trauma (2.4%); and craniotomy for tumor (1.6%) cases. Seven cases of deep vein thrombosis progressed to pulmonary embolisms, and 66 of 70 VTEs occurred while on pharmacological VTEP. Fifty-four bleeding complications occurred on or after POD2 following initiation of VTEP. These bleeding complications consisted of any new clinically or radiographically observed hemorrhages. Twenty-eight of the 54 delayed bleeding complications required operative intervention with 1 mortality. Forty-five patients were on anticoagulation when the initial bleeding event occurred. Overall, an estimated 0.5% incidence of delayed bleeding complications was noted with 99.4% of patients within the study cohort remaining VTE free. This VTEP protocol was determined to afford a good risk-to-benefit ratio for a wide variety of neurosurgical procedures.

Evaluating the effect of human activity patterns on air pollution exposure using an integrated field-based and agent-based modelling framework

Science.gov (United States)

Schmitz, Oliver; Beelen, Rob M. J.; de Bakker, Merijn P.; Karssenberg, Derek

2015-04-01

Constructing spatio-temporal numerical models to support risk assessment, such as assessing the exposure of humans to air pollution, often requires the integration of field-based and agent-based modelling approaches. Continuous environmental variables such as air pollution are best represented using the field-based approach which considers phenomena as continuous fields having attribute values at all locations. When calculating human exposure to such pollutants it is, however, preferable to consider the population as a set of individuals each with a particular activity pattern. This would allow to account for the spatio-temporal variation in a pollutant along the space-time paths travelled by individuals, determined, for example, by home and work locations, road network, and travel times. Modelling this activity pattern requires an agent-based or individual based modelling approach. In general, field- and agent-based models are constructed with the help of separate software tools, while both approaches should play together in an interacting way and preferably should be combined into one modelling framework, which would allow for efficient and effective implementation of models by domain specialists. To overcome this lack in integrated modelling frameworks, we aim at the development of concepts and software for an integrated field-based and agent-based modelling framework. Concepts merging field- and agent-based modelling were implemented by extending PCRaster (http://www.pcraster.eu), a field-based modelling library implemented in C++, with components for 1) representation of discrete, mobile, agents, 2) spatial networks and algorithms by integrating the NetworkX library (http://networkx.github.io), allowing therefore to calculate e.g. shortest routes or total transport costs between locations, and 3) functions for field-network interactions, allowing to assign field-based attribute values to networks (i.e. as edge weights), such as aggregated or averaged

An architecture for integration of multidisciplinary models

DEFF Research Database (Denmark)

Belete, Getachew F.; Voinov, Alexey; Holst, Niels

2014-01-01

Integrating multidisciplinary models requires linking models: that may operate at different temporal and spatial scales; developed using different methodologies, tools and techniques; different levels of complexity; calibrated for different ranges of inputs and outputs, etc. On the other hand......, Enterprise Application Integration, and Integration Design Patterns. We developed an architecture of a multidisciplinary model integration framework that brings these three aspects of integration together. Service-oriented-based platform independent architecture that enables to establish loosely coupled...

GOLD: Integration of model-based control systems with artificial intelligence and workstations

International Nuclear Information System (INIS)

Lee, M.; Clearwater, S.

1987-08-01

Our experience with model-based accelerator control started at SPEAR. Since that time nearly all accelerator beamlines have been controlled using model-based application programs, for example, PEP and SLC at SLAC. In order to take advantage of state-of-the-art hardware and software technology, the design and implementation of the accelerator control programs have undergone radical changes with time. Consequently, SPEAR, PEP and SLC all use different control programs. Since many of these application programs are embedded deep into the control system, they had to be rewritten each time. Each time this rewriting has occurred a great deal of time and effort has been spent on training physicists and programmers to do the job. Now, we have developed an integrated system called GOLD (Genetic Orbit and Lattice Debugger) for debugging and correcting trajectory errors in accelerator lattices. The system consists of a lattice modeling program (COMFORT), a beam simulator (PLUS), a graphical workstation environment (micro-VAX) and an expert system (ABLE). This paper will describe some of the features and applications of our integrated system with emphasis on the automation offered by expert systems. 5 refs

[Dynamics of lagophthalmos depending on facial nerve repair and its intraoperative monitoring in neurosurgical patients].

Science.gov (United States)

Tabachnikova, T V; Serova, N K; Shimansky, V N

2014-01-01

Over 200 patients with acoustic neuromas and over 100 patients with posterior cranial fossa meningiomas are annually operated on at the N.N. Burdenko Neurosurgical Institute. Intraoperative monitoring of the facial nerve function is used in most patients with tumors of the posterior cranial fossa to identify the facial nerve in the surgical wound. If the anatomical integrity of the facial nerve in the cranial cavity cannot be retained, facial nerve repair is performed to restore the facial muscle function. Intraoperative electrical stimulation of the facial nerve has a great prognostic significance to evaluate the dynamics of lagophthalmos in the late postoperative period and to select the proper method for lagophthalmos correction. When the facial nerve was reinnervated by the descending branch or trunk of the hypoglossal nerve, sufficient eyelid closure was observed only in 3 patients out of 17.

[Brain injury knowledge in family members of neurosurgical patients].

Science.gov (United States)

Navarro-Main, Blanca; Castaño-León, Ana M; Munarriz, Pablo M; Gómez, Pedro A; Rios-Lago, Marcos; Lagares, Alfonso

Several studies have shown misconceptions about brain injury in different populations. The aim of this study was to assess the knowledge and perceptions about brain injury of family members of neurosurgical patients in our hospital. The participants (n=81) were relatives of patients admitted to the neurosurgery department between February and August 2016. They voluntarily completed a 19-item true-false format survey about brain injury based on a translation of other questionnaires used in previous studies from other countries (USA, Canada, UK, Ireland and New Zealand). Also, some sociodemographic data were collected (age, sex, education level and the patient's pathology). Data analysis was developed through graphical modelling with a regularisation parameter plotted on a network representing the association of the items of the questionnaire from the response pattern of participants. Data analysis showed two conceptual areas with a high rate of wrong answers: behaviour and management of patients, and expectations about acquired brain injury recovery. The results obtained in this study would enable us to objectify misconceptions about acquired brain injury in patients' relatives attended in the neurosurgery department. This lack of knowledge could be a great obstacle in patients' recovery process. Therefore, we suggest placing the emphasis on the provision of information on brain injury to patients' families, especially with regard to its symptoms and course of development. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Working Conditions and Lifestyle of Female Surgeons Affiliated to the Japan Neurosurgical Society: Findings of Individual and Institutional Surveys

OpenAIRE

FUJIMAKI, Takamitsu; SHIBUI, Soichiro; KATO, Yoko; MATSUMURA, Akira; YAMASAKI, Mami; DATE, Isao; HONGO, Kazuhiro; KURODA, Satoshi; MATSUMAE, Mitsunori; NAKAO, Naoyuki; SAKURADA, Kaori; SHIMOKAWA, Shoko; KAYAMA, Takamasa

2015-01-01

To investigate the working conditions of female neurosurgeons in Japan, two surveys were conducted by The Japan Neurosurgical Society: one involving female neurosurgeons themselves and the other involving the chiefs of neurosurgical departments. The responses were received from 224 (43.8%) female neurosurgeons and 496 (61.2%) departmental chiefs. About half (50.2%) of the female neurosurgeons were married and 39.2% had children (average number of children, 1.27). Their work was full-time in 8...

Management of post-neurosurgical meningitis: narrative review.

Science.gov (United States)

Hussein, K; Bitterman, R; Shofty, B; Paul, M; Neuberger, A

2017-09-01

Infections complicating neurosurgery pose unacceptable mortality and morbidity. To summarize what is known about the epidemiology, diagnosis and treatment of post-neurosurgical meningitis (PNM). PubMed, references of identified studies and reviews, and personal experience when evidence was lacking. The incidence and pathogen distribution of PNM is highly variable. A shift towards Gram-negative bacteria has been observed with use of antibiotic prophylaxis and antibiotic-coated devices directed mainly against Gram-positive bacteria. However, knowledge of the local epidemiology is necessary to treat PNM. The diagnosis of PNM is difficult because, unlike community-acquired meningitis, symptoms are less specific; patients are ill at baseline and many neurosurgical conditions mimic meningitis and cause cerebrospinal fluid (CSF) abnormalities. Pivotal CSF findings for diagnosis of PNM are the CSF glucose, CSF lactate and Gram stain. CSF leucocyte counts are not specific in PNM. Current diagnostic capabilities leave a non-negligible category of patients with microbiologically negative, uncertain diagnosis of PNM. There is no high-quality evidence on several cardinal issues in PNM management, including the effectiveness of intraventricular or intrathecal (IV/IT) antibiotics, effectiveness of dual antibiotic therapy for multidrug-resistant Gram-negative bacteria; clinical benefit of routine therapeutic drug monitoring; and safest timing of shunt replacement. Some data point to a potential benefit of IV/IT antibiotic treatment, mainly for PNM caused by carbapenem-resistant Gram-negative bacteria. Carbapenem-colistin combination therapy is suggested for PNM caused by carbapenem-resistant Gram-negative bacteria with a carbapenem MIC ≤8 mg/L. Guiding the optimal management of PNM will necessitate collaborative multicentre efforts and unique study designs. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights

Integration of model-based control systems with artificial intelligence and workstations

International Nuclear Information System (INIS)

Lee, M.; Clearwater, S.

1987-01-01

Experience with model based accelerator control started at SPEAR. Since that SPEAR. Since that time nearly all accelerator beam lines have been controlled using model-based application programs, for example, PEP and SLC at SLAC. In order to take advantage of state-of-the-art hardware and software technology, the design and implementation of the accelerator control programs have undergone radical changes with time. Consequently, SPEAR, PEP, and SLC all use different control programs. Since many of these application programs are imbedded deep into the control system, they had to be rewritten each time. Each time this rewriting has occurred a great deal of time and effort has been spent on training physicists and programmers to do the job. Now, these application programs have been developed for a fourth time. This time, however, the programs being developed are generic so that they will not have to be done again. An integrated system called GOLD (Generic Orbit ampersand Lattice Debugger) has been developed for debugging and correcting trajectory errors in accelerator lattices. The system consists of a lattice modeling program (COMFORT), a beam simulator (PLUS), a graphical workstation environment (micro-VAX) and an expert system (ABLE). This paper will describe some of the features and applications of our integrated system with emphasis on the automation offered by expert systems. 5 refs., 4 figs

Employing Model-Based Reasoning in Interdisciplinary Research Teams: Evidence-Based Practices for Integrating Knowledge Across Systems

Science.gov (United States)

Pennington, D. D.; Vincent, S.

2017-12-01

The NSF-funded project "Employing Model-Based Reasoning in Socio-Environmental Synthesis (EMBeRS)" has developed a generic model for exchanging knowledge across disciplines that is based on findings from the cognitive, learning, social, and organizational sciences addressing teamwork in complex problem solving situations. Two ten-day summer workshops for PhD students from large, NSF-funded interdisciplinary projects working on a variety of water issues were conducted in 2016 and 2017, testing the model by collecting a variety of data, including surveys, interviews, audio/video recordings, material artifacts and documents, and photographs. This presentation will introduce the EMBeRS model, the design of workshop activities based on the model, and results from surveys and interviews with the participating students. Findings suggest that this approach is very effective for developing a shared, integrated research vision across disciplines, compared with activities typically provided by most large research projects, and that students believe the skills developed in the EMBeRS workshops are unique and highly desireable.

Impact of clinical trials on neurosurgical practice: an assessment of case volume.

Science.gov (United States)

Simon, Scott D; Koyama, Tatsuki; Zacharia, Brad E; Schirmer, Clemens M; Cheng, Joseph S

2015-04-01

To evaluate the effect of important trials on the practice of neurosurgery. We hypothesized that evidence from trials addressing the management of intracranial aneurysms (International Subarachnoid Aneurysm Trial [ISAT]) and nontraumatic intracerebral hemorrhages (Surgical Trial in Intracerebral Hemorrhage [STICH]) and vertebral augmentation for osteoporotic vertebral body fractures had a significant impact on the frequency of the corresponding neurosurgical procedures. A Medicare administrative database was queried for corresponding Common Procedural Terminology codes and units billed per calendar year. The effects of ISAT and STICH were evaluated using a generalized linear model. The effect of the vertebral augmentation study was evaluated using a t test. After publication of ISAT in 2002, the rate of increase in proportion of cerebral aneurysms that were treated with embolization (Common Procedural Terminology code 61624) per year increased from 3.9% to 5.5% (P = 0.01). After publication of STICH in 2005, the number of craniotomies performed for intracerebral hematoma decreased from 2341 in 2002 to 1646 in 2011 (P = 0.03). After 2 publications in 2009, performance of vertebral augmentation decreased from a high of 99,961 in 2009 per year to 77,108 in 2013 (P = 0.002). Randomized clinical trials remain the gold standard in the medical community to demonstrate efficacy, but their true impact relies on rapid and extensive assimilation into everyday medical practice. However, the described methodology establishes a temporal relationship only and does not prove causation. Nonetheless, trends in procedural volume suggest that the results of these select randomized clinical trials had a significant effect on neurosurgical practice affecting Medicare patients within an interval of a few years. Copyright © 2015 Elsevier Inc. All rights reserved.

Integrative structure modeling with the Integrative Modeling Platform.

Science.gov (United States)

Webb, Benjamin; Viswanath, Shruthi; Bonomi, Massimiliano; Pellarin, Riccardo; Greenberg, Charles H; Saltzberg, Daniel; Sali, Andrej

2018-01-01

Building models of a biological system that are consistent with the myriad data available is one of the key challenges in biology. Modeling the structure and dynamics of macromolecular assemblies, for example, can give insights into how biological systems work, evolved, might be controlled, and even designed. Integrative structure modeling casts the building of structural models as a computational optimization problem, for which information about the assembly is encoded into a scoring function that evaluates candidate models. Here, we describe our open source software suite for integrative structure modeling, Integrative Modeling Platform (https://integrativemodeling.org), and demonstrate its use. © 2017 The Protein Society.

[Antigravity suit used for neurosurgical operations in sitting position].

Science.gov (United States)

Szpiro-Zurkowska, A; Milczarek, Z; Marchel, A; Jagielski, J

1996-01-01

The aviator's antigravity suit (G-suit) was used for 40 operations on neurosurgical patients operated on in sitting position. The G-suit was filled with air to 0.2 atmosphere (20 kPa) pressure in 26 cases, and 0.3 atm. (30 kPa) in 14 cases. In all cases G-suit filling was followed by central venous pressure rise and mean arterial pressure rise. Venous air embolism was found in 5 (12.5%) patients. No other complications connected with the use of G-suit were observed.

The Spectrum of Altmetrics in Neurosurgery: The Top 100 "Trending" Articles in Neurosurgical Journals.

Science.gov (United States)

Wang, Justin; Alotaibi, Naif M; Ibrahim, George M; Kulkarni, Abhaya V; Lozano, Andres M

2017-07-01

Social media are increasingly used for the dissemination of scientific publications by most medical journals. The role of social media in increasing awareness of published works in neurosurgery has not been previously explored. Here, we present a qualitative analysis of the highest trending works in neurosurgery along with a correlation analysis with their social media metrics. We performed a comprehensive search for neurosurgical publications using the Altmetric database. The Altmetric database provides a weighted total score of all online mentions for an article received on Facebook, Twitter, blogs, and mainstream media sources. Our search was limited to articles published within the social media era (January 2010-January 2017). Descriptive and correlational statistics were performed for all articles. The top 100 articles in altmetrics were selected for qualitative analysis. A total of 5794 articles were included in this study. The average Altmetric score in neurosurgical articles was 4.7 (standard deviation ±22.4). Journals with a social media account had significantly higher Altmetric scores for their articles compared with those without an account (P articles in altmetrics belonged primarily to the Journal of Neurosurgery (33%) followed by Neurosurgery (29%). This is the first study that details the spectrum of Altmetric scores among neurosurgical journals. Social media presence for journals is important for greater outreach and engagement. Prediction of traditional citation using altmetrics data requires a future prospective study. Copyright © 2017 Elsevier Inc. All rights reserved.

Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients

DEFF Research Database (Denmark)

Petersen, Lonnie Grove; Petersen, Johan Casper Grove; Andresen, Morten

2016-01-01

.4±4.2 mmHg when standing up (Phydrostatic pressure gradient with reference just below the heart, likely reflecting the venous hydrostatic...... indifference point. When upright, the decrease in ICP was attenuated, corresponding to formation of a separate hydrostatic gradient with reference to the base of the skull, likely reflecting the site of venous collapse. ICP therefore seems to be governed by pressure in the draining veins and collapse of neck......We evaluated postural effects on intracranial pressure (ICP) and cerebral perfusion pressure (CPP: mean arterial pressure (MAP) - ICP) in neurosurgical patients undergoing 24-hour ICP monitoring as part of their diagnostic workup. We identified 9 patients (5 women, age 44±20 yrs.; mean±SD) who were...

Patterns in neurosurgical adverse events: endovascular neurosurgery.

Science.gov (United States)

Wong, Judith M; Ziewacz, John E; Panchmatia, Jaykar R; Bader, Angela M; Pandey, Aditya S; Thompson, B Gregory; Frerichs, Kai; Gawande, Atul A

2012-11-01

As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event. Intraprocedural and periprocedural prevention and rescue regimens are advocated to minimize this risk; however, evidence on the optimal use of anticoagulant and antithrombotic agents is limited. Furthermore, it is unknown what proportion of eligible patients receive any prophylactic treatment. Groin-site hematoma is the most common access-related complication. Data from the cardiac literature indicate an overall incidence of 9% to 32%, but data specific to neuroendovascular therapy are scant. Manual compression, compression adjuncts, and closure devices are used with varying rates of success, but no standardized protocols have been tested on a broad scale. Contrast-induced nephropathy is one of the more common causes of hospital-acquired renal insufficiency, with an incidence of 30% in high-risk patients after contrast administration. Evidence from medical fields supports the use of various preventive strategies. Intraprocedural vessel rupture is infrequent, with the reported incidence ranging from 1% to 9%, but it is potentially devastating. Improvements in device technology combined with proper endovascular technique play an important role in reducing

A comparative analysis of neurosurgical online education materials to assess patient comprehension.

Science.gov (United States)

Agarwal, Nitin; Chaudhari, Amit; Hansberry, David R; Tomei, Krystal L; Prestigiacomo, Charles J

2013-10-01

Americans have increasingly utilized the internet as a first-line resource for a variety of information, including healthcare-oriented materials. Therefore, these online resources should be written at a level the average American can understand. Patient education resources specifically written for and available to the public were downloaded from the American Association of Neurological Surgeons website and assessed for their level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Grading, Coleman-Liau Index, and Gunning-Fog Index. A total of 71 subsections from different neurosurgical specialties were reviewed, including Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor material. All neurosurgical subspecialty education material provided on the American Association of Neurological Surgeons website was uniformly written at a level that was too high, as assessed by all modalities. In order to reach a larger patient population, patient education materials on the American Association of Neurological Surgeons website should be revised with the goal of simplifying readability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Neurosurgical considerations after bull goring during festivities in Spain and Latin America.

Science.gov (United States)

Spiotta, Alejandro M; Matoses, Salvador Martorell

2011-08-01

Bullfighting is a highly popular activity during festivities in Spain and Latin America. A scientific society for bullfight injuries, Congreso Internacional de Cirugía Taurina, was founded on November 24, 1974, in recognition of the distinctive pattern of injury that results from bull goring, and a subspecialty of general surgical trauma with emphasis on the acute surgical management of bull-goring injuries has emerged. Injuries to the head and neck are less frequent than genitourinary, inguinal, and abdominal injuries, but are more severe and more likely to result in death. This report reviews the primary venues in which bull goring and associated injuries occur, including the bullfight and the running of the bulls. The biomechanics of the primary and secondary goring injuries are reviewed, with an emphasis on those with the potential to result in neurosurgical injuries. This results in a very unique and devastating pattern of injury that combines penetrating and blunt mechanisms and results in polytrauma. Neurosurgical expertise should be immediately available on-site in the event of a life-threatening neurological injury.

Integration of Simulink Models with Component-based Software Models

DEFF Research Database (Denmark)

Marian, Nicolae

2008-01-01

Model based development aims to facilitate the development of embedded control systems by emphasizing the separation of the design level from the implementation level. Model based design involves the use of multiple models that represent different views of a system, having different semantics...... of abstract system descriptions. Usually, in mechatronics systems, design proceeds by iterating model construction, model analysis, and model transformation. Constructing a MATLAB/Simulink model, a plant and controller behavior is simulated using graphical blocks to represent mathematical and logical...... constraints. COMDES (Component-based Design of Software for Distributed Embedded Systems) is such a component-based system framework developed by the software engineering group of Mads Clausen Institute for Product Innovation (MCI), University of Southern Denmark. Once specified, the software model has...

Hierarchical Agent-Based Integrated Modelling Approach for Microgrids with Adoption of EVs and HRES

Directory of Open Access Journals (Sweden)

Peng Han

2014-01-01

Full Text Available The large adoption of electric vehicles (EVs, hybrid renewable energy systems (HRESs, and the increasing of the loads shall bring significant challenges to the microgrid. The methodology to model microgrid with high EVs and HRESs penetrations is the key to EVs adoption assessment and optimized HRESs deployment. However, considering the complex interactions of the microgrid containing massive EVs and HRESs, any previous single modelling approaches are insufficient. Therefore in this paper, the methodology named Hierarchical Agent-based Integrated Modelling Approach (HAIMA is proposed. With the effective integration of the agent-based modelling with other advanced modelling approaches, the proposed approach theoretically contributes to a new microgrid model hierarchically constituted by microgrid management layer, component layer, and event layer. Then the HAIMA further links the key parameters and interconnects them to achieve the interactions of the whole model. Furthermore, HAIMA practically contributes to a comprehensive microgrid operation system, through which the assessment of the proposed model and the impact of the EVs adoption are achieved. Simulations show that the proposed HAIMA methodology will be beneficial for the microgrid study and EV’s operation assessment and shall be further utilized for the energy management, electricity consumption prediction, the EV scheduling control, and HRES deployment optimization.

State of the Art : Integrated Management of Requirements in Model-Based Software Engineering

OpenAIRE

Thörn, Christer

2006-01-01

This report describes the background and future of research concerning integrated management of requirements in model-based software engineering. The focus is on describing the relevant topics and existing theoretical backgrounds that form the basis for the research. The report describes the fundamental difficulties of requirements engineering for software projects, and proposes that the results and methods of models in software engineering can help leverage those problems. Taking inspiration...

The Importance of Perioperative Prophylaxis with Cefuroxime or Ceftriaxone in the Surgical Site Infections Prevention after Cranial and Spinal Neurosurgical Procedures.

Science.gov (United States)

Dimovska-Gavrilovska, Aleksandra; Chaparoski, Aleksandar; Gavrilovski, Andreja; Milenkovikj, Zvonko

2017-09-01

Introduction Surgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%. Different antibiotics and administration regimes have been used in the perioperative prophylaxis so far, and there are numerous comparative studies regarding their efficiency, however, it is generally indicated that the choice thereof should be based on information and local specifics connected to the most probable bacterial causers, which would possibly contaminate the surgical site and cause infection, and moreover, the mandatory compliance with the principles of providing adequate concentration of the drug at the time of the anticipated contamination. Objective Comparing the protective effect of two perioperative prophylactic antibiotic regimes using cefuroxime (second generation cephalosporin) and ceftriaxone (third generation cephalosporin) in the prevention of postoperative surgical site infections after elective and urgent cranial and spinal neurosurgical procedures at the University Clinic for Neurosurgery in Skopje in the period of the first three months of 2016. Design of the study Prospective randomized comparative study. Outcome measures Establishing the clinical outcome represented as prevalence of superficial and deep incision and organ/space postoperative surgical site infections. Material and method We analyzed prospectively 40 patients who received parenteral antibiotic prophylaxis with two antibiotic regimes one hour before the routine neurosurgical cranial and spinal surgical procedures; the patients were randomized in two groups, according to the order of admission and participation in the study, alternately, non-selectively, those persons who fulfilled inclusion criteria were placed in one of the two programmed regimes with cefuroxime in the first, and cefotaxime in the

Integrating Biodiversity into Biosphere-Atmosphere Interactions Using Individual-Based Models (IBM)

Science.gov (United States)

Wang, B.; Shugart, H. H., Jr.; Lerdau, M.

2017-12-01

A key component regulating complex, nonlinear, and dynamic biosphere-atmosphere interactions is the inherent diversity of biological systems. The model frameworks currently widely used, i.e., Plant Functional Type models) do not even begin to capture the metabolic and taxonomic diversity found in many terrestrial systems. We propose that a transition from PFT-based to individual-based modeling approaches (hereafter referred to as IBM) is essential for integrating biodiversity into research on biosphere-atmosphere interactions. The proposal emerges from our studying the interactions of forests with atmospheric processes in the context of climate change using an individual-based forest volatile organic compounds model, UVAFME-VOC. This individual-based model can explicitly simulate VOC emissions based on an explicit modelling of forest dynamics by computing the growth, death, and regeneration of each individual tree of different species and their competition for light, moisture, and nutrient, from which system-level VOC emissions are simulated by explicitly computing and summing up each individual's emissions. We found that elevated O3 significantly altered the forest dynamics by favoring species that are O3-resistant, which, meanwhile, are producers of isoprene. Such compositional changes, on the one hand, resulted in unsuppressed forest productivity and carbon stock because of the compensation by O3-resistant species. On the other hand, with more isoprene produced arising from increased producers, a possible positive feedback loop between tropospheric O3 and forest thereby emerged. We also found that climate warming will not always stimulate isoprene emissions because warming simultaneously reduces isoprene emissions by causing a decline in the abundance of isoprene-emitting species. These results suggest that species diversity is of great significance and that individual-based modelling strategies should be applied in studying biosphere-atmosphere interactions.

Integrated Age-based Krill Model Fish Res 2015

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — An integrated, age-structured model was fitted to different combinations of survey data using two forms of selectivity (logistic or double-logistic) with...

Complex fluid network optimization and control integrative design based on nonlinear dynamic model

International Nuclear Information System (INIS)

Sui, Jinxue; Yang, Li; Hu, Yunan

2016-01-01

In view of distribution according to complex fluid network’s needs, this paper proposed one optimization computation method of the nonlinear programming mathematical model based on genetic algorithm. The simulation result shows that the overall energy consumption of the optimized fluid network has a decrease obviously. The control model of the fluid network is established based on nonlinear dynamics. We design the control law based on feedback linearization, take the optimal value by genetic algorithm as the simulation data, can also solve the branch resistance under the optimal value. These resistances can provide technical support and reference for fluid network design and construction, so can realize complex fluid network optimization and control integration design.

An integrative model for the dynamics of ICT-based innovations in education

Directory of Open Access Journals (Sweden)

Castulus Kolo

2009-12-01

Full Text Available Empirical evidence underlines the importance of ICT-based innovations in education for at least two reasons: They prepare for a future workplace in a knowledge society increasingly dependent on ICT and furthermore, they support student-centred learning processes. However, adoption of ICT in educational organizations in general as well as of specific ICT-based innovations varies broadly across nations as there are many different influencing factors with strong interdependencies. In order to better understand the dynamics of innovations in education, in this article we expose to discussion an integrative model based on a combination of models of individual and organizational adoption processes and their interplay with a socio-economic environment. The authors propose this concept of an “educational innovation system” to analyse differences in the diffusion of ICT-based innovations across countries and to better understand educational policies and their impact on classroom practice.

A numerical integration-based yield estimation method for integrated circuits

International Nuclear Information System (INIS)

Liang Tao; Jia Xinzhang

2011-01-01

A novel integration-based yield estimation method is developed for yield optimization of integrated circuits. This method tries to integrate the joint probability density function on the acceptability region directly. To achieve this goal, the simulated performance data of unknown distribution should be converted to follow a multivariate normal distribution by using Box-Cox transformation (BCT). In order to reduce the estimation variances of the model parameters of the density function, orthogonal array-based modified Latin hypercube sampling (OA-MLHS) is presented to generate samples in the disturbance space during simulations. The principle of variance reduction of model parameters estimation through OA-MLHS together with BCT is also discussed. Two yield estimation examples, a fourth-order OTA-C filter and a three-dimensional (3D) quadratic function are used for comparison of our method with Monte Carlo based methods including Latin hypercube sampling and importance sampling under several combinations of sample sizes and yield values. Extensive simulations show that our method is superior to other methods with respect to accuracy and efficiency under all of the given cases. Therefore, our method is more suitable for parametric yield optimization. (semiconductor integrated circuits)

A numerical integration-based yield estimation method for integrated circuits

Energy Technology Data Exchange (ETDEWEB)

Liang Tao; Jia Xinzhang, E-mail: tliang@yahoo.cn [Key Laboratory of Ministry of Education for Wide Bandgap Semiconductor Materials and Devices, School of Microelectronics, Xidian University, Xi' an 710071 (China)

2011-04-15

A novel integration-based yield estimation method is developed for yield optimization of integrated circuits. This method tries to integrate the joint probability density function on the acceptability region directly. To achieve this goal, the simulated performance data of unknown distribution should be converted to follow a multivariate normal distribution by using Box-Cox transformation (BCT). In order to reduce the estimation variances of the model parameters of the density function, orthogonal array-based modified Latin hypercube sampling (OA-MLHS) is presented to generate samples in the disturbance space during simulations. The principle of variance reduction of model parameters estimation through OA-MLHS together with BCT is also discussed. Two yield estimation examples, a fourth-order OTA-C filter and a three-dimensional (3D) quadratic function are used for comparison of our method with Monte Carlo based methods including Latin hypercube sampling and importance sampling under several combinations of sample sizes and yield values. Extensive simulations show that our method is superior to other methods with respect to accuracy and efficiency under all of the given cases. Therefore, our method is more suitable for parametric yield optimization. (semiconductor integrated circuits)

Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.

Science.gov (United States)

Abdelgadir, Jihad; Tran, Tu; Muhindo, Alex; Obiga, Doomwin; Mukasa, John; Ssenyonjo, Hussein; Muhumza, Michael; Kiryabwire, Joel; Haglund, Michael M; Sloan, Frank A

2017-05-01

There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning. In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda). During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%). This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. Copyright © 2017 Elsevier Inc. All rights reserved.

GOLD: Integration of model-based control systems with artificial intelligence and workstations

International Nuclear Information System (INIS)

Lee, M.; Clearwater, S.

1987-08-01

Our experience with model based accelerator control started at SPEAR. Since that time nearly all accelerator beam lines have been controlled using model-based application programs, for example, PEP and SLC at SLAC. In order to take advantage of state-of-the-art hardware and software technology, the design and implementation of the accelerator control programs have undergone radical change with time. Consequently, SPEAR, PEP, and SLC all use different control programs. Since many of these application programs are imbedded deep into the control system, they had to be rewritten each time. Each time this rewriting has occurred a great deal of time and effort has been spent on training physicists and programmers to do the job. Now, we have developed these application programs for a fourth time. This time, however, the programs we are developing are generic so that we will not have to do it again. We have developed an integrated system called GOLD (Generic Orbit and Lattice Debugger) for debugging and correcting trajectory errors in accelerator lattices. The system consists of a lattice modeling program (COMFORT), a beam simulator (PLUS), a graphical workstation environment (micro-VAX) and an expert system (ABLE). This paper will describe some of the features and applications of our integrated system with emphasis on the automation offered by expert systems. 5 refs

Neurosurgical Management of Nonmissile Penetrating Cranial Lesions.

Science.gov (United States)

de Holanda, Luciano Ferreira; Pereira, Benedito Jamilson A; Holanda, Rafael Rodrigues; Neto, José Targino; de Holanda, Carlos Vanderlei M; Giudicissi Filho, Miguel; de Oliveira, Nathalia Ribeiro Cunha; de Oliveira, Jean G

2016-06-01

The objective of this study is to present a case series of nonmissile penetrating (NMP) injuries and to establish a workflow for an uncommon mechanism of traumatic head injury through the analysis of each case, classification of the type of lesion, management, and outcome score at follow-up. From January 1991 to December 2008, 36,000 patients presenting with traumatic brain injury (TBI) were admitted in the Department of Neurosurgery, Hospital Antônio Targino, Campina Grande-PB, Brazil. From these patients, 11 presenting with lesions caused by NMP objects were selected. Among the 11 patients, 9 were men and 2 were women. Their ages ranged from 7 to 74 years old (mean age ± SD, 29.1 ± 22.99 years). All patients underwent neuroradiologic evaluation. The entry point was classified as natural (orbit) or artificial (skull transfixation), and we also divided the patients presenting with secondary parenchymal or vascular damage from those presenting with only lesions caused by the primary penetration into the cranium and meninges. All patients were neurosurgically treated with removal of the foreign body through craniotomy, except the patient whose object (pen) was removed without craniotomy with local anesthesia. Glasgow Coma Scale (GCS) score on admission was a statistically significant factor on prognosis, and any patient who presented with a GCS score of 15 evolved satisfactorily, and there were no deaths in this group of patients (P = 0.04). TBIs caused by NMP objects are unusual and caused by aggression, self-inflicted harm (in the case of psychiatric patients), and accident. The foreign body may enter into the skull through a natural hole (orbit, nose, mouth, or ear) or crosses the skull, causing a fracture and creating an artificial hole. Preoperative neuroradiologic assessment is paramount for the correct neurosurgical approach. The main prognostic factor for these patients is the GCS score at admission. Copyright © 2016 Elsevier Inc. All rights reserved.

Integrated Main Propulsion System Performance Reconstruction Process/Models

Science.gov (United States)

Lopez, Eduardo; Elliott, Katie; Snell, Steven; Evans, Michael

2013-01-01

The Integrated Main Propulsion System (MPS) Performance Reconstruction process provides the MPS post-flight data files needed for postflight reporting to the project integration management and key customers to verify flight performance. This process/model was used as the baseline for the currently ongoing Space Launch System (SLS) work. The process utilizes several methodologies, including multiple software programs, to model integrated propulsion system performance through space shuttle ascent. It is used to evaluate integrated propulsion systems, including propellant tanks, feed systems, rocket engine, and pressurization systems performance throughout ascent based on flight pressure and temperature data. The latest revision incorporates new methods based on main engine power balance model updates to model higher mixture ratio operation at lower engine power levels.

A new mechatronic assistance system for the neurosurgical operating theatre: implementation, assessment of accuracy and application concepts.

Science.gov (United States)

Rachinger, Jens; Bumm, Klaus; Wurm, Jochen; Bohr, Christopher; Nissen, Urs; Dannenmann, Tim; Buchfelder, Michael; Iro, Heinrich; Nimsky, Christopher

2007-01-01

To introduce a new robotic system to the field of neurosurgery and report on a preliminary assessment of accuracy as well as on envisioned application concepts. Based on experience with another system (Evolution 1, URS Inc., Schwerin, Germany), technical advancements are discussed. The basic module is an industrial 6 degrees of freedom robotic arm with a modified control element. The system combines frameless stereotaxy, robotics, and endoscopy. The robotic reproducibility error and the overall error were evaluated. For accuracy testing CT markers were placed on a cadaveric head and pinpointed with the robot's tool tip, both fully automated and telemanipulatory. Applicability in a clinical setting, user friendliness, safety and flexibility were assessed. The new system is suitable for use in the neurosurgical operating theatre. Hard- and software are user-friendly and flexible. The mean reproducibility error was 0.052-0.062 mm, the mean overall error was 0.816 mm. The system is less cumbersome and much easier to use than the Evolution 1. With its user-friendly interface and reliable safety features, its high application accuracy and flexibility, the new system is a versatile robotic platform for various neurosurgical applications. Adaptations for different applications are currently being realized. Copyright (c) 2007 S. Karger AG, Basel.

Analysis of disruptive events and precarious situations caused by interaction with neurosurgical microscope.

Science.gov (United States)

Eivazi, Shahram; Afkari, Hoorieh; Bednarik, Roman; Leinonen, Ville; Tukiainen, Markku; Jääskeläinen, Juha E

2015-07-01

Developments in micro-neurosurgical microscopes have improved operating precision and ensured the quality of outcomes. Using the stereoscopic magnified view, however, necessitates frequent manual adjustments to the microscope during an operation. This article reports on an investigation of the interaction details concerning a state-of-the-art micro-neurosurgical microscope. The video data from detailed observations of neurosurgeons' interaction patterns with the microscope were analysed to examine disruptive events caused by adjusting the microscope. The primary findings show that interruptions caused by adjusting the microscope handgrips and mouth switch prolong the surgery time up to 10%. Surgeons, we observed, avoid interaction with the microscope's controls, settings, and configurations by working at the edge of the view, operating on a non-focused view, and assuming unergonomic body postures. The lack of an automatic method for adjusting the microscope is a major problem that causes interruptions during micro-neurosurgery. From this understanding of disruptive events, we discuss the opportunities and limitations of interactive technologies that aim to reduce the frequency or shorten the duration of interruptions caused by microscope adjustment.

Neurosurgical outcomes after intracerebral hemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST).

Science.gov (United States)

Steiner, Thorsten; Vincent, Catherine; Morris, Stephen; Davis, Stephen; Vallejo-Torres, Laura; Christensen, Michael C

2011-01-01

The value of neurosurgical interventions after spontaneous intracerebral hemorrhage (SICH) is uncertain. We evaluated clinical outcomes in patients diagnosed with SICH within 3 hours of symptom onset who underwent hematoma evacuation or external ventricular drainage (EVD) of the hematoma in the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). FAST was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. Neurosurgical procedures (hematoma evacuation and external ventricular drainage) performed at any point after hospital admission were prospectively recorded. Clinical outcomes evaluated were post-SICH disability, as assessed by the modified Rankin Scale; neurologic impairment, as assessed by the National Institutes of Health Stroke Scale; and mortality at 90 days after SICH onset. The impact of neurosurgical procedures on clinical outcomes was evaluated using multivariate logistic regression analysis, controlling for relevant baseline characteristics. Fifty-five of 821 patients underwent neurosurgery. Patients who underwent hematoma evacuation or EVD were on average younger, had greater baseline neurologic impairment, and lower levels of consciousness compared with patients who did not undergo neurosurgery. After adjusting for these differences and other relevant baseline characteristics, we found that neurosurgery was generally associated with unfavorable outcomes at day 90. Among the patients who underwent hematoma evacuation, those with lobar ICH had less ICH expansion than those with deep gray matter ICH, and the smaller expansion was associated with lower mortality. ICH volume was substantially decreased in patients who underwent hematoma evacuation between 24 and 72 hours after hospital admission, and this was associated with better clinical outcome. In conclusion, a small number of patients who underwent neurosurgery in FAST exhibited no overall clinical benefit

Modeling and Analysis of Hybrid Cellular/WLAN Systems with Integrated Service-Based Vertical Handoff Schemes

Science.gov (United States)

Xia, Weiwei; Shen, Lianfeng

We propose two vertical handoff schemes for cellular network and wireless local area network (WLAN) integration: integrated service-based handoff (ISH) and integrated service-based handoff with queue capabilities (ISHQ). Compared with existing handoff schemes in integrated cellular/WLAN networks, the proposed schemes consider a more comprehensive set of system characteristics such as different features of voice and data services, dynamic information about the admitted calls, user mobility and vertical handoffs in two directions. The code division multiple access (CDMA) cellular network and IEEE 802.11e WLAN are taken into account in the proposed schemes. We model the integrated networks by using multi-dimensional Markov chains and the major performance measures are derived for voice and data services. The important system parameters such as thresholds to prioritize handoff voice calls and queue sizes are optimized. Numerical results demonstrate that the proposed ISHQ scheme can maximize the utilization of overall bandwidth resources with the best quality of service (QoS) provisioning for voice and data services.

Separations and safeguards model integration.

Energy Technology Data Exchange (ETDEWEB)

Cipiti, Benjamin B.; Zinaman, Owen

2010-09-01

Research and development of advanced reprocessing plant designs can greatly benefit from the development of a reprocessing plant model capable of transient solvent extraction chemistry. This type of model can be used to optimize the operations of a plant as well as the designs for safeguards, security, and safety. Previous work has integrated a transient solvent extraction simulation module, based on the Solvent Extraction Process Having Interaction Solutes (SEPHIS) code developed at Oak Ridge National Laboratory, with the Separations and Safeguards Performance Model (SSPM) developed at Sandia National Laboratory, as a first step toward creating a more versatile design and evaluation tool. The goal of this work was to strengthen the integration by linking more variables between the two codes. The results from this integrated model show expected operational performance through plant transients. Additionally, ORIGEN source term files were integrated into the SSPM to provide concentrations, radioactivity, neutron emission rate, and thermal power data for various spent fuels. This data was used to generate measurement blocks that can determine the radioactivity, neutron emission rate, or thermal power of any stream or vessel in the plant model. This work examined how the code could be expanded to integrate other separation steps and benchmark the results to other data. Recommendations for future work will be presented.

Complex Behavior in an Integrate-and-Fire Neuron Model Based on Small World Networks

International Nuclear Information System (INIS)

Lin Min; Chen Tianlun

2005-01-01

Based on our previously pulse-coupled integrate-and-fire neuron model in small world networks, we investigate the complex behavior of electroencephalographic (EEG)-like activities produced by such a model. We find EEG-like activities have obvious chaotic characteristics. We also analyze the complex behaviors of EEG-like signals, such as spectral analysis, reconstruction of the phase space, the correlation dimension, and so on.

Bending of Euler-Bernoulli nanobeams based on the strain-driven and stress-driven nonlocal integral models: a numerical approach

Science.gov (United States)

Oskouie, M. Faraji; Ansari, R.; Rouhi, H.

2018-04-01

Eringen's nonlocal elasticity theory is extensively employed for the analysis of nanostructures because it is able to capture nanoscale effects. Previous studies have revealed that using the differential form of the strain-driven version of this theory leads to paradoxical results in some cases, such as bending analysis of cantilevers, and recourse must be made to the integral version. In this article, a novel numerical approach is developed for the bending analysis of Euler-Bernoulli nanobeams in the context of strain- and stress-driven integral nonlocal models. This numerical approach is proposed for the direct solution to bypass the difficulties related to converting the integral governing equation into a differential equation. First, the governing equation is derived based on both strain-driven and stress-driven nonlocal models by means of the minimum total potential energy. Also, in each case, the governing equation is obtained in both strong and weak forms. To solve numerically the derived equations, matrix differential and integral operators are constructed based upon the finite difference technique and trapezoidal integration rule. It is shown that the proposed numerical approach can be efficiently applied to the strain-driven nonlocal model with the aim of resolving the mentioned paradoxes. Also, it is able to solve the problem based on the strain-driven model without inconsistencies of the application of this model that are reported in the literature.

Demystifying process mapping: a key step in neurosurgical quality improvement initiatives.

Science.gov (United States)

McLaughlin, Nancy; Rodstein, Jennifer; Burke, Michael A; Martin, Neil A

2014-08-01

Reliable delivery of optimal care can be challenging for care providers. Health care leaders have integrated various business tools to assist them and their teams in ensuring consistent delivery of safe and top-quality care. The cornerstone to all quality improvement strategies is the detailed understanding of the current state of a process, captured by process mapping. Process mapping empowers caregivers to audit how they are currently delivering care to subsequently strategically plan improvement initiatives. As a community, neurosurgery has clearly shown dedication to enhancing patient safety and delivering quality care. A care redesign strategy named NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety) is currently being developed and piloted within our department. Through this initiative, a multidisciplinary team led by a clinician neurosurgeon has process mapped the way care is currently being delivered throughout the entire episode of care. Neurosurgeons are becoming leaders in quality programs, and their education on the quality improvement strategies and tools is essential. The authors present a comprehensive review of process mapping, demystifying its planning, its building, and its analysis. The particularities of using process maps, initially a business tool, in the health care arena are discussed, and their specific use in an academic neurosurgical department is presented.

Simulated lumbar minimally invasive surgery educational model with didactic and technical components.

Science.gov (United States)

Chitale, Rohan; Ghobrial, George M; Lobel, Darlene; Harrop, James

2013-10-01

The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography-navigated guidance also improved from 28.3 to 26.6. Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

Geographic proximity to specialized pediatric neurosurgical care in the contiguous United States.

Science.gov (United States)

Ahmed, Abdul-Kareem; Duhaime, Ann-Christine; Smith, Timothy R

2018-04-01

OBJECTIVE Absent from an analysis of supply is consideration of the geographic distribution of pediatric neurosurgeons. Several patient socioeconomic metrics are known to be associated with outcome in pediatric neurosurgical diseases, such as hydrocephalus. The purpose of this study was to determine current geographic proximity to pediatric neurosurgical care using professional society databases. This study also sought to establish how socioeconomic factors are related to distance to care, using federal government-collected data. METHODS A list of currently practicing American Board of Pediatric Neurological Surgery (ABPNS)-certified neurosurgeons was compiled (ABPNS group). A separate list of practicing members of the Joint Pediatric Section (JPS) of the American Association of Neurological Surgeons/Congress of Neurological Surgeons was prepared (JPS group). Current primary practice locations were collected from each professional society database for each ABPNS or JPS neurosurgeon and were charted using ArcGIS mapping software (ESRI, version 10.3) on a United States Census Bureau map. The straight distance from the centroid of each zip code tabulation area (ZCTA) to the nearest neurosurgeon was determined by group type of neurosurgeon (ABPNS vs ABPNS + JPS). ZCTA-level data on demographic and socioeconomic factors were acquired from the American Community Survey, including data in children and young adults (0-18 or 0-24 years old) and the general population. These data were compared by distance to care and by groups of neurosurgeons (Pearson's chi-square analysis; the threshold of significance was set at 0.05). RESULTS Three hundred fifty-five practicing neurosurgeons providing pediatric care were located, of whom 215 surgeons were certified by the ABPNS and 140 were JPS members only. The analysis showed that 1 pediatric neurosurgeon is in practice for every 289,799 persons up to the age of 24 years. The average distance between a ZCTA and the nearest pediatric

Train integrity detection risk analysis based on PRISM

Science.gov (United States)

Wen, Yuan

2018-04-01

GNSS based Train Integrity Monitoring System (TIMS) is an effective and low-cost detection scheme for train integrity detection. However, as an external auxiliary system of CTCS, GNSS may be influenced by external environments, such as uncertainty of wireless communication channels, which may lead to the failure of communication and positioning. In order to guarantee the reliability and safety of train operation, a risk analysis method of train integrity detection based on PRISM is proposed in this article. First, we analyze the risk factors (in GNSS communication process and the on-board communication process) and model them. Then, we evaluate the performance of the model in PRISM based on the field data. Finally, we discuss how these risk factors influence the train integrity detection process.

A new head-mounted display-based augmented reality system in neurosurgical oncology: a study on phantom.

Science.gov (United States)

Cutolo, Fabrizio; Meola, Antonio; Carbone, Marina; Sinceri, Sara; Cagnazzo, Federico; Denaro, Ennio; Esposito, Nicola; Ferrari, Mauro; Ferrari, Vincenzo

2017-12-01

Benefits of minimally invasive neurosurgery mandate the development of ergonomic paradigms for neuronavigation. Augmented Reality (AR) systems can overcome the shortcomings of commercial neuronavigators. The aim of this work is to apply a novel AR system, based on a head-mounted stereoscopic video see-through display, as an aid in complex neurological lesion targeting. Effectiveness was investigated on a newly designed patient-specific head mannequin featuring an anatomically realistic brain phantom with embedded synthetically created tumors and eloquent areas. A two-phase evaluation process was adopted in a simulated small tumor resection adjacent to Broca's area. Phase I involved nine subjects without neurosurgical training in performing spatial judgment tasks. In Phase II, three surgeons were involved in assessing the effectiveness of the AR-neuronavigator in performing brain tumor targeting on a patient-specific head phantom. Phase I revealed the ability of the AR scene to evoke depth perception under different visualization modalities. Phase II confirmed the potentialities of the AR-neuronavigator in aiding the determination of the optimal surgical access to the surgical target. The AR-neuronavigator is intuitive, easy-to-use, and provides three-dimensional augmented information in a perceptually-correct way. The system proved to be effective in guiding skin incision, craniotomy, and lesion targeting. The preliminary results encourage a structured study to prove clinical effectiveness. Moreover, our testing platform might be used to facilitate training in brain tumour resection procedures.

MEASURING INFORMATION INTEGR-ATION MODEL FOR CAD/CMM

Institute of Scientific and Technical Information of China (English)

无

2003-01-01

A CAD/CMM workpiece modeling system based on IGES file is proposed. The modeling system is implemented by using a new method for labelling the tolerance items of 3D workpiece. The concept-"feature face" is used in the method. First the CAD data of workpiece are extracted and recognized automatically. Then a workpiece model is generated, which is the integration of pure 3D geometry form with its corresponding inspection items. The principle of workpiece modeling is also presented. At last, the experiment results are shown and correctness of the model is certified.

Assistance to neurosurgical planning: using a fuzzy spatial graph model of the brain for locating anatomical targets in MRI

Science.gov (United States)

Villéger, Alice; Ouchchane, Lemlih; Lemaire, Jean-Jacques; Boire, Jean-Yves

2007-03-01

Symptoms of neurodegenerative pathologies such as Parkinson's disease can be relieved through Deep Brain Stimulation. This neurosurgical technique relies on high precision positioning of electrodes in specific areas of the basal ganglia and the thalamus. These subcortical anatomical targets must be located at pre-operative stage, from a set of MRI acquired under stereotactic conditions. In order to assist surgical planning, we designed a semi-automated image analysis process for extracting anatomical areas of interest. Complementary information, provided by both patient's data and expert knowledge, is represented as fuzzy membership maps, which are then fused by means of suitable possibilistic operators in order to achieve the segmentation of targets. More specifically, theoretical prior knowledge on brain anatomy is modelled within a 'virtual atlas' organised as a spatial graph: a list of vertices linked by edges, where each vertex represents an anatomical structure of interest and contains relevant information such as tissue composition, whereas each edge represents a spatial relationship between two structures, such as their relative directions. The model is built using heterogeneous sources of information such as qualitative descriptions from the expert, or quantitative information from prelabelled images. For each patient, tissue membership maps are extracted from MR data through a classification step. Prior model and patient's data are then matched by using a research algorithm (or 'strategy') which simultaneously computes an estimation of the location of every structures. The method was tested on 10 clinical images, with promising results. Location and segmentation results were statistically assessed, opening perspectives for enhancements.

Modelling of Operative Report Documents for Data Integration into an openEHR-Based Enterprise Data Warehouse.

Science.gov (United States)

Haarbrandt, Birger; Wilschko, Andreas; Marschollek, Michael

2016-01-01

In order to integrate operative report documents from two operating room management systems into a data warehouse, we investigated the application of the two-level modelling approach of openEHR to create a shared data model. Based on the systems' analyses, a template consisting of 13 archetypes has been developed. Of these 13 archetypes, 3 have been obtained from the international archetype repository of the openEHR foundation. The remaining 10 archetypes have been newly created. The template was evaluated by an application system expert and through conducting a first test mapping of real-world data from one of the systems. The evaluation showed that by using the two-level modelling approach of openEHR, we succeeded to represent an integrated and shared information model for operative report documents. More research is needed to learn about the limitations of this approach in other data integration scenarios.

Integration of distributed energy resources into low voltage grid: A market-based multiperiod optimization model

Energy Technology Data Exchange (ETDEWEB)

Mashhour, Elahe; Moghaddas-Tafreshi, S.M. [Faculty of Electrical Engineering, K.N. Toosi University of Technology, Seyd Khandan, P.O. Box 16315-1355, Shariati, Tehran (Iran)

2010-04-15

This paper develops a multiperiod optimization model for an interconnected micro grid with hierarchical control that participates in wholesale energy market to maximize its benefit (i.e. revenues-costs). In addition to the operational constraints of distributed energy resources (DER) including both inter-temporal and non-inter-temporal types, the adequacy and steady-state security constraints of micro grid and its power losses are incorporated in the optimization model. In the presented model, DER are integrated into low voltage grid considering both technical and economical aspects. This integration as a micro grid can participate in wholesale energy market as an entity with dual role including producer and consumer based on the direction of exchanged power. The developed model is evaluated by testing on a micro grid considering different cases and the results are analyzed. (author)

Enabling model customization and integration

Science.gov (United States)

Park, Minho; Fishwick, Paul A.

2003-09-01

Until fairly recently, the idea of dynamic model content and presentation were treated synonymously. For example, if one was to take a data flow network, which captures the dynamics of a target system in terms of the flow of data through nodal operators, then one would often standardize on rectangles and arrows for the model display. The increasing web emphasis on XML, however, suggests that the network model can have its content specified in an XML language, and then the model can be represented in a number of ways depending on the chosen style. We have developed a formal method, based on styles, that permits a model to be specified in XML and presented in 1D (text), 2D, and 3D. This method allows for customization and personalization to exert their benefits beyond e-commerce, to the area of model structures used in computer simulation. This customization leads naturally to solving the bigger problem of model integration - the act of taking models of a scene and integrating them with that scene so that there is only one unified modeling interface. This work focuses mostly on customization, but we address the integration issue in the future work section.

Model integration and a theory of models

OpenAIRE

Dolk, Daniel R.; Kottemann, Jeffrey E.

1993-01-01

Model integration extends the scope of model management to include the dimension of manipulation as well. This invariably leads to comparisons with database theory. Model integration is viewed from four perspectives: Organizational, definitional, procedural, and implementational. Strategic modeling is discussed as the organizational motivation for model integration. Schema and process integration are examined as the logical and manipulation counterparts of model integr...

A Transmission-Cost-Based Model to Estimate the Amount of Market-Integrable Wind Resources

DEFF Research Database (Denmark)

Morales González, Juan Miguel; Pinson, Pierre; Madsen, Henrik

2012-01-01

are made to share the expenses in transmission derived from their integration, they may see the doors of electricity markets closed for not being competitive enough. This paper presents a model to decide the amount of wind resources that are economically exploitable at a given location from a transmission......In the pursuit of the large-scale integration of wind power production, it is imperative to evaluate plausible frictions among the stochastic nature of wind generation, electricity markets, and the investments in transmission required to accommodate larger amounts of wind. If wind producers......-cost perspective. This model accounts for the uncertain character of wind by using a modeling framework based on stochastic optimization, simulates market barriers by means of a bi-level structure, and considers the financial risk of investments in transmission through the conditional value-at-risk. The major...

Development of a physically-based planar inductors VHDL-AMS model for integrated power converter design

Science.gov (United States)

Ammouri, Aymen; Ben Salah, Walid; Khachroumi, Sofiane; Ben Salah, Tarek; Kourda, Ferid; Morel, Hervé

2014-05-01

Design of integrated power converters needs prototype-less approaches. Specific simulations are required for investigation and validation process. Simulation relies on active and passive device models. Models of planar devices, for instance, are still not available in power simulator tools. There is, thus, a specific limitation during the simulation process of integrated power systems. The paper focuses on the development of a physically-based planar inductor model and its validation inside a power converter during transient switching. The planar inductor model remains a complex device to model, particularly when the skin, the proximity and the parasitic capacitances effects are taken into account. Heterogeneous simulation scheme, including circuit and device models, is successfully implemented in VHDL-AMS language and simulated in Simplorer platform. The mixed simulation results has been favorably tested and compared with practical measurements. It is found that the multi-domain simulation results and measurements data are in close agreement.

Renewed mer model of integral management

Directory of Open Access Journals (Sweden)

Janko Belak

2015-12-01

Full Text Available Background: The research work on entrepreneurship, enterprise's policy and management, which started in 1992, successfully continued in the following years. Between 1992 and 2011, more than 400 academics and other researchers have participated in research work (MER research program whose main orientation has been the creation of their own model of integral management. Results: In past years, academics (researchers and authors of published papers from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Byelorussia, Canada, the Czech Republic, Croatia, Estonia, France, Germany, Hungary, Italy, Poland, Romania, Russia, the Slovak Republic, Slovenia, Switzerland, Ukraine, and the US have cooperated in MER programs, coming from more than fifty institutions. Thus, scientific doctrines of different universities influenced the development of the MER model which is based on both horizontal and vertical integration of the enterprises' governance and management processes, instruments and institutions into a consistently operating unit. Conclusions: The presented MER model is based on the multi-layer integration of governance and management with an enterprise and its environment, considering the fundamental desires for the enterprises' existence and, thus, their quantitative as well as qualitative changes. The process, instrumental, and institutional integrity of the governance and management is also the initial condition for the implementation of all other integration factors.

Medical negligence. An overview of legal theory and neurosurgical practice: duty of care.

Science.gov (United States)

Todd, Nicholas V

2014-04-01

A working knowledge of the legal principles of medical negligence is helpful to neurosurgeons. It helps them to act in a "reasonable, responsible and logical" manner, that is a practice that is consistent with the surgical practice of their peers. This article will review and explain the relevant medical law in relation to duty of care with illustrative neurosurgical cases.

Neurosurgical tactile discrimination training with haptic-based virtual reality simulation.

Science.gov (United States)

Patel, Achal; Koshy, Nick; Ortega-Barnett, Juan; Chan, Hoi C; Kuo, Yong-Fan; Luciano, Cristian; Rizzi, Silvio; Matulyauskas, Martin; Kania, Patrick; Banerjee, Pat; Gasco, Jaime

2014-12-01

To determine if a computer-based simulation with haptic technology can help surgical trainees improve tactile discrimination using surgical instruments. Twenty junior medical students participated in the study and were randomized into two groups. Subjects in Group A participated in virtual simulation training using the ImmersiveTouch simulator (ImmersiveTouch, Inc., Chicago, IL, USA) that required differentiating the firmness of virtual spheres using tactile and kinesthetic sensation via haptic technology. Subjects in Group B did not undergo any training. With their visual fields obscured, subjects in both groups were then evaluated on their ability to use the suction and bipolar instruments to find six elastothane objects with areas ranging from 1.5 to 3.5 cm2 embedded in a urethane foam brain cavity model while relying on tactile and kinesthetic sensation only. A total of 73.3% of the subjects in Group A (simulation training) were able to find the brain cavity objects in comparison to 53.3% of the subjects in Group B (no training) (P  =  0.0183). There was a statistically significant difference in the total number of Group A subjects able to find smaller brain cavity objects (size ≤ 2.5 cm2) compared to that in Group B (72.5 vs. 40%, P  =  0.0032). On the other hand, no significant difference in the number of subjects able to detect larger objects (size ≧ 3 cm2) was found between Groups A and B (75 vs. 80%, P  =  0.7747). Virtual computer-based simulators with integrated haptic technology may improve tactile discrimination required for microsurgical technique.

A recurrent neural model for proto-object based contour integration and figure-ground segregation.

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Hu, Brian; Niebur, Ernst

2017-12-01

Visual processing of objects makes use of both feedforward and feedback streams of information. However, the nature of feedback signals is largely unknown, as is the identity of the neuronal populations in lower visual areas that receive them. Here, we develop a recurrent neural model to address these questions in the context of contour integration and figure-ground segregation. A key feature of our model is the use of grouping neurons whose activity represents tentative objects ("proto-objects") based on the integration of local feature information. Grouping neurons receive input from an organized set of local feature neurons, and project modulatory feedback to those same neurons. Additionally, inhibition at both the local feature level and the object representation level biases the interpretation of the visual scene in agreement with principles from Gestalt psychology. Our model explains several sets of neurophysiological results (Zhou et al. Journal of Neuroscience, 20(17), 6594-6611 2000; Qiu et al. Nature Neuroscience, 10(11), 1492-1499 2007; Chen et al. Neuron, 82(3), 682-694 2014), and makes testable predictions about the influence of neuronal feedback and attentional selection on neural responses across different visual areas. Our model also provides a framework for understanding how object-based attention is able to select both objects and the features associated with them.

Integrated Arts-Based Teaching (IAT) Model for Brain-Based Learning

Science.gov (United States)

Inocian, Reynaldo B.

2015-01-01

This study analyzes teaching strategies among the eight books in Principles and Methods of Teaching recommended for use in the College of Teacher Education in the Philippines. It seeks to answer the following objectives: (1) identify the most commonly used teaching strategies congruent with the integrated arts-based teaching (IAT) and (2) design…

Spectrum of neurosurgical complications following medical tourism: challenges of patients without borders.

Science.gov (United States)

Idowu, Emmanuel Olufemi; Adewole, Oladipo Adeboluji

2015-03-01

The cost of medical care and availability of resources (human and facilities) which differs from nation to nation are amongst others, factors driving medical tourism (MT) despite its potential drawbacks. The aim of the study was to analyse all patients that presented with neurosurgical complications following MT. A single institution prospective study was carried out. Data which included patients' demographics, diagnosis, Glasgow coma scale score at admission, type of complication, and outcome were collected over a 3 year period and analysed. A total of 23 neurosurgical cases were seen during the study period with a median age of 42 years (17-70 years). India is the most common country visited by Nigerian patients. Nine patients died from various complications on arrival in Nigeria. There was no significant statistical difference between the outcome and patients clinical status prior to travel (p=0.107), country where the surgery was done (p=0.776), admission GCS in Nigeria (p=0.169), and redo surgery in Nigeria (0.181). Government in different nations should have legislations to ensure that medical tourists' receive appropriate care abroad, proper follow-up care upon their return, and also promulgate laws to regulate quasi and organised MT agencies that are operating in a regulatory vacuum.

A VGI data integration framework based on linked data model

Science.gov (United States)

Wan, Lin; Ren, Rongrong

2015-12-01

This paper aims at the geographic data integration and sharing method for multiple online VGI data sets. We propose a semantic-enabled framework for online VGI sources cooperative application environment to solve a target class of geospatial problems. Based on linked data technologies - which is one of core components of semantic web, we can construct the relationship link among geographic features distributed in diverse VGI platform by using linked data modeling methods, then deploy these semantic-enabled entities on the web, and eventually form an interconnected geographic data network to support geospatial information cooperative application across multiple VGI data sources. The mapping and transformation from VGI sources to RDF linked data model is presented to guarantee the unique data represent model among different online social geographic data sources. We propose a mixed strategy which combined spatial distance similarity and feature name attribute similarity as the measure standard to compare and match different geographic features in various VGI data sets. And our work focuses on how to apply Markov logic networks to achieve interlinks of the same linked data in different VGI-based linked data sets. In our method, the automatic generating method of co-reference object identification model according to geographic linked data is discussed in more detail. It finally built a huge geographic linked data network across loosely-coupled VGI web sites. The results of the experiment built on our framework and the evaluation of our method shows the framework is reasonable and practicable.

Noninvasive Hemodynamic Measurements During Neurosurgical Procedures in Sitting Position.

Science.gov (United States)

Schramm, Patrick; Tzanova, Irene; Gööck, Tilman; Hagen, Frank; Schmidtmann, Irene; Engelhard, Kristin; Pestel, Gunther

2017-07-01

Neurosurgical procedures in sitting position need advanced cardiovascular monitoring. Transesophageal echocardiography (TEE) to measure cardiac output (CO)/cardiac index (CI) and stroke volume (SV), and invasive arterial blood pressure measurements for systolic (ABPsys), diastolic (ABPdiast) and mean arterial pressure (MAP) are established monitoring technologies for these kind of procedures. A noninvasive device for continuous monitoring of blood pressure and CO based on a modified Penaz technique (volume-clamp method) was introduced recently. In the present study the noninvasive blood pressure measurements were compared with invasive arterial blood pressure monitoring, and the noninvasive CO monitoring to TEE measurements. Measurements of blood pressure and CO were performed in 35 patients before/after giving a fluid bolus and a change from supine to sitting position, start of surgery, and repositioning from sitting to supine at the end of surgery. Data pairs from the noninvasive device (Nexfin HD) versus arterial line measurements (ABPsys, ABPdiast, MAP) and versus TEE (CO, CI, SV) were compared using Bland-Altman analysis and percentage error. All parameters compared (CO, CI, SV, ABPsys, ABPdiast, MAP) showed a large bias and wide limits of agreement. Percentage error was above 30% for all parameters except ABPsys. The noninvasive device based on a modified Penaz technique cannot replace arterial blood pressure monitoring or TEE in anesthetized patients undergoing neurosurgery in sitting position.

An Integrated Scenario Ensemble-Based Framework for Hurricane Evacuation Modeling: Part 1-Decision Support System.

Science.gov (United States)

Davidson, Rachel A; Nozick, Linda K; Wachtendorf, Tricia; Blanton, Brian; Colle, Brian; Kolar, Randall L; DeYoung, Sarah; Dresback, Kendra M; Yi, Wenqi; Yang, Kun; Leonardo, Nicholas

2018-03-30

This article introduces a new integrated scenario-based evacuation (ISE) framework to support hurricane evacuation decision making. It explicitly captures the dynamics, uncertainty, and human-natural system interactions that are fundamental to the challenge of hurricane evacuation, but have not been fully captured in previous formal evacuation models. The hazard is represented with an ensemble of probabilistic scenarios, population behavior with a dynamic decision model, and traffic with a dynamic user equilibrium model. The components are integrated in a multistage stochastic programming model that minimizes risk and travel times to provide a tree of evacuation order recommendations and an evaluation of the risk and travel time performance for that solution. The ISE framework recommendations offer an advance in the state of the art because they: (1) are based on an integrated hazard assessment (designed to ultimately include inland flooding), (2) explicitly balance the sometimes competing objectives of minimizing risk and minimizing travel time, (3) offer a well-hedged solution that is robust under the range of ways the hurricane might evolve, and (4) leverage the substantial value of increasing information (or decreasing degree of uncertainty) over the course of a hurricane event. A case study for Hurricane Isabel (2003) in eastern North Carolina is presented to demonstrate how the framework is applied, the type of results it can provide, and how it compares to available methods of a single scenario deterministic analysis and a two-stage stochastic program. © 2018 Society for Risk Analysis.

Model-based Engineering for the Integration of Manufacturing Systems with Advanced Analytics

OpenAIRE

Lechevalier , David; Narayanan , Anantha; Rachuri , Sudarsan; Foufou , Sebti; Lee , Y Tina

2016-01-01

Part 3: Interoperability and Systems Integration; International audience; To employ data analytics effectively and efficiently on manufacturing systems, engineers and data scientists need to collaborate closely to bring their domain knowledge together. In this paper, we introduce a domain-specific modeling approach to integrate a manufacturing system model with advanced analytics, in particular neural networks, to model predictions. Our approach combines a set of meta-models and transformatio...

SBMLmod: a Python-based web application and web service for efficient data integration and model simulation.

Science.gov (United States)

Schäuble, Sascha; Stavrum, Anne-Kristin; Bockwoldt, Mathias; Puntervoll, Pål; Heiland, Ines

2017-06-24

Systems Biology Markup Language (SBML) is the standard model representation and description language in systems biology. Enriching and analysing systems biology models by integrating the multitude of available data, increases the predictive power of these models. This may be a daunting task, which commonly requires bioinformatic competence and scripting. We present SBMLmod, a Python-based web application and service, that automates integration of high throughput data into SBML models. Subsequent steady state analysis is readily accessible via the web service COPASIWS. We illustrate the utility of SBMLmod by integrating gene expression data from different healthy tissues as well as from a cancer dataset into a previously published model of mammalian tryptophan metabolism. SBMLmod is a user-friendly platform for model modification and simulation. The web application is available at http://sbmlmod.uit.no , whereas the WSDL definition file for the web service is accessible via http://sbmlmod.uit.no/SBMLmod.wsdl . Furthermore, the entire package can be downloaded from https://github.com/MolecularBioinformatics/sbml-mod-ws . We envision that SBMLmod will make automated model modification and simulation available to a broader research community.

Towards An Intelligent Model-Based Decision Support System For An Integrated Oil Company (EGPC)

International Nuclear Information System (INIS)

Khorshid, M.; Hassan, H.; Abdel Latife, M.A.

2004-01-01

Decision Support System (DSS) is an interactive, flexible and adaptable computer-based support system specially developed for supporting the solution of unstructured management problems [31] DSS has become widespread for oil industry domain in recent years. The computer-based DSS, which were developed and implemented in oil industry, are used to address the complex short-term planning and operational issues associated with downstream industry. Most of these applications concentrate on the data-centered tools, while the model-centered applications of DSS are still very limited up till now [20]. This study develops an Intelligent Model-Based DSS for an integrated oil company, to help policy makers and petroleum planner in improving the effectiveness of the strategic planning in oil sector. This domain basically imposes semi-structured or unstructured decisions and involves a very complex modeling process

Neurosurgical operating computerized tomographic scanner system

International Nuclear Information System (INIS)

Okudera, Hiroshi; Sugita, Kenichiro; Kobayashi, Shigeaki; Kimishima, Sakae; Yoshida, Hisashi.

1988-01-01

A neurosurgical operating computerized tomography scanner system is presented. This system has been developed for obtaining intra- and postoperative CT images in the operating room. A TCT-300 scanner (manufactured by the Toshiba Co., Tokyo) is placed in the operating room. The realization of a true intraoperative CT image requires certain improvements in the CT scanner and operating table. To adjust the axis of the co-ordinates of the motor system of the MST-7000 microsurgical operating table (manufactured by the Mizuho Ika Co., Tokyo) to the CT scanner, we have designed an interface and a precise motor system so that the computer of the CT scanner can directly control the movement of the operating table. Furthermore, a new head-fixation system has been designed for producing artifact-free intraoperative CT images. The head-pins of the head-fixation system are made of carbon-fiber bars and titanium tips. A simulation study of the total system in the operating room with the CT scanner, operating table, and head holder using a skull model yielded a degree of error similar to that in the phantom testing of the original scanner. Three patients underwent resection of a glial tumor using this system. Intraoperative CT scans taken after dural opening showed a bulging of the cortex, a shift in the central structure, and a displacement of the cortical subarachnoid spaces under the influence of gravity. With a contrast medium the edge of the surrounding brain after resection was enhanced and the residual tumor mass was demonstrated clearly. This system makes it possible to obtain a noninvasive intraoperative image in a situation where structural shifts are taking place. (author)

Intraoperative intrinsic optical imaging of human somatosensory cortex during neurosurgical operations.

Science.gov (United States)

Sato, Katsushige; Nariai, Tadashi; Momose-Sato, Yoko; Kamino, Kohtaro

2017-07-01

Intrinsic optical imaging as developed by Grinvald et al. is a powerful technique for monitoring neural function in the in vivo central nervous system. The advent of this dye-free imaging has also enabled us to monitor human brain function during neurosurgical operations. We briefly describe our own experience in functional mapping of the human somatosensory cortex, carried out using intraoperative optical imaging. The maps obtained demonstrate new additional evidence of a hierarchy for sensory response patterns in the human primary somatosensory cortex.

Correlates of Condom-use Self-efficacy on the EPPM-based Integrated Model among Chinese College Students.

Science.gov (United States)

Jin, Shan Shan; Bu, Kai; Chen, Fang Fang; Xu, Hui Fang; Li, Yi; Zhao, Dong Hui; Xu, Fang; Li, Jing Yan; Han, Meng Jie; Wang, Ning; Wang, Lu

2017-02-01

To explore the predictors of condom-use self-efficacy in Chinese college students according to the extended parallel process model (EPPM)-based integrated model. A total of 3,081 college students were anonymously surveyed through self-administered questionnaires in Guangzhou and Harbin, China. A structural equation model was applied to assess the integrated model. Among the participants, 1,387 (46.7%) were male, 1,586 (53.3%) were female, and the average age was 18.6 years. The final integrated model was acceptable. Apart from the direct effect (r = 0.23), perceived severity had two indirect effects on condom-use self-efficacy through the attitude to HIV education (r = 0.40) and intention to engage in premarital sex (r = -0.16), respectively. However, the perceived susceptibility mediated through the intention to engage in premarital sex (intent-to-premarital-sex) had a poor indirect impact on condom-use self-efficacy (total effect was -0.06). Furthermore, attitude toward HIV health education (r = 0.49) and intent-to-premarital-sex (r = -0.31) had a strong direct effect on condom-use self-efficacy. In addition, male students perceived higher susceptibility, stronger intent-to-premarital-sex, and lower condom-use self-efficacy than female students. The integrated model may be used to assess the determinants of condom-use self-efficacy among Chinese college students. Future research should focus on raising the severity perception, HIV-risk-reduction motivation, and the premarital abstinence intention among college students. Furthermore, considering the gender differences observed in the present survey, single-sex HIV education is required in school-based HIV/sex intervention. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

An Enhanced Error Model for EKF-Based Tightly-Coupled Integration of GPS and Land Vehicle's Motion Sensors.

Science.gov (United States)

Karamat, Tashfeen B; Atia, Mohamed M; Noureldin, Aboelmagd

2015-09-22

Reduced inertial sensor systems (RISS) have been introduced by many researchers as a low-cost, low-complexity sensor assembly that can be integrated with GPS to provide a robust integrated navigation system for land vehicles. In earlier works, the developed error models were simplified based on the assumption that the vehicle is mostly moving on a flat horizontal plane. Another limitation is the simplified estimation of the horizontal tilt angles, which is based on simple averaging of the accelerometers' measurements without modelling their errors or tilt angle errors. In this paper, a new error model is developed for RISS that accounts for the effect of tilt angle errors and the accelerometer's errors. Additionally, it also includes important terms in the system dynamic error model, which were ignored during the linearization process in earlier works. An augmented extended Kalman filter (EKF) is designed to incorporate tilt angle errors and transversal accelerometer errors. The new error model and the augmented EKF design are developed in a tightly-coupled RISS/GPS integrated navigation system. The proposed system was tested on real trajectories' data under degraded GPS environments, and the results were compared to earlier works on RISS/GPS systems. The findings demonstrated that the proposed enhanced system introduced significant improvements in navigational performance.

Quantitative analysis of magnetic resonance imaging susceptibility artifacts caused by neurosurgical biomaterials. Comparison of 0.5, 1.5, and 3.0 tesla magnetic fields

International Nuclear Information System (INIS)

Matsuura, Hideki; Inoue, Takashi; Ogasawara, Kuniaki; Sasaki, Makoto; Konno, Hiromu; Kuzu, Yasutaka; Nishimoto, Hideaki; Ogawa, Akira

2005-01-01

Magnetic resonance (MR) imaging is an important diagnostic tool for neurosurgical diseases but susceptibility artifacts caused by biomaterial instrumentation frequently causes difficulty in visualizing postoperative changes. The susceptibility artifacts caused by neurosurgical biomaterials were compared quantitatively by 0.5, 1.5, and 3.0 Tesla MR imaging. MR imaging of uniform size and shape of pieces ceramic (zirconia), pure titanium, titanium alloy, and cobalt-based alloy was performed at 0.5, 1.5, and 3.0 Tesla. A linear region of interest was defined across the center of the biomaterial in the transverse direction, and the susceptibility artifact diameter was calculated. Susceptibility artifacts developed around all biomaterials at all magnetic field strengths. The artifact diameters caused by pure titanium, titanium alloy, and cobalt-based alloy increased in the order of 0.5, 1.5, to 3.0 Tesla magnetic fields. The artifact diameter of ceramic was not influenced by magnetic field strength, and was the smallest of all biomaterials at all magnetic field strengths. The artifacts caused by biomaterials except ceramic increase with the magnetic field strength. Ceramic instrumentation will minimize artifacts in all magnetic fields. (author)

Optimizing water resources management in large river basins with integrated surface water-groundwater modeling: A surrogate-based approach

Science.gov (United States)

Wu, Bin; Zheng, Yi; Wu, Xin; Tian, Yong; Han, Feng; Liu, Jie; Zheng, Chunmiao

2015-04-01

Integrated surface water-groundwater modeling can provide a comprehensive and coherent understanding on basin-scale water cycle, but its high computational cost has impeded its application in real-world management. This study developed a new surrogate-based approach, SOIM (Surrogate-based Optimization for Integrated surface water-groundwater Modeling), to incorporate the integrated modeling into water management optimization. Its applicability and advantages were evaluated and validated through an optimization research on the conjunctive use of surface water (SW) and groundwater (GW) for irrigation in a semiarid region in northwest China. GSFLOW, an integrated SW-GW model developed by USGS, was employed. The study results show that, due to the strong and complicated SW-GW interactions, basin-scale water saving could be achieved by spatially optimizing the ratios of groundwater use in different irrigation districts. The water-saving potential essentially stems from the reduction of nonbeneficial evapotranspiration from the aqueduct system and shallow groundwater, and its magnitude largely depends on both water management schemes and hydrological conditions. Important implications for water resources management in general include: first, environmental flow regulation needs to take into account interannual variation of hydrological conditions, as well as spatial complexity of SW-GW interactions; and second, to resolve water use conflicts between upper stream and lower stream, a system approach is highly desired to reflect ecological, economic, and social concerns in water management decisions. Overall, this study highlights that surrogate-based approaches like SOIM represent a promising solution to filling the gap between complex environmental modeling and real-world management decision-making.

Analysis of e-learning implementation readiness based on integrated elr model

Science.gov (United States)

Adiyarta, K.; Napitupulu, D.; Rahim, R.; Abdullah, D.; Setiawan, MI

2018-04-01

E-learning nowadays has become a requirement for institutions to support their learning activities. To adopt e-learning, an institution requires a large strategy and resources for optimal application. Unfortunately, not all institutions that have used e-learning got the desired results or expectations. This study aims to identify the extent of the level of readiness of e-learning implementation in institution X. The degree of institutional readiness will determine the success of future e-learning utilization. In addition, institutional readiness measurement are needed to evaluate the effectiveness of strategies in e-learning development. The research method used is survey with questionnaire designed based on integration of 8 best practice ELR (e-learning readiness) model. The results showed that from 13 factors of integrated ELR model being measured, there are 3 readiness factors included in the category of not ready and needs a lot of work. They are human resource (2.57), technology skill (2.38) and content factors (2.41). In general, e-learning implementation in institutions is in the category of not ready but needs some of work (3.27). Therefore, the institution should consider which factors or areas of ELR factors are considered still not ready and needs improvement in the future.

An integrated development environment for PMESII model authoring, integration, validation, and debugging

Science.gov (United States)

Pioch, Nicholas J.; Lofdahl, Corey; Sao Pedro, Michael; Krikeles, Basil; Morley, Liam

2007-04-01

To foster shared battlespace awareness in Air Operations Centers supporting the Joint Forces Commander and Joint Force Air Component Commander, BAE Systems is developing a Commander's Model Integration and Simulation Toolkit (CMIST), an Integrated Development Environment (IDE) for model authoring, integration, validation, and debugging. CMIST is built on the versatile Eclipse framework, a widely used open development platform comprised of extensible frameworks that enable development of tools for building, deploying, and managing software. CMIST provides two distinct layers: 1) a Commander's IDE for supporting staff to author models spanning the Political, Military, Economic, Social, Infrastructure, Information (PMESII) taxonomy; integrate multiple native (third-party) models; validate model interfaces and outputs; and debug the integrated models via intuitive controls and time series visualization, and 2) a PMESII IDE for modeling and simulation developers to rapidly incorporate new native simulation tools and models to make them available for use in the Commander's IDE. The PMESII IDE provides shared ontologies and repositories for world state, modeling concepts, and native tool characterization. CMIST includes extensible libraries for 1) reusable data transforms for semantic alignment of native data with the shared ontology, and 2) interaction patterns to synchronize multiple native simulations with disparate modeling paradigms, such as continuous-time system dynamics, agent-based discrete event simulation, and aggregate solution methods such as Monte Carlo sampling over dynamic Bayesian networks. This paper describes the CMIST system architecture, our technical approach to addressing these semantic alignment and synchronization problems, and initial results from integrating Political-Military-Economic models of post-war Iraq spanning multiple modeling paradigms.

[Psychotherapy of patients with brain lesions: an integrative model based on neuropsychological and psychodynamic perspectives].

Science.gov (United States)

Ouss-Ryngaert, Lisa

2010-12-01

Our model of psychotherapy for patients with brain lesions is based on an integrative approach of psychobehavioral symptoms, especially from the neuropsychological and psychodynamic perspectives. Adjustment of technical modalities and aims of psychoanalytical therapy is required for these patients. The analysis of the influence of cognitive disorders on transference and contre-transference plays a major role, including the role of procedural processes in changes in the intersubjective relationship between the patient and the therapist. Two vignettes are presented to illustrate our model, which respects the integrity of the cognitive and psychodynamic approaches and can be implemented by only one therapist, using alternatively each lecture, or by a working team bringing to light the different aspects of the same symptom.

Integrating systems biology models and biomedical ontologies.

Science.gov (United States)

Hoehndorf, Robert; Dumontier, Michel; Gennari, John H; Wimalaratne, Sarala; de Bono, Bernard; Cook, Daniel L; Gkoutos, Georgios V

2011-08-11

Systems biology is an approach to biology that emphasizes the structure and dynamic behavior of biological systems and the interactions that occur within them. To succeed, systems biology crucially depends on the accessibility and integration of data across domains and levels of granularity. Biomedical ontologies were developed to facilitate such an integration of data and are often used to annotate biosimulation models in systems biology. We provide a framework to integrate representations of in silico systems biology with those of in vivo biology as described by biomedical ontologies and demonstrate this framework using the Systems Biology Markup Language. We developed the SBML Harvester software that automatically converts annotated SBML models into OWL and we apply our software to those biosimulation models that are contained in the BioModels Database. We utilize the resulting knowledge base for complex biological queries that can bridge levels of granularity, verify models based on the biological phenomenon they represent and provide a means to establish a basic qualitative layer on which to express the semantics of biosimulation models. We establish an information flow between biomedical ontologies and biosimulation models and we demonstrate that the integration of annotated biosimulation models and biomedical ontologies enables the verification of models as well as expressive queries. Establishing a bi-directional information flow between systems biology and biomedical ontologies has the potential to enable large-scale analyses of biological systems that span levels of granularity from molecules to organisms.

Surgical bedside master console for neurosurgical robotic system.

Science.gov (United States)

Arata, Jumpei; Kenmotsu, Hajime; Takagi, Motoki; Hori, Tatsuya; Miyagi, Takahiro; Fujimoto, Hideo; Kajita, Yasukazu; Hayashi, Yuichiro; Chinzei, Kiyoyuki; Hashizume, Makoto

2013-01-01

We are currently developing a neurosurgical robotic system that facilitates access to residual tumors and improves brain tumor removal surgical outcomes. The system combines conventional and robotic surgery allowing for a quick conversion between the procedures. This concept requires a new master console that can be positioned at the surgical bedside and be sterilized. The master console was developed using new technologies, such as a parallel mechanism and pneumatic sensors. The parallel mechanism is a purely passive 5-DOF (degrees of freedom) joystick based on the author's haptic research. The parallel mechanism enables motion input of conventional brain tumor removal surgery with a compact, intuitive interface that can be used in a conventional surgical environment. In addition, the pneumatic sensors implemented on the mechanism provide an intuitive interface and electrically isolate the tool parts from the mechanism so they can be easily sterilized. The 5-DOF parallel mechanism is compact (17 cm width, 19cm depth, and 15cm height), provides a 505,050 mm and 90° workspace and is highly backdrivable (0.27N of resistance force representing the surgical motion). The evaluation tests revealed that the pneumatic sensors can properly measure the suction strength, grasping force, and hand contact. In addition, an installability test showed that the master console can be used in a conventional surgical environment. The proposed master console design was shown to be feasible for operative neurosurgery based on comprehensive testing. This master console is currently being tested for master-slave control with a surgical robotic system.

The Balance-Scale Task Revisited: A Comparison of Statistical Models for Rule-Based and Information-Integration Theories of Proportional Reasoning.

Directory of Open Access Journals (Sweden)

Abe D Hofman

Full Text Available We propose and test three statistical models for the analysis of children's responses to the balance scale task, a seminal task to study proportional reasoning. We use a latent class modelling approach to formulate a rule-based latent class model (RB LCM following from a rule-based perspective on proportional reasoning and a new statistical model, the Weighted Sum Model, following from an information-integration approach. Moreover, a hybrid LCM using item covariates is proposed, combining aspects of both a rule-based and information-integration perspective. These models are applied to two different datasets, a standard paper-and-pencil test dataset (N = 779, and a dataset collected within an online learning environment that included direct feedback, time-pressure, and a reward system (N = 808. For the paper-and-pencil dataset the RB LCM resulted in the best fit, whereas for the online dataset the hybrid LCM provided the best fit. The standard paper-and-pencil dataset yielded more evidence for distinct solution rules than the online data set in which quantitative item characteristics are more prominent in determining responses. These results shed new light on the discussion on sequential rule-based and information-integration perspectives of cognitive development.

Integrated Ecological River Health Assessments, Based on Water Chemistry, Physical Habitat Quality and Biological Integrity

Directory of Open Access Journals (Sweden)

Ji Yoon Kim

2015-11-01

Full Text Available This study evaluated integrative river ecosystem health using stressor-based models of physical habitat health, chemical water health, and biological health of fish and identified multiple-stressor indicators influencing the ecosystem health. Integrated health responses (IHRs, based on star-plot approach, were calculated from qualitative habitat evaluation index (QHEI, nutrient pollution index (NPI, and index of biological integrity (IBI in four different longitudinal regions (Groups I–IV. For the calculations of IHRs values, multi-metric QHEI, NPI, and IBI models were developed and their criteria for the diagnosis of the health were determined. The longitudinal patterns of the river were analyzed by a self-organizing map (SOM model and the key major stressors in the river were identified by principal component analysis (PCA. Our model scores of integrated health responses (IHRs suggested that mid-stream and downstream regions were impaired, and the key stressors were closely associated with nutrient enrichment (N and P and organic matter pollutions from domestic wastewater disposal plants and urban sewage. This modeling approach of IHRs may be used as an effective tool for evaluations of integrative ecological river health..

Vertical integration and market power: A model-based analysis of restructuring in the Korean electricity market

International Nuclear Information System (INIS)

Bunn, Derek W.; Martoccia, Maria; Ochoa, Patricia; Kim, Haein; Ahn, Nam-Sung; Yoon, Yong-Beom

2010-01-01

An agent-based simulation model is developed using computational learning to investigate the impact of vertical integration between electricity generators and retailers on market power in a competitive wholesale market setting. It is observed that if partial vertical integration creates some market foreclosure, whether this leads to an increase or decrease in market power is situation specific. A detailed application to the Korean market structure reveals this to be the case. We find that in various cases, whilst vertical integration generally reduces spot prices, it can increase or decrease the market power of other market generators, depending upon the market share and the technology segment of the market, which is integrated, as well as the market concentrations before and after the integration.

Vertical integration and market power. A model-based analysis of restructuring in the Korean electricity market

Energy Technology Data Exchange (ETDEWEB)

Bunn, Derek W.; Martoccia, Maria; Ochoa, Patricia [London Business School, London (United Kingdom); Kim, Haein; Ahn, Nam-Sung; Yoon, Yong-Beom [Korean Electric Power Corporation, Seoul (Korea)

2010-07-15

An agent-based simulation model is developed using computational learning to investigate the impact of vertical integration between electricity generators and retailers on market power in a competitive wholesale market setting. It is observed that if partial vertical integration creates some market foreclosure, whether this leads to an increase or decrease in market power is situation specific. A detailed application to the Korean market structure reveals this to be the case. We find that in various cases, whilst vertical integration generally reduces spot prices, it can increase or decrease the market power of other market generators, depending upon the market share and the technology segment of the market, which is integrated, as well as the market concentrations before and after the integration. (author)

Vertical integration and market power: A model-based analysis of restructuring in the Korean electricity market

Energy Technology Data Exchange (ETDEWEB)

Bunn, Derek W., E-mail: dbunn@london.ed [London Business School, London (United Kingdom); Martoccia, Maria; Ochoa, Patricia [London Business School, London (United Kingdom); Kim, Haein; Ahn, Nam-Sung; Yoon, Yong-Beom [Korean Electric Power Corporation, Seoul (Korea, Republic of)

2010-07-15

An agent-based simulation model is developed using computational learning to investigate the impact of vertical integration between electricity generators and retailers on market power in a competitive wholesale market setting. It is observed that if partial vertical integration creates some market foreclosure, whether this leads to an increase or decrease in market power is situation specific. A detailed application to the Korean market structure reveals this to be the case. We find that in various cases, whilst vertical integration generally reduces spot prices, it can increase or decrease the market power of other market generators, depending upon the market share and the technology segment of the market, which is integrated, as well as the market concentrations before and after the integration.

Traffic Multiresolution Modeling and Consistency Analysis of Urban Expressway Based on Asynchronous Integration Strategy

Directory of Open Access Journals (Sweden)

Liyan Zhang

2017-01-01

Full Text Available The paper studies multiresolution traffic flow simulation model of urban expressway. Firstly, compared with two-level hybrid model, three-level multiresolution hybrid model has been chosen. Then, multiresolution simulation framework and integration strategies are introduced. Thirdly, the paper proposes an urban expressway multiresolution traffic simulation model by asynchronous integration strategy based on Set Theory, which includes three submodels: macromodel, mesomodel, and micromodel. After that, the applicable conditions and derivation process of the three submodels are discussed in detail. In addition, in order to simulate and evaluate the multiresolution model, “simple simulation scenario” of North-South Elevated Expressway in Shanghai has been established. The simulation results showed the following. (1 Volume-density relationships of three submodels are unanimous with detector data. (2 When traffic density is high, macromodel has a high precision and smaller error and the dispersion of results is smaller. Compared with macromodel, simulation accuracies of micromodel and mesomodel are lower but errors are bigger. (3 Multiresolution model can simulate characteristics of traffic flow, capture traffic wave, and keep the consistency of traffic state transition. Finally, the results showed that the novel multiresolution model can have higher simulation accuracy and it is feasible and effective in the real traffic simulation scenario.

GSFLOW - Coupled Ground-Water and Surface-Water Flow Model Based on the Integration of the Precipitation-Runoff Modeling System (PRMS) and the Modular Ground-Water Flow Model (MODFLOW-2005)

Science.gov (United States)

Markstrom, Steven L.; Niswonger, Richard G.; Regan, R. Steven; Prudic, David E.; Barlow, Paul M.

2008-01-01

The need to assess the effects of variability in climate, biota, geology, and human activities on water availability and flow requires the development of models that couple two or more components of the hydrologic cycle. An integrated hydrologic model called GSFLOW (Ground-water and Surface-water FLOW) was developed to simulate coupled ground-water and surface-water resources. The new model is based on the integration of the U.S. Geological Survey Precipitation-Runoff Modeling System (PRMS) and the U.S. Geological Survey Modular Ground-Water Flow Model (MODFLOW). Additional model components were developed, and existing components were modified, to facilitate integration of the models. Methods were developed to route flow among the PRMS Hydrologic Response Units (HRUs) and between the HRUs and the MODFLOW finite-difference cells. This report describes the organization, concepts, design, and mathematical formulation of all GSFLOW model components. An important aspect of the integrated model design is its ability to conserve water mass and to provide comprehensive water budgets for a location of interest. This report includes descriptions of how water budgets are calculated for the integrated model and for individual model components. GSFLOW provides a robust modeling system for simulating flow through the hydrologic cycle, while allowing for future enhancements to incorporate other simulation techniques.

Nature-based integration

DEFF Research Database (Denmark)

Pitkänen, Kati; Oratuomi, Joose; Hellgren, Daniela

Increased attention to, and careful planning of the integration of migrants into Nordic societies is ever more important. Nature based integration is a new solution to respond to this need. This report presents the results of a Nordic survey and workshop and illustrates current practices of nature...... based integration by case study descriptions from Denmark, Sweden Norway and Finland. Across Nordic countries several practical projects and initiatives have been launched to promote the benefits of nature in integration and there is also growing academic interest in the topic. Nordic countries have...... the potential of becoming real forerunners in nature based integration even at the global scale....

Model Based Optimization of Integrated Low Voltage DC-DC Converter for Energy Harvesting Applications

Science.gov (United States)

Jayaweera, H. M. P. C.; Muhtaroğlu, Ali

2016-11-01

A novel model based methodology is presented to determine optimal device parameters for the fully integrated ultra low voltage DC-DC converter for energy harvesting applications. The proposed model feasibly contributes to determine the maximum efficient number of charge pump stages to fulfill the voltage requirement of the energy harvester application. The proposed DC-DC converter based power consumption model enables the analytical derivation of the charge pump efficiency when utilized simultaneously with the known LC tank oscillator behavior under resonant conditions, and voltage step up characteristics of the cross-coupled charge pump topology. The verification of the model has been done using a circuit simulator. The optimized system through the established model achieves more than 40% maximum efficiency yielding 0.45 V output with single stage, 0.75 V output with two stages, and 0.9 V with three stages for 2.5 kΩ, 3.5 kΩ and 5 kΩ loads respectively using 0.2 V input.

Multi-perspective workflow modeling for online surgical situation models.

Science.gov (United States)

Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas

2015-04-01

Surgical workflow management is expected to enable situation-aware adaptation and intelligent systems behavior in an integrated operating room (OR). The overall aim is to unburden the surgeon and OR staff from both manual maintenance and information seeking tasks. A major step toward intelligent systems behavior is a stable classification of the surgical situation from multiple perspectives based on performed low-level tasks. The present work proposes a method for the classification of surgical situations based on multi-perspective workflow modeling. A model network that interconnects different types of surgical process models is described. Various aspects of a surgical situation description were considered: low-level tasks, high-level tasks, patient status, and the use of medical devices. A study with sixty neurosurgical interventions was conducted to evaluate the performance of our approach and its robustness against incomplete workflow recognition input. A correct classification rate of over 90% was measured for high-level tasks and patient status. The device usage models for navigation and neurophysiology classified over 95% of the situations correctly, whereas the ultrasound usage was more difficult to predict. Overall, the classification rate decreased with an increasing level of input distortion. Autonomous adaptation of medical devices and intelligent systems behavior do not currently depend solely on low-level tasks. Instead, they require a more general type of understanding of the surgical condition. The integration of various surgical process models in a network provided a comprehensive representation of the interventions and allowed for the generation of extensive situation descriptions. Multi-perspective surgical workflow modeling and online situation models will be a significant pre-requisite for reliable and intelligent systems behavior. Hence, they will contribute to a cooperative OR environment. Copyright © 2015 Elsevier Inc. All rights reserved.

Is the omega sign a reliable landmark for the neurosurgical team? An anatomical study about the central sulcus region

Directory of Open Access Journals (Sweden)

Thiago Rodrigues

2015-11-01

Full Text Available ABSTRACTThe central sulcus region is an eloquent area situated between the frontal and parietal lobes. During neurosurgical procedures, it is sometimes difficult to understand the cortical anatomy of this region.Objective Find alternative ways to anatomically navigate in this region during neurosurgical procedures.Method We analyzed eighty two human hemispheres using a surgical microscope and completed a review of the literature about central sulcus region.Results In 68/82 hemispheres, the central sulcus did not reach the posterior ramus of the lateral sulcus. A knob on the second curve of the precentral gyrus was reliably identified in only 64/82 hemispheres.Conclusion The morphometric data presented in this article can be useful as supplementary method to identify the central sulcus region landmarks.

An Integrated Hydro-Economic Modelling Framework to Evaluate Water Allocation Strategies I: Model Development.

NARCIS (Netherlands)

George, B.; Malano, H.; Davidson, B.; Hellegers, P.; Bharati, L.; Sylvain, M.

2011-01-01

In this paper an integrated modelling framework for water resources planning and management that can be used to carry out an analysis of alternative policy scenarios for water allocation and use is described. The modelling approach is based on integrating a network allocation model (REALM) and a

Medical Device Integration Model Based on the Internet of Things

Science.gov (United States)

Hao, Aiyu; Wang, Ling

2015-01-01

At present, hospitals in our country have basically established the HIS system, which manages registration, treatment, and charge, among many others, of patients. During treatment, patients need to use medical devices repeatedly to acquire all sorts of inspection data. Currently, the output data of the medical devices are often manually input into information system, which is easy to get wrong or easy to cause mismatches between inspection reports and patients. For some small hospitals of which information construction is still relatively weak, the information generated by the devices is still presented in the form of paper reports. When doctors or patients want to have access to the data at a given time again, they can only look at the paper files. Data integration between medical devices has long been a difficult problem for the medical information system, because the data from medical devices are lack of mandatory unified global standards and have outstanding heterogeneity of devices. In order to protect their own interests, manufacturers use special protocols, etc., thus causing medical decices to still be the "lonely island" of hospital information system. Besides, unfocused application of the data will lead to failure to achieve a reasonable distribution of medical resources. With the deepening of IT construction in hospitals, medical information systems will be bound to develop towards mobile applications, intelligent analysis, and interconnection and interworking, on the premise that there is an effective medical device integration (MDI) technology. To this end, this paper presents a MDI model based on the Internet of Things (IoT). Through abstract classification, this model is able to extract the common characteristics of the devices, resolve the heterogeneous differences between them, and employ a unified protocol to integrate data between devices. And by the IoT technology, it realizes interconnection network of devices and conducts associate matching

Modeling energy-economy interactions using integrated models

International Nuclear Information System (INIS)

Uyterlinde, M.A.

1994-06-01

Integrated models are defined as economic energy models that consist of several submodels, either coupled by an interface module, or embedded in one large model. These models can be used for energy policy analysis. Using integrated models yields the following benefits. They provide a framework in which energy-economy interactions can be better analyzed than in stand-alone models. Integrated models can represent both energy sector technological details, as well as the behaviour of the market and the role of prices. Furthermore, the combination of modeling methodologies in one model can compensate weaknesses of one approach with strengths of another. These advantages motivated this survey of the class of integrated models. The purpose of this literature survey therefore was to collect and to present information on integrated models. To carry out this task, several goals were identified. The first goal was to give an overview of what is reported on these models in general. The second one was to find and describe examples of such models. Other goals were to find out what kinds of models were used as component models, and to examine the linkage methodology. Solution methods and their convergence properties were also a subject of interest. The report has the following structure. In chapter 2, a 'conceptual framework' is given. In chapter 3 a number of integrated models is described. In a table, a complete overview is presented of all described models. Finally, in chapter 4, the report is summarized, and conclusions are drawn regarding the advantages and drawbacks of integrated models. 8 figs., 29 refs

POLARIS: Agent-based modeling framework development and implementation for integrated travel demand and network and operations simulations

Energy Technology Data Exchange (ETDEWEB)

Auld, Joshua; Hope, Michael; Ley, Hubert; Sokolov, Vadim; Xu, Bo; Zhang, Kuilin

2016-03-01

This paper discusses the development of an agent-based modelling software development kit, and the implementation and validation of a model using it that integrates dynamic simulation of travel demand, network supply and network operations. A description is given of the core utilities in the kit: a parallel discrete event engine, interprocess exchange engine, and memory allocator, as well as a number of ancillary utilities: visualization library, database IO library, and scenario manager. The overall framework emphasizes the design goals of: generality, code agility, and high performance. This framework allows the modeling of several aspects of transportation system that are typically done with separate stand-alone software applications, in a high-performance and extensible manner. The issue of integrating such models as dynamic traffic assignment and disaggregate demand models has been a long standing issue for transportation modelers. The integrated approach shows a possible way to resolve this difficulty. The simulation model built from the POLARIS framework is a single, shared-memory process for handling all aspects of the integrated urban simulation. The resulting gains in computational efficiency and performance allow planning models to be extended to include previously separate aspects of the urban system, enhancing the utility of such models from the planning perspective. Initial tests with case studies involving traffic management center impacts on various network events such as accidents, congestion and weather events, show the potential of the system.

The Process Model of Group-Based Emotion: Integrating Intergroup Emotion and Emotion Regulation Perspectives.

Science.gov (United States)

Goldenberg, Amit; Halperin, Eran; van Zomeren, Martijn; Gross, James J

2016-05-01

Scholars interested in emotion regulation have documented the different goals and strategies individuals have for regulating their emotions. However, little attention has been paid to the regulation of group-based emotions, which are based on individuals' self-categorization as a group member and occur in response to situations perceived as relevant for that group. We propose a model for examining group-based emotion regulation that integrates intergroup emotions theory and the process model of emotion regulation. This synergy expands intergroup emotion theory by facilitating further investigation of different goals (i.e., hedonic or instrumental) and strategies (e.g., situation selection and modification strategies) used to regulate group-based emotions. It also expands emotion regulation research by emphasizing the role of self-categorization (e.g., as an individual or a group member) in the emotional process. Finally, we discuss the promise of this theoretical synergy and suggest several directions for future research on group-based emotion regulation. © 2015 by the Society for Personality and Social Psychology, Inc.

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

Science.gov (United States)

Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

2015-01-01

Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

Post-neurosurgical meningitis: Management of cerebrospinal fluid drainage catheters influences the evolution of infection

OpenAIRE

Laura Soavi; Manuela Rosina; Roberto Stefini; Alessia Fratianni; Barbara Cadeo; Silvia Magri; Nicola Latronico; Marco Fontanella; Liana Signorini

2016-01-01

Background: In order to better define the pathogenic role of cerebrospinal fluid (CSF) drainage catheters in postoperative patients, we comparatively analyze the clinical course of device and non-device-related meningitis. Methods: This is an observational, partially prospective, study on consecutive adult patients who developed meningitis after undergoing neurosurgical procedures at the Neurosurgery and Neurointensive care Departments, Spedali Civili, Brescia, Italy, between January 1999...

Combining integrated river modelling and agent based social simulation for river management; The case study of the Grensmaas project

NARCIS (Netherlands)

Valkering, P.; Krywkow, Jorg; Rotmans, J.; van der Veen, A.; Douben, N.; van Os, A.G.

2003-01-01

In this paper we present a coupled Integrated River Model – Agent Based Social Simulation model (IRM-ABSS) for river management. The models represent the case of the ongoing river engineering project “Grensmaas”. In the ABSS model stakeholders are represented as computer agents negotiating a river

Breaking bad news to a prospective cross-sectional sample of patients’ relatives in a Nigerian neurosurgical service

Directory of Open Access Journals (Sweden)

Amos Olufemi Adeleye

2013-08-01

Full Text Available Objectives: Breaking of medical bad news is anecdotally deemed culturally unacceptable, even intolerable, to native Africans. We explored this hypothesis among a cohort of relatives of patients who had difficult neurosurgical diagnoses in an indigenous practice. Materials and Methods: A semi-structured, interviewer-administered questionnaire was used in a cross-sectional survey among a consecutive cohort of surrogates / relatives of concerned patients. Their opinion and preferences regarding the full disclosure of the grave neurosurgical diagnoses, and prognoses, of their wards were analysed. Results: A total of 114 patients’ relatives, 83 (72.8% females, were sampled. They were mainly young adults, mean age 40.2(SD 14.2 years; 57% had only basic literacy education; but the majority, 97%, declared themselves to have serious religious commitments. Ninety nine percent of the study participants deemed it desirable that either they or the patients concerned be told the bad news; 80.7% felt that this is best done with both patients and relations in attendance; 3.5% felt only the patients need be told. These preferences are similar to those expressed by the patients themselves in an earlier study. But a nearly significant greater proportion of patients’ relatives (15 vs 5%, p=0.06 would rather be the only ones to be told the patients’ bad news. Conclusions: This data-driven study showed that contrary to anecdotal belief about them, a cohort of native Nigerian-African surrogates of neurosurgical patients was well disposed to receiving, and appeared able to handle well, the full disclosure of difficult medical diagnostic / prognostic information.

An Enhanced Error Model for EKF-Based Tightly-Coupled Integration of GPS and Land Vehicle’s Motion Sensors

Science.gov (United States)

Karamat, Tashfeen B.; Atia, Mohamed M.; Noureldin, Aboelmagd

2015-01-01

Reduced inertial sensor systems (RISS) have been introduced by many researchers as a low-cost, low-complexity sensor assembly that can be integrated with GPS to provide a robust integrated navigation system for land vehicles. In earlier works, the developed error models were simplified based on the assumption that the vehicle is mostly moving on a flat horizontal plane. Another limitation is the simplified estimation of the horizontal tilt angles, which is based on simple averaging of the accelerometers’ measurements without modelling their errors or tilt angle errors. In this paper, a new error model is developed for RISS that accounts for the effect of tilt angle errors and the accelerometer’s errors. Additionally, it also includes important terms in the system dynamic error model, which were ignored during the linearization process in earlier works. An augmented extended Kalman filter (EKF) is designed to incorporate tilt angle errors and transversal accelerometer errors. The new error model and the augmented EKF design are developed in a tightly-coupled RISS/GPS integrated navigation system. The proposed system was tested on real trajectories’ data under degraded GPS environments, and the results were compared to earlier works on RISS/GPS systems. The findings demonstrated that the proposed enhanced system introduced significant improvements in navigational performance. PMID:26402680

A cortical edge-integration model of object-based lightness computation that explains effects of spatial context and individual differences

Science.gov (United States)

Rudd, Michael E.

2014-01-01

Previous work has demonstrated that perceived surface reflectance (lightness) can be modeled in simple contexts in a quantitatively exact way by assuming that the visual system first extracts information about local, directed steps in log luminance, then spatially integrates these steps along paths through the image to compute lightness (Rudd and Zemach, 2004, 2005, 2007). This method of computing lightness is called edge integration. Recent evidence (Rudd, 2013) suggests that human vision employs a default strategy to integrate luminance steps only along paths from a common background region to the targets whose lightness is computed. This implies a role for gestalt grouping in edge-based lightness computation. Rudd (2010) further showed the perceptual weights applied to edges in lightness computation can be influenced by the observer's interpretation of luminance steps as resulting from either spatial variation in surface reflectance or illumination. This implies a role for top-down factors in any edge-based model of lightness (Rudd and Zemach, 2005). Here, I show how the separate influences of grouping and attention on lightness can be modeled in tandem by a cortical mechanism that first employs top-down signals to spatially select regions of interest for lightness computation. An object-based network computation, involving neurons that code for border-ownership, then automatically sets the neural gains applied to edge signals surviving the earlier spatial selection stage. Only the borders that survive both processing stages are spatially integrated to compute lightness. The model assumptions are consistent with those of the cortical lightness model presented earlier by Rudd (2010, 2013), and with neurophysiological data indicating extraction of local edge information in V1, network computations to establish figure-ground relations and border ownership in V2, and edge integration to encode lightness and darkness signals in V4. PMID:25202253

A Cortical Edge-integration Model of Object-Based Lightness Computation that Explains Effects of Spatial Context and Individual Differences

Directory of Open Access Journals (Sweden)

Michael E Rudd

2014-08-01

Full Text Available Previous work demonstrated that perceived surface reflectance (lightness can be modeled in simple contexts in a quantitatively exact way by assuming that the visual system first extracts information about local, directed steps in log luminance, then spatial integrates these steps along paths through the image to compute lightness (Rudd & Zemach, 2004, 2005, 2007. This method of computing lightness is called edge integration. Recent evidence (Rudd, 2013 suggests that the human vision employs a default strategy to integrate luminance steps only along paths from a common background region to the targets whose lightness is computed. This implies a role for gestalt grouping in edge-based lightness computation. Rudd (2010 further showed the perceptual weights applied to edges in lightness computation can be influenced by the observer’s interpretation of luminance steps as resulting from either spatial variation in surface reflectance or illumination. This implies a role for top-down factors in any edge-based model of lightness (Rudd & Zemach, 2005. Here, I show how the separate influences of grouping and attention on lightness can be together modeled by a cortical mechanism that first employs top-down signals to spatially select regions of interest for lightness computation. An object-based network computation, involving neurons that code for border-ownership, then automatically sets the neural gains applied to edge signals surviving the earlier spatial selection stage. Only the borders that survive both processing stages are spatially integrated to compute lightness. The model assumptions are consistent with those of the cortical lightness model presented earlier by Rudd (2010, 2013, and with neurophysiological data indicating extraction of local edge information in V1, network computations to establish figure-ground relations and border ownership in V2, and edge integration to encode lightness and darkness signals in V4.

A cortical edge-integration model of object-based lightness computation that explains effects of spatial context and individual differences.

Science.gov (United States)

Rudd, Michael E

2014-01-01

Previous work has demonstrated that perceived surface reflectance (lightness) can be modeled in simple contexts in a quantitatively exact way by assuming that the visual system first extracts information about local, directed steps in log luminance, then spatially integrates these steps along paths through the image to compute lightness (Rudd and Zemach, 2004, 2005, 2007). This method of computing lightness is called edge integration. Recent evidence (Rudd, 2013) suggests that human vision employs a default strategy to integrate luminance steps only along paths from a common background region to the targets whose lightness is computed. This implies a role for gestalt grouping in edge-based lightness computation. Rudd (2010) further showed the perceptual weights applied to edges in lightness computation can be influenced by the observer's interpretation of luminance steps as resulting from either spatial variation in surface reflectance or illumination. This implies a role for top-down factors in any edge-based model of lightness (Rudd and Zemach, 2005). Here, I show how the separate influences of grouping and attention on lightness can be modeled in tandem by a cortical mechanism that first employs top-down signals to spatially select regions of interest for lightness computation. An object-based network computation, involving neurons that code for border-ownership, then automatically sets the neural gains applied to edge signals surviving the earlier spatial selection stage. Only the borders that survive both processing stages are spatially integrated to compute lightness. The model assumptions are consistent with those of the cortical lightness model presented earlier by Rudd (2010, 2013), and with neurophysiological data indicating extraction of local edge information in V1, network computations to establish figure-ground relations and border ownership in V2, and edge integration to encode lightness and darkness signals in V4.

Effect of Geopolitical Forces on Neurosurgical Training in Sub-Saharan Africa.

Science.gov (United States)

Dempsey, Kara E; Qureshi, Mahmood M; Ondoma, Solomon M; Dempsey, Robert J

2017-05-01

The population of Sub-Saharan Africa suffers from a critical shortage and maldistribution of health care professionals, especially highlighted in surgical subspecialties, such as neurosurgery. In light of The Lancet report and the World Health Organization's directive to provide essential surgical care through the developing world, solutions need to be found to close this training and distribution gap. Methods correcting the situation will only succeed if one understands the geopolitical forces which have shaped the distribution of health care in the region and continue to this day. Solutions have evolved from service to service with education. The partnering organizations, the Foundation of International Education in Neurological Surgery and the World Federation of Neurosurgical Societies, have supported neurosurgical training in the developing world, including curriculum, equipment, facilities, certification, and local acceptance, with a goal of developing a self-sustaining program within the developing country. These ideas heavily rely on partnerships to address classic geopolitical forces, including geography, drought, warfare, ethnic tensions, poverty, and lack of training facilities. Each can be addressed through partnerships, such as development of dyads with programs in developed countries and ongoing programs owned by the countries in question, but partnered with multiple international societies, institutions, and universities. This paper provides both a historic and topical overview of the forces at work which need to be addressed for success in delivering specialized care. This must always result in a self-sustaining program operated by the people of the home country with worldwide support through philanthropy and partnerships. Published by Elsevier Inc.

Integrative platform based on the mechatronics model for educational technologies focused on competence

Science.gov (United States)

Vlaşin, I.; Greta, S.; Dache, L.; Mătieş, V.

2016-08-01

Mechatronics is a model of transdisciplinary integration, entirely functional, with remarkable results for mankind. The incredible progress that the global economy has taken in the last decades is based on this new approach, the integrative type, which is present at the foundation of mechatronics. This kind of integrative approach is necessary for building a quality education focused on competence. The requirements from the social and economic environment, the needs of the young people who prepare themselves for an active life and the offers of the education providers are still not too interconnected to offer a satisfying education. This is the reason why the efforts to balance the demand, the needs and the offer are essential to ensure a better integration of students into society. Using a transcultural perspective, we can achieve a constructive approach. The education providers, together with the socio-economic environment, establish a clear structure of competence in multiple domains and of the instruments which can assure it. The scientific demarche, in the spirit of this paper approach the, answers the natural questions from the educational process: „Why, How and What do I learn?”.

VBSM: VCC-Based Black Box Service Model with Enhanced Data Integrity

Directory of Open Access Journals (Sweden)

Won Min Kang

2014-10-01

Full Text Available Recently, intelligent transport systems have been applied to vehicle cloud environments. Such technology is especially useful for the systematic management of road traffic. Moreover, automobiles are increasingly equipped with a black box for accident prevention and preservation of evidence. Vehicle black boxes have become mandatory because black box images and voice data have served as forensic evidence in courts. However, the data from black boxes can be forged or modified by man-in-the-middle (MITM attacks and message hijacking. In this paper, we propose a vehicle cloud computing-based black box service model that can provide integrity for black box data through digital signatures in vehicle cloud computing (VCC environments. Our proposed model protects against MITM attacks and message hijacking using only a hash value and digital signature. Moreover, a mirroring technique (RAID 1 provides backup and recovery to protect the data from a traffic accident.

An integrative model of organizational safety behavior.

Science.gov (United States)

Cui, Lin; Fan, Di; Fu, Gui; Zhu, Cherrie Jiuhua

2013-06-01

This study develops an integrative model of safety management based on social cognitive theory and the total safety culture triadic framework. The purpose of the model is to reveal the causal linkages between a hazardous environment, safety climate, and individual safety behaviors. Based on primary survey data from 209 front-line workers in one of the largest state-owned coal mining corporations in China, the model is tested using structural equation modeling techniques. An employee's perception of a hazardous environment is found to have a statistically significant impact on employee safety behaviors through a psychological process mediated by the perception of management commitment to safety and individual beliefs about safety. The integrative model developed here leads to a comprehensive solution that takes into consideration the environmental, organizational and employees' psychological and behavioral aspects of safety management. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

Integrated materials–structural models

DEFF Research Database (Denmark)

Stang, Henrik; Geiker, Mette Rica

2008-01-01

, repair works and strengthening methods for structures. A very significant part of the infrastructure consists of reinforced concrete structures. Even though reinforced concrete structures typically are very competitive, certain concrete structures suffer from various types of degradation. A framework...... should define a framework in which materials research results eventually should fit in and on the other side the materials research should define needs and capabilities in structural modelling. Integrated materials-structural models of a general nature are almost non-existent in the field of cement based...

An integrated modeling framework of socio-economic, biophysical, and hydrological processes in Midwest landscapes: Remote sensing data, agro-hydrological model, and agent-based model

Science.gov (United States)

Ding, Deng

Intensive human-environment interactions are taking place in Midwestern agricultural systems. An integrated modeling framework is suitable for predicting dynamics of key variables of the socio-economic, biophysical, hydrological processes as well as exploring the potential transitions of system states in response to changes of the driving factors. The purpose of this dissertation is to address issues concerning the interacting processes and consequent changes in land use, water balance, and water quality using an integrated modeling framework. This dissertation is composed of three studies in the same agricultural watershed, the Clear Creek watershed in East-Central Iowa. In the first study, a parsimonious hydrologic model, the Threshold-Exceedance-Lagrangian Model (TELM), is further developed into RS-TELM (Remote Sensing TELM) to integrate remote sensing vegetation data for estimating evapotranspiration. The goodness of fit of RS-TELM is comparable to a well-calibrated SWAT (Soil and Water Assessment Tool) and even slightly superior in capturing intra-seasonal variability of stream flow. The integration of RS LAI (Leaf Area Index) data improves the model's performance especially over the agriculture dominated landscapes. The input of rainfall datasets with spatially explicit information plays a critical role in increasing the model's goodness of fit. In the second study, an agent-based model is developed to simulate farmers' decisions on crop type and fertilizer application in response to commodity and biofuel crop prices. The comparison between simulated crop land percentage and crop rotations with satellite-based land cover data suggest that farmers may be underestimating the effects that continuous corn production has on yields (yield drag). The simulation results given alternative market scenarios based on a survey of agricultural land owners and operators in the Clear Creek Watershed show that, farmers see cellulosic biofuel feedstock production in the form

Challenges in horizontal model integration.

Science.gov (United States)

Kolczyk, Katrin; Conradi, Carsten

2016-03-11

Systems Biology has motivated dynamic models of important intracellular processes at the pathway level, for example, in signal transduction and cell cycle control. To answer important biomedical questions, however, one has to go beyond the study of isolated pathways towards the joint study of interacting signaling pathways or the joint study of signal transduction and cell cycle control. Thereby the reuse of established models is preferable, as it will generally reduce the modeling effort and increase the acceptance of the combined model in the field. Obtaining a combined model can be challenging, especially if the submodels are large and/or come from different working groups (as is generally the case, when models stored in established repositories are used). To support this task, we describe a semi-automatic workflow based on established software tools. In particular, two frequent challenges are described: identification of the overlap and subsequent (re)parameterization of the integrated model. The reparameterization step is crucial, if the goal is to obtain a model that can reproduce the data explained by the individual models. For demonstration purposes we apply our workflow to integrate two signaling pathways (EGF and NGF) from the BioModels Database.

Working time of neurosurgical residents in Europe--results of a multinational survey.

Science.gov (United States)

Stienen, Martin N; Netuka, David; Demetriades, Andreas K; Ringel, Florian; Gautschi, Oliver P; Gempt, Jens; Kuhlen, Dominique; Schaller, Karl

2016-01-01

The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training. A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time). A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work 80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p 50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002). The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work

Vertically Integrated Models for Carbon Storage Modeling in Heterogeneous Domains

Science.gov (United States)

Bandilla, K.; Celia, M. A.

2017-12-01

Numerical modeling is an essential tool for studying the impacts of geologic carbon storage (GCS). Injection of carbon dioxide (CO2) into deep saline aquifers leads to multi-phase flow (injected CO2 and resident brine), which can be described by a set of three-dimensional governing equations, including mass-balance equation, volumetric flux equations (modified Darcy), and constitutive equations. This is the modeling approach on which commonly used reservoir simulators such as TOUGH2 are based. Due to the large density difference between CO2 and brine, GCS models can often be simplified by assuming buoyant segregation and integrating the three-dimensional governing equations in the vertical direction. The integration leads to a set of two-dimensional equations coupled with reconstruction operators for vertical profiles of saturation and pressure. Vertically-integrated approaches have been shown to give results of comparable quality as three-dimensional reservoir simulators when applied to realistic CO2 injection sites such as the upper sand wedge at the Sleipner site. However, vertically-integrated approaches usually rely on homogeneous properties over the thickness of a geologic layer. Here, we investigate the impact of general (vertical and horizontal) heterogeneity in intrinsic permeability, relative permeability functions, and capillary pressure functions. We consider formations involving complex fluvial deposition environments and compare the performance of vertically-integrated models to full three-dimensional models for a set of hypothetical test cases consisting of high permeability channels (streams) embedded in a low permeability background (floodplains). The domains are randomly generated assuming that stream channels can be represented by sinusoidal waves in the plan-view and by parabolas for the streams' cross-sections. Stream parameters such as width, thickness and wavelength are based on values found at the Ketzin site in Germany. Results from the

Decision-Based Design Integrating Consumer Preferences into Engineering Design

CERN Document Server

Chen, Wei; Wassenaar, Henk Jan

2013-01-01

Building upon the fundamental principles of decision theory, Decision-Based Design: Integrating Consumer Preferences into Engineering Design presents an analytical approach to enterprise-driven Decision-Based Design (DBD) as a rigorous framework for decision making in engineering design.  Once the related fundamentals of decision theory, economic analysis, and econometrics modelling are established, the remaining chapters describe the entire process, the associated analytical techniques, and the design case studies for integrating consumer preference modeling into the enterprise-driven DBD framework. Methods for identifying key attributes, optimal design of human appraisal experiments, data collection, data analysis, and demand model estimation are presented and illustrated using engineering design case studies. The scope of the chapters also provides: •A rigorous framework of integrating the interests from both producer and consumers in engineering design, •Analytical techniques of consumer choice model...

An Integrated Model Based on a Hierarchical Indices System for Monitoring and Evaluating Urban Sustainability

Directory of Open Access Journals (Sweden)

Xulin Guo

2013-02-01

Full Text Available Over 50% of world’s population presently resides in cities, and this number is expected to rise to ~70% by 2050. Increasing urbanization problems including population growth, urban sprawl, land use change, unemployment, and environmental degradation, have markedly impacted urban residents’ Quality of Life (QOL. Therefore, urban sustainability and its measurement have gained increasing attention from administrators, urban planners, and scientific communities throughout the world with respect to improving urban development and human well-being. The widely accepted definition of urban sustainability emphasizes the balancing development of three primary domains (urban economy, society, and environment. This article attempts to improve the aforementioned definition of urban sustainability by incorporating a human well-being dimension. Major problems identified in existing urban sustainability indicator (USI models include a weak integration of potential indicators, poor measurement and quantification, and insufficient spatial-temporal analysis. To tackle these challenges an integrated USI model based on a hierarchical indices system was established for monitoring and evaluating urban sustainability. This model can be performed by quantifying indicators using both traditional statistical approaches and advanced geomatic techniques based on satellite imagery and census data, which aims to provide a theoretical basis for a comprehensive assessment of urban sustainability from a spatial-temporal perspective.

Has the impact of the working time regulations changed neurosurgical trainees' attitudes towards the European working time directive 5 years on?

Science.gov (United States)

Cowie, Christopher J A; Pešić-Smith, Jonathan D; Boukas, Alexandros; Nelson, Richard J

2013-10-01

We report the results from a survey of the British Neurosurgical Trainees' Association which aimed to assess current rota patterns and their compliance with the government's working time regulations. The survey questioned whether trainees felt that shift working, imposed as a result of the European working time directive, is continuing to impact on patient care and training opportunities in neurosurgery. The responses to this survey indicate that neurosurgical trainees remain concerned with the impact that the current working time regulations have on all facets of their work: training, work- life balance, and the provision of patient care. The survey comments show that the majority would support a change in legislation to allow greater flexibility in the working time regulations.

Reconstruction of biological networks based on life science data integration.

Science.gov (United States)

Kormeier, Benjamin; Hippe, Klaus; Arrigo, Patrizio; Töpel, Thoralf; Janowski, Sebastian; Hofestädt, Ralf

2010-10-27

For the implementation of the virtual cell, the fundamental question is how to model and simulate complex biological networks. Therefore, based on relevant molecular database and information systems, biological data integration is an essential step in constructing biological networks. In this paper, we will motivate the applications BioDWH--an integration toolkit for building life science data warehouses, CardioVINEdb--a information system for biological data in cardiovascular-disease and VANESA--a network editor for modeling and simulation of biological networks. Based on this integration process, the system supports the generation of biological network models. A case study of a cardiovascular-disease related gene-regulated biological network is also presented.

Stereoscopic Three-Dimensional Neuroanatomy Lectures Enhance Neurosurgical Training: Prospective Comparison with Traditional Teaching.

Science.gov (United States)

Clark, Anna D; Guilfoyle, Mathew R; Candy, Nicholas G; Budohoski, Karol P; Hofmann, Riikka; Barone, Damiano G; Santarius, Thomas; Kirollos, Ramez W; Trivedi, Rikin A

2017-12-01

Stereoscopic three-dimensional (3D) imaging is increasingly used in the teaching of neuroanatomy and although this is mainly aimed at undergraduate medical students, it has enormous potential for enhancing the training of neurosurgeons. This study aims to assess whether 3D lecturing is an effective method of enhancing the knowledge and confidence of neurosurgeons and how it compares with traditional two-dimensional (2D) lecturing and cadaveric training. Three separate teaching sessions for neurosurgical trainees were organized: 1) 2D course (2D lecture + cadaveric session), 2) 3D lecture alone, and 3) 3D course (3D lecture + cadaveric session). Before and after each session, delegates were asked to complete questionnaires containing questions relating to surgical experience, anatomic knowledge, confidence in performing procedures, and perceived value of 3D, 2D, and cadaveric teaching. Although both 2D and 3D lectures and courses were similarly effective at improving self-rated knowledge and understanding, the 3D lecture and course were associated with significantly greater gains in confidence reported by the delegates for performing a subfrontal approach and sylvian fissure dissection. Stereoscopic 3D lectures provide neurosurgical trainees with greater confidence for performing standard operative approaches and enhances the benefit of subsequent practical experience in developing technical skills in cadaveric dissection. Copyright © 2017. Published by Elsevier Inc.

Integrated freight network model : a GIS-based platform for transportation analyses.

Science.gov (United States)

2015-01-01

The models currently used to examine the behavior transportation systems are usually mode-specific. That is, they focus on a single mode (i.e. railways, highways, or waterways). The lack of : integration limits the usefulness of models to analyze the...

An integrated model of statistical process control and maintenance based on the delayed monitoring

International Nuclear Information System (INIS)

Yin, Hui; Zhang, Guojun; Zhu, Haiping; Deng, Yuhao; He, Fei

2015-01-01

This paper develops an integrated model of statistical process control and maintenance decision. The proposal of delayed monitoring policy postpones the sampling process till a scheduled time and contributes to ten-scenarios of the production process, where equipment failure may occur besides quality shift. The equipment failure and the control chart alert trigger the corrective maintenance and the predictive maintenance, respectively. The occurrence probability, the cycle time and the cycle cost of each scenario are obtained by integral calculation; therefore, a mathematical model is established to minimize the expected cost by using the genetic algorithm. A Monte Carlo simulation experiment is conducted and compared with the integral calculation in order to ensure the analysis of the ten-scenario model. Another ordinary integrated model without delayed monitoring is also established as comparison. The results of a numerical example indicate satisfactory economic performance of the proposed model. Finally, a sensitivity analysis is performed to investigate the effect of model parameters. - Highlights: • We develop an integrated model of statistical process control and maintenance. • We propose delayed monitoring policy and derive an economic model with 10 scenarios. • We consider two deterioration mechanisms, quality shift and equipment failure. • The delayed monitoring policy will help reduce the expected cost

Principles of integrated modeling of coal seam mining

Energy Technology Data Exchange (ETDEWEB)

Magda, R

1983-01-01

Mathematical modeling of underground coal mining is discussed. Construction of a mathematical model of an underground mine is analyzed. The model is based on integrating the elementary units (modules). A so-called elementary mining field is defined with the example of a longwall face. A model of an elementary coal seam zone is constructed by integrating the elementary mining fields (in time and space) and supplementing them with a suitable model of mine roadway structure. By integrating the elementary coal seam zones a model of mining level is constructed. Such a mathematical model is used for optimizing the selected mining parameters e.g. structure of mine roadways, size of a coal mine, and organizational scheme of underground mining in a mine or in a mine section using the standardized optimization criterion e.g. investment. Use of the integration model of underground mining for optimizing coal mine construction is evaluated. The following elements of investment and operating cost are considered: shaft excavation, shaft equipment, investment in mining sections, ventilation, mine draining etc. 1 reference.

Models, methods and software for distributed knowledge acquisition for the automated construction of integrated expert systems knowledge bases

International Nuclear Information System (INIS)

Dejneko, A.O.

2011-01-01

Based on an analysis of existing models, methods and means of acquiring knowledge, a base method of automated knowledge acquisition has been chosen. On the base of this method, a new approach to integrate information acquired from knowledge sources of different typologies has been proposed, and the concept of a distributed knowledge acquisition with the aim of computerized formation of the most complete and consistent models of problem areas has been introduced. An original algorithm for distributed knowledge acquisition from databases, based on the construction of binary decision trees has been developed [ru

International Subarachnoid Aneurysm Trial 2009 : Endovascular Coiling of Ruptured Intracranial Aneurysms Has No Significant Advantage Over Neurosurgical Clipping

NARCIS (Netherlands)

Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Mooij, Jan Jakob A.; Van Dijk, J. Marc C.

In the May 2009 issue of The Lancet Neurology, the 5-year follow-up results of the International Subarachnoid Aneurysm Trial (ISAT) were published. The authors concluded that, although the significant difference between coiling and neurosurgical clipping of ruptured intracranial aneurysms in terms

On-board adaptive model for state of charge estimation of lithium-ion batteries based on Kalman filter with proportional integral-based error adjustment

Science.gov (United States)

Wei, Jingwen; Dong, Guangzhong; Chen, Zonghai

2017-10-01

With the rapid development of battery-powered electric vehicles, the lithium-ion battery plays a critical role in the reliability of vehicle system. In order to provide timely management and protection for battery systems, it is necessary to develop a reliable battery model and accurate battery parameters estimation to describe battery dynamic behaviors. Therefore, this paper focuses on an on-board adaptive model for state-of-charge (SOC) estimation of lithium-ion batteries. Firstly, a first-order equivalent circuit battery model is employed to describe battery dynamic characteristics. Then, the recursive least square algorithm and the off-line identification method are used to provide good initial values of model parameters to ensure filter stability and reduce the convergence time. Thirdly, an extended-Kalman-filter (EKF) is applied to on-line estimate battery SOC and model parameters. Considering that the EKF is essentially a first-order Taylor approximation of battery model, which contains inevitable model errors, thus, a proportional integral-based error adjustment technique is employed to improve the performance of EKF method and correct model parameters. Finally, the experimental results on lithium-ion batteries indicate that the proposed EKF with proportional integral-based error adjustment method can provide robust and accurate battery model and on-line parameter estimation.

An Analysis of Delay-based and Integrator-based Sequence Detectors for Grid-Connected Converters

DEFF Research Database (Denmark)

Khazraj, Hesam; Silva, Filipe Miguel Faria da; Bak, Claus Leth

2017-01-01

-signal cancellation operators are the main members of the delay-based sequence detectors. The aim of this paper is to provide a theoretical and experimental comparative study between integrator and delay based sequence detectors. The theoretical analysis is conducted based on the small-signal modelling......Detecting and separating positive and negative sequence components of the grid voltage or current is of vital importance in the control of grid-connected power converters, HVDC systems, etc. To this end, several techniques have been proposed in recent years. These techniques can be broadly...... classified into two main classes: The integrator-based techniques and Delay-based techniques. The complex-coefficient filter-based technique, dual second-order generalized integrator-based method, multiple reference frame approach are the main members of the integrator-based sequence detector and the delay...

Integrative oncology for breast cancer patients: introduction of an expert-based model

International Nuclear Information System (INIS)

Dobos, Gustav J; Voiss, Petra; Schwidde, Ilka; Choi, Kyung-Eun; Paul, Anna; Kirschbaum, Barbara; Saha, Felix J; Kuemmel, Sherko

2012-01-01

Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient’s psychological and spiritual needs. The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices. Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed. Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients

Feasibility of simultaneous sodium fluorescein and indocyanine green injection in neurosurgical procedures.

Science.gov (United States)

Acerbi, F; Restelli, F; Broggi, M; Schiariti, M; Ferroli, P

2016-07-01

The objective of this study is to assess the feasibility of simultaneous Sodium Fluorescein (SF) and Indocyanine Green (ICG) injection during neurosurgical procedures. Three patients harboring a high-grade glioma (HGG) were retrospectively identified in the surgical database of the Neurosurgical Unit 2 at the Foundation IRCCS Istituto Neurologico C. Besta in Milan, by having received intraoperatively both SF for tumor resection and ICG for vasculature angiographic studies in the same surgical procedure. We identified 2 males and 1 female (age range 25-60). Lesions were located in the left temporo-polar area and hippocampus (1 case), right superior frontal gyrus (1 case), left supplementary motor area (1 case). All the three lesions showed Magnetic Resonance Imaging (MRI) characteristics of HGG and, for this reason, in all patients a fluorescein-guided tumor removal was proposed. In the same surgical procedure ICG videoangiography was considered necessary in order to study arterial and venous vasculature, given by the strict relation of the tumor with an unexpected Posterior Communicating Artery (PComA) aneurysm in one case and with cortical drainage veins complexes in the other two cases. In all cases a microscope equipped with both YELLOW560 and IR800 integrated filters (Pentero 900, Carl Zeiss, Oberkorchen, Germany) was used. Fluorescein was i.v. injected at a dose of 5mg/kg immediately after patient intubation. ICG was i.v. injected in bolus on demand of the operating surgeon at a dose of 12.5mg. No side-effects related to simultaneous injection of SF and ICG were identified. In all three cases, the use of SF allowed to better visualize the tumor areas during surgical removal, thus leading to a radical resection until no macroscopic appearance of residual tumor mass and no fluorescence was visible in the surgical cavity. ICG videoangiography confirmed the patency of branches of internal carotid artery after clipping of an unexpected small PComA aneurysm found

Integrating Seasonal Oscillations into Basel II Behavioural Scoring Models

Directory of Open Access Journals (Sweden)

Goran Klepac

2007-09-01

Full Text Available The article introduces a new methodology of temporal influence measurement (seasonal oscillations, temporal patterns for behavioural scoring development purposes. The paper shows how significant temporal variables can be recognised and then integrated into the behavioural scoring models in order to improve model performance. Behavioural scoring models are integral parts of the Basel II standard on Internal Ratings-Based Approaches (IRB. The IRB approach much more precisely reflects individual risk bank profile.A solution of the problem of how to analyze and integrate macroeconomic and microeconomic factors represented in time series into behavioural scorecard models will be shown in the paper by using the REF II model.

MMM: A toolbox for integrative structure modeling.

Science.gov (United States)

Jeschke, Gunnar

2018-01-01

Structural characterization of proteins and their complexes may require integration of restraints from various experimental techniques. MMM (Multiscale Modeling of Macromolecules) is a Matlab-based open-source modeling toolbox for this purpose with a particular emphasis on distance distribution restraints obtained from electron paramagnetic resonance experiments on spin-labelled proteins and nucleic acids and their combination with atomistic structures of domains or whole protomers, small-angle scattering data, secondary structure information, homology information, and elastic network models. MMM does not only integrate various types of restraints, but also various existing modeling tools by providing a common graphical user interface to them. The types of restraints that can support such modeling and the available model types are illustrated by recent application examples. © 2017 The Protein Society.

Theories and Frameworks for Online Education: Seeking an Integrated Model

Science.gov (United States)

Picciano, Anthony G.

2017-01-01

This article examines theoretical frameworks and models that focus on the pedagogical aspects of online education. After a review of learning theory as applied to online education, a proposal for an integrated "Multimodal Model for Online Education" is provided based on pedagogical purpose. The model attempts to integrate the work of…

Integrity Based Access Control Model for Multilevel XML Document

Institute of Scientific and Technical Information of China (English)

HONG Fan; FENG Xue-bin; HUANO Zhi; ZHENG Ming-hui

2008-01-01

XML's increasing popularity highlights the security demand for XML documents. A mandatory access control model for XML document is presented on the basis of investigation of the function dependency of XML documents and discussion of the integrity properties of multilevel XML document. Then, the algorithms for decomposition/recovery multilevel XML document into/from single level document are given, and the manipulation rules for typical operations of XQuery and XUpdate: QUERY, INSERT,UPDATE, and REMOVE, are elaborated. The multilevel XML document access model can meet the requirement of sensitive information processing application.

Nonlinear integral equations for the sausage model

Science.gov (United States)

Ahn, Changrim; Balog, Janos; Ravanini, Francesco

2017-08-01

The sausage model, first proposed by Fateev, Onofri, and Zamolodchikov, is a deformation of the O(3) sigma model preserving integrability. The target space is deformed from the sphere to ‘sausage’ shape by a deformation parameter ν. This model is defined by a factorizable S-matrix which is obtained by deforming that of the O(3) sigma model by a parameter λ. Clues for the deformed sigma model are provided by various UV and IR information through the thermodynamic Bethe ansatz (TBA) analysis based on the S-matrix. Application of TBA to the sausage model is, however, limited to the case of 1/λ integer where the coupled integral equations can be truncated to a finite number. In this paper, we propose a finite set of nonlinear integral equations (NLIEs), which are applicable to generic value of λ. Our derivation is based on T-Q relations extracted from the truncated TBA equations. For a consistency check, we compute next-leading order corrections of the vacuum energy and extract the S-matrix information in the IR limit. We also solved the NLIE both analytically and numerically in the UV limit to get the effective central charge and compared with that of the zero-mode dynamics to obtain exact relation between ν and λ. Dedicated to the memory of Petr Petrovich Kulish.

Save the patient a trip. Outcome difference between conservatively treated patients with traumatic brain injury in a nonspecialized intensive care unit vs a specialized neurosurgical intensive care unit in the Sultanate of Oman.

Science.gov (United States)

Al-Kashmiri, Ammar M; Al-Shaqsi, Sultan Z; Al-Kharusi, Adil S; Al-Tamimi, Laila A

2015-06-01

Traumatic brain injury (TBI) continues to be the main cause of death among trauma patients. Accurate diagnosis and timely surgical interventions are critical steps in reducing the mortality from this disease. For patients who have no surgically reversible head injury pathology, the decision to transfer to a dedicated neurosurgical unit is usually controversial. To compare the outcome of patients with severe TBI treated conservatively in a specialized neurosurgical intensive care unit (ICU) and those treated conservatively at a general ICU in the Sultanate of Oman. Retrospective cohort study. This is a retrospective study of patients with severe TBI admitted to Khoula Hospital ICU (specialized neurosurgical ICU) and Nizwa Hospital ICU (general ICU) in Oman in 2013. Surgically treated patients were excluded. Data extracted included demographics, injury details, interventions, and outcomes. The outcome variables included mortality, length of stay, length of ICU days, and ventilated days. There were 100 patients with severe TBI treated conservatively at Khoula Hospital compared with 74 patients at Nizwa Hospital. Basic demographics were similar between the 2 groups. No significant difference was found in mortality, length of stay, ICU days, and ventilation days. There is no difference in outcome between patients with TBI treated conservatively in a specialized neurosurgical ICU and those treated in a general nonspecialized ICU in Oman in 2013. Therefore, unless neurosurgical intervention is warranted or expected, patients with TBI may be managed in a general ICU, saving the risk and expense of a transfer to a specialized neurosurgical ICU. Copyright © 2015 Elsevier Inc. All rights reserved.

A Data-Driven, Integrated Flare Model Based on Self-Organized Criticality

Science.gov (United States)

Dimitropoulou, M.; Isliker, H.; Vlahos, L.; Georgoulis, M.

2013-09-01

flaring events with scaling indices in good agreement with observations. We therefore conclude that well-known statistical properties of flares are reproduced after active regions reach self-organized criticality. The significant enhancement in both the static and the dynamic integrated flare models is that they initiate the simulation from observations, thus facilitating energy calculation in physical units. Especially in the dynamic version of the model, the driving of the system is based on observed, evolving vector magnetograms, allowing for the separation between MHD and kinetic timescales through the assignment of distinct MHD timestamps to each interpolation step.

A Graph Based Framework to Model Virus Integration Sites

Directory of Open Access Journals (Sweden)

Raffaele Fronza

2016-01-01

Here, we addressed the challenge to: 1 define the notion of CIS on graph models, 2 demonstrate that the structure of CIS enters in the category of scale-free networks and 3 show that our network approach analyzes CIS dynamically in an integrated systems biology framework using the Retroviral Transposon Tagged Cancer Gene Database (RTCGD as a testing dataset.

CAD-Based Modeling of Advanced Rotary Wing Structures for Integrated 3-D Aeromechanics Analysis

Science.gov (United States)

Staruk, William

This dissertation describes the first comprehensive use of integrated 3-D aeromechanics modeling, defined as the coupling of 3-D solid finite element method (FEM) structural dynamics with 3-D computational fluid dynamics (CFD), for the analysis of a real helicopter rotor. The development of this new methodology (a departure from how rotor aeroelastic analysis has been performed for 40 years), its execution on a real rotor, and the fundamental understanding of aeromechanics gained from it, are the key contributions of this dissertation. This work also presents the first CFD/CSD analysis of a tiltrotor in edgewise flight, revealing many of its unique loading mechanisms. The use of 3-D FEM, integrated with a trim solver and aerodynamics modeling, has the potential to enhance the design of advanced rotors by overcoming fundamental limitations of current generation beam-based analysis tools and offering integrated internal dynamic stress and strain predictions for design. Two primary goals drove this research effort: 1) developing a methodology to create 3-D CAD-based brick finite element models of rotors including multibody joints, controls, and aerodynamic interfaces, and 2) refining X3D, the US Army's next generation rotor structural dynamics solver featuring 3-D FEM within a multibody formulation with integrated aerodynamics, to model a tiltrotor in the edgewise conversion flight regime, which drives critical proprotor structural loads. Prior tiltrotor analysis has primarily focused on hover aerodynamics with rigid blades or forward flight whirl-flutter stability with simplified aerodynamics. The first goal was met with the development of a detailed methodology for generating multibody 3-D structural models, starting from CAD geometry, continuing to higher-order hexahedral finite element meshing, to final assembly of the multibody model by creating joints, assigning material properties, and defining the aerodynamic interface. Several levels of verification and

Working toward integrated models of alpine plant distribution.

Science.gov (United States)

Carlson, Bradley Z; Randin, Christophe F; Boulangeat, Isabelle; Lavergne, Sébastien; Thuiller, Wilfried; Choler, Philippe

2013-10-01

Species distribution models (SDMs) have been frequently employed to forecast the response of alpine plants to global changes. Efforts to model alpine plant distribution have thus far been primarily based on a correlative approach, in which ecological processes are implicitly addressed through a statistical relationship between observed species occurrences and environmental predictors. Recent evidence, however, highlights the shortcomings of correlative SDMs, especially in alpine landscapes where plant species tend to be decoupled from atmospheric conditions in micro-topographic habitats and are particularly exposed to geomorphic disturbances. While alpine plants respond to the same limiting factors as plants found at lower elevations, alpine environments impose a particular set of scale-dependent and hierarchical drivers that shape the realized niche of species and that require explicit consideration in a modelling context. Several recent studies in the European Alps have successfully integrated both correlative and process-based elements into distribution models of alpine plants, but for the time being a single integrative modelling framework that includes all key drivers remains elusive. As a first step in working toward a comprehensive integrated model applicable to alpine plant communities, we propose a conceptual framework that structures the primary mechanisms affecting alpine plant distributions. We group processes into four categories, including multi-scalar abiotic drivers, gradient dependent species interactions, dispersal and spatial-temporal plant responses to disturbance. Finally, we propose a methodological framework aimed at developing an integrated model to better predict alpine plant distribution.

Model-based sensorimotor integration for multi-joint control: development of a virtual arm model.

Science.gov (United States)

Song, D; Lan, N; Loeb, G E; Gordon, J

2008-06-01

An integrated, sensorimotor virtual arm (VA) model has been developed and validated for simulation studies of control of human arm movements. Realistic anatomical features of shoulder, elbow and forearm joints were captured with a graphic modeling environment, SIMM. The model included 15 musculotendon elements acting at the shoulder, elbow and forearm. Muscle actions on joints were evaluated by SIMM generated moment arms that were matched to experimentally measured profiles. The Virtual Muscle (VM) model contained appropriate admixture of slow and fast twitch fibers with realistic physiological properties for force production. A realistic spindle model was embedded in each VM with inputs of fascicle length, gamma static (gamma(stat)) and dynamic (gamma(dyn)) controls and outputs of primary (I(a)) and secondary (II) afferents. A piecewise linear model of Golgi Tendon Organ (GTO) represented the ensemble sampling (I(b)) of the total muscle force at the tendon. All model components were integrated into a Simulink block using a special software tool. The complete VA model was validated with open-loop simulation at discrete hand positions within the full range of alpha and gamma drives to extrafusal and intrafusal muscle fibers. The model behaviors were consistent with a wide variety of physiological phenomena. Spindle afferents were effectively modulated by fusimotor drives and hand positions of the arm. These simulations validated the VA model as a computational tool for studying arm movement control. The VA model is available to researchers at website http://pt.usc.edu/cel .

Effects of computer tomography on diagnosis of neurological and neurosurgical diseases

International Nuclear Information System (INIS)

Katzner, E.

1981-01-01

Computer tomography is presently the primary procedure for correct diagnosis of many neurological and neurosurgical diseases. Other expensive and riskier diagnostic methods have become superfluous. Selective and clearly indicated application of the undoubtedly expensive computer tomography ultimately spares unnecessary costs for hospitalization and less conclusive examination methods. Wheras the indications in the craniocerebral region can now be considered confirmed, spinal computer tomography is still in the development stage. With certain indications, e.g. in prolapsed lumbar intervertebral disk, a similar performance to that of CT can be obtained with myelography, so that the latter method is likely to be superceded by computer tomography. (orig.) [de

Integrated Site Model Process Model Report

International Nuclear Information System (INIS)

Booth, T.

2000-01-01

The Integrated Site Model (ISM) provides a framework for discussing the geologic features and properties of Yucca Mountain, which is being evaluated as a potential site for a geologic repository for the disposal of nuclear waste. The ISM is important to the evaluation of the site because it provides 3-D portrayals of site geologic, rock property, and mineralogic characteristics and their spatial variabilities. The ISM is not a single discrete model; rather, it is a set of static representations that provide three-dimensional (3-D), computer representations of site geology, selected hydrologic and rock properties, and mineralogic-characteristics data. These representations are manifested in three separate model components of the ISM: the Geologic Framework Model (GFM), the Rock Properties Model (RPM), and the Mineralogic Model (MM). The GFM provides a representation of the 3-D stratigraphy and geologic structure. Based on the framework provided by the GFM, the RPM and MM provide spatial simulations of the rock and hydrologic properties, and mineralogy, respectively. Functional summaries of the component models and their respective output are provided in Section 1.4. Each of the component models of the ISM considers different specific aspects of the site geologic setting. Each model was developed using unique methodologies and inputs, and the determination of the modeled units for each of the components is dependent on the requirements of that component. Therefore, while the ISM represents the integration of the rock properties and mineralogy into a geologic framework, the discussion of ISM construction and results is most appropriately presented in terms of the three separate components. This Process Model Report (PMR) summarizes the individual component models of the ISM (the GFM, RPM, and MM) and describes how the three components are constructed and combined to form the ISM

Reconstruction of biological networks based on life science data integration

Directory of Open Access Journals (Sweden)

Kormeier Benjamin

2010-06-01

Full Text Available For the implementation of the virtual cell, the fundamental question is how to model and simulate complex biological networks. Therefore, based on relevant molecular database and information systems, biological data integration is an essential step in constructing biological networks. In this paper, we will motivate the applications BioDWH - an integration toolkit for building life science data warehouses, CardioVINEdb - a information system for biological data in cardiovascular-disease and VANESA- a network editor for modeling and simulation of biological networks. Based on this integration process, the system supports the generation of biological network models. A case study of a cardiovascular-disease related gene-regulated biological network is also presented.

A framework for different levels of integration of computational models into web-based virtual patients.

Science.gov (United States)

Kononowicz, Andrzej A; Narracott, Andrew J; Manini, Simone; Bayley, Martin J; Lawford, Patricia V; McCormack, Keith; Zary, Nabil

2014-01-23

Virtual patients are increasingly common tools used in health care education to foster learning of clinical reasoning skills. One potential way to expand their functionality is to augment virtual patients' interactivity by enriching them with computational models of physiological and pathological processes. The primary goal of this paper was to propose a conceptual framework for the integration of computational models within virtual patients, with particular focus on (1) characteristics to be addressed while preparing the integration, (2) the extent of the integration, (3) strategies to achieve integration, and (4) methods for evaluating the feasibility of integration. An additional goal was to pilot the first investigation of changing framework variables on altering perceptions of integration. The framework was constructed using an iterative process informed by Soft System Methodology. The Virtual Physiological Human (VPH) initiative has been used as a source of new computational models. The technical challenges associated with development of virtual patients enhanced by computational models are discussed from the perspectives of a number of different stakeholders. Concrete design and evaluation steps are discussed in the context of an exemplar virtual patient employing the results of the VPH ARCH project, as well as improvements for future iterations. The proposed framework consists of four main elements. The first element is a list of feasibility features characterizing the integration process from three perspectives: the computational modelling researcher, the health care educationalist, and the virtual patient system developer. The second element included three integration levels: basic, where a single set of simulation outcomes is generated for specific nodes in the activity graph; intermediate, involving pre-generation of simulation datasets over a range of input parameters; advanced, including dynamic solution of the model. The third element is the

Multi-agent based modeling for electric vehicle integration in a distribution network operation

DEFF Research Database (Denmark)

Hu, Junjie; Morais, Hugo; Lind, Morten

2016-01-01

The purpose of this paper is to present a multi-agent based modeling technology for simulating and operating a hierarchical energy management of a power distribution system with focus on EVs integration. The proposed multi-agent system consists of four types of agents: i) Distribution system...... operator (DSO) technical agent and ii) DSO market agents that both belong to the top layer of the hierarchy and their roles are to manage the distribution network by avoiding grid congestions and using congestion prices to coordinate the energy scheduled; iii) Electric vehicle virtual power plant agents...

Neurosurgical management of L-asparaginase induced haemorrhagic stroke.

LENUS (Irish Health Repository)

Ogbodo, Elisha

2012-01-01

The authors describe a case of L-asparaginase induced intracranial thrombosis and subsequent haemorrhage in a newly diagnosed 30-year-old man with acute lymphoblastic leukaemia who was successfully managed by surgical intervention. At presentation, he had a Glasgow Coma Score of 7\\/15, was aphasic and had dense right hemiplegia. Neuroimaging revealed an acute anterior left middle cerebral artery infarct with parenchymal haemorrhagic conversion, mass effect and subfalcine herniation. He subsequently underwent left frontal craniotomy and evacuation of large frontal haematoma and decompressive craniectomy for cerebral oedema. Six months postoperatively he underwent titanium cranioplasty. He had made good clinical recovery and is currently mobilising independently with mild occasional episodes of expressive dysphasia, difficulty with fine motor movement on the right side, and has remained seizure free. This is the first documented case of L-asparaginase induced haemorrhagic stroke managed by neurosurgical intervention. The authors emphasise the possible role of surgery in managing chemotherapy induced intracranial complications.

Standardized Application of Laxatives and Physical Measures in Neurosurgical Intensive Care Patients Improves Defecation Pattern but Is Not Associated with Lower Intracranial Pressure

Directory of Open Access Journals (Sweden)

Martin Kieninger

2014-01-01

Full Text Available Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP on bowel movement, intracranial pressure (ICP, and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

Standardized application of laxatives and physical measures in neurosurgical intensive care patients improves defecation pattern but is not associated with lower intracranial pressure.

Science.gov (United States)

Kieninger, Martin; Sinner, Barbara; Graf, Bernhard; Grassold, Astrid; Bele, Sylvia; Seemann, Milena; Künzig, Holger; Zech, Nina

2014-01-01

Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

An Anatomically Constrained Model for Path Integration in the Bee Brain.

Science.gov (United States)

Stone, Thomas; Webb, Barbara; Adden, Andrea; Weddig, Nicolai Ben; Honkanen, Anna; Templin, Rachel; Wcislo, William; Scimeca, Luca; Warrant, Eric; Heinze, Stanley

2017-10-23

Path integration is a widespread navigational strategy in which directional changes and distance covered are continuously integrated on an outward journey, enabling a straight-line return to home. Bees use vision for this task-a celestial-cue-based visual compass and an optic-flow-based visual odometer-but the underlying neural integration mechanisms are unknown. Using intracellular electrophysiology, we show that polarized-light-based compass neurons and optic-flow-based speed-encoding neurons converge in the central complex of the bee brain, and through block-face electron microscopy, we identify potential integrator cells. Based on plausible output targets for these cells, we propose a complete circuit for path integration and steering in the central complex, with anatomically identified neurons suggested for each processing step. The resulting model circuit is thus fully constrained biologically and provides a functional interpretation for many previously unexplained architectural features of the central complex. Moreover, we show that the receptive fields of the newly discovered speed neurons can support path integration for the holonomic motion (i.e., a ground velocity that is not precisely aligned with body orientation) typical of bee flight, a feature not captured in any previously proposed model of path integration. In a broader context, the model circuit presented provides a general mechanism for producing steering signals by comparing current and desired headings-suggesting a more basic function for central complex connectivity, from which path integration may have evolved. Copyright © 2017 Elsevier Ltd. All rights reserved.

COGMIR: A computer model for knowledge integration

Energy Technology Data Exchange (ETDEWEB)

Chen, Z.X.

1988-01-01

This dissertation explores some aspects of knowledge integration, namely, accumulation of scientific knowledge and performing analogical reasoning on the acquired knowledge. Knowledge to be integrated is conveyed by paragraph-like pieces referred to as documents. By incorporating some results from cognitive science, the Deutsch-Kraft model of information retrieval is extended to a model for knowledge engineering, which integrates acquired knowledge and performs intelligent retrieval. The resulting computer model is termed COGMIR, which stands for a COGnitive Model for Intelligent Retrieval. A scheme, named query invoked memory reorganization, is used in COGMIR for knowledge integration. Unlike some other schemes which realize knowledge integration through subjective understanding by representing new knowledge in terms of existing knowledge, the proposed scheme suggests at storage time only recording the possible connection of knowledge acquired from different documents. The actual binding of the knowledge acquired from different documents is deferred to query time. There is only one way to store knowledge and numerous ways to utilize the knowledge. Each document can be represented as a whole as well as its meaning. In addition, since facts are constructed from the documents, document retrieval and fact retrieval are treated in a unified way. When the requested knowledge is not available, query invoked memory reorganization can generate suggestion based on available knowledge through analogical reasoning. This is done by revising the algorithms developed for document retrieval and fact retrieval, and by incorporating Gentner's structure mapping theory. Analogical reasoning is treated as a natural extension of intelligent retrieval, so that two previously separate research areas are combined. A case study is provided. All the components are implemented as list structures similar to relational data-bases.

Research on the Integration of Bionic Geometry Modeling and Simulation of Robot Foot Based on Characteristic Curve

Science.gov (United States)

He, G.; Zhu, H.; Xu, J.; Gao, K.; Zhu, D.

2017-09-01

The bionic research of shape is an important aspect of the research on bionic robot, and its implementation cannot be separated from the shape modeling and numerical simulation of the bionic object, which is tedious and time-consuming. In order to improve the efficiency of shape bionic design, the feet of animals living in soft soil and swamp environment are taken as bionic objects, and characteristic skeleton curve, section curve, joint rotation variable, position and other parameters are used to describe the shape and position information of bionic object’s sole, toes and flipper. The geometry modeling of the bionic object is established by using the parameterization of characteristic curves and variables. Based on this, the integration framework of parametric modeling and finite element modeling, dynamic analysis and post-processing of sinking process in soil is proposed in this paper. The examples of bionic ostrich foot and bionic duck foot are also given. The parametric modeling and integration technique can achieve rapid improved design based on bionic object, and it can also greatly improve the efficiency and quality of robot foot bionic design, and has important practical significance to improve the level of bionic design of robot foot’s shape and structure.

An emotion-based view of acquisition integration capability

NARCIS (Netherlands)

Q.N. Huy (Quy N.); T.H. Reus (Taco)

2011-01-01

markdownabstractWe propose an emotion-based view of acquisition integration capability by developing an inter-firm model that focuses on dealing constructively with emotions during various organizational identification processes following mergers and acquisitions. The model describes diverse types

Integrating high dimensional bi-directional parsing models for gene mention tagging.

Science.gov (United States)

Hsu, Chun-Nan; Chang, Yu-Ming; Kuo, Cheng-Ju; Lin, Yu-Shi; Huang, Han-Shen; Chung, I-Fang

2008-07-01

Tagging gene and gene product mentions in scientific text is an important initial step of literature mining. In this article, we describe in detail our gene mention tagger participated in BioCreative 2 challenge and analyze what contributes to its good performance. Our tagger is based on the conditional random fields model (CRF), the most prevailing method for the gene mention tagging task in BioCreative 2. Our tagger is interesting because it accomplished the highest F-scores among CRF-based methods and second over all. Moreover, we obtained our results by mostly applying open source packages, making it easy to duplicate our results. We first describe in detail how we developed our CRF-based tagger. We designed a very high dimensional feature set that includes most of information that may be relevant. We trained bi-directional CRF models with the same set of features, one applies forward parsing and the other backward, and integrated two models based on the output scores and dictionary filtering. One of the most prominent factors that contributes to the good performance of our tagger is the integration of an additional backward parsing model. However, from the definition of CRF, it appears that a CRF model is symmetric and bi-directional parsing models will produce the same results. We show that due to different feature settings, a CRF model can be asymmetric and the feature setting for our tagger in BioCreative 2 not only produces different results but also gives backward parsing models slight but constant advantage over forward parsing model. To fully explore the potential of integrating bi-directional parsing models, we applied different asymmetric feature settings to generate many bi-directional parsing models and integrate them based on the output scores. Experimental results show that this integrated model can achieve even higher F-score solely based on the training corpus for gene mention tagging. Data sets, programs and an on-line service of our gene

Fuzzy knowledge bases integration based on ontology

OpenAIRE

Ternovoy, Maksym; Shtogrina, Olena

2012-01-01

the paper describes the approach for fuzzy knowledge bases integration with the usage of ontology. This approach is based on metadata-base usage for integration of different knowledge bases with common ontology. The design process of metadata-base is described.

Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies.

Science.gov (United States)

Umansky, Felix; Black, Peter L; DiRocco, Concenzio; Ferrer, Enrique; Goel, Atul; Malik, Ghaus M; Mathiesen, Tiit; Mendez, Ivar; Palmer, James D; Juanotena, Jorge Rodriguez; Fraifeld, Shifra; Rosenfeld, Jeffrey V

2011-01-01

This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility. However, it is our intent that the fundamental principles enunciated here should serve as a guide in the day-to-day practice of neurosurgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Diverse methods for integrable models

NARCIS (Netherlands)

Fehér, G.

2017-01-01

This thesis is centered around three topics, sharing integrability as a common theme. This thesis explores different methods in the field of integrable models. The first two chapters are about integrable lattice models in statistical physics. The last chapter describes an integrable quantum chain.

CTBT Integrated Verification System Evaluation Model

Energy Technology Data Exchange (ETDEWEB)

Edenburn, M.W.; Bunting, M.L.; Payne, A.C. Jr.

1997-10-01

Sandia National Laboratories has developed a computer based model called IVSEM (Integrated Verification System Evaluation Model) to estimate the performance of a nuclear detonation monitoring system. The IVSEM project was initiated in June 1994, by Sandia`s Monitoring Systems and Technology Center and has been funded by the US Department of Energy`s Office of Nonproliferation and National Security (DOE/NN). IVSEM is a simple, top-level, modeling tool which estimates the performance of a Comprehensive Nuclear Test Ban Treaty (CTBT) monitoring system and can help explore the impact of various sensor system concepts and technology advancements on CTBT monitoring. One of IVSEM`s unique features is that it integrates results from the various CTBT sensor technologies (seismic, infrasound, radionuclide, and hydroacoustic) and allows the user to investigate synergy among the technologies. Specifically, IVSEM estimates the detection effectiveness (probability of detection) and location accuracy of the integrated system and of each technology subsystem individually. The model attempts to accurately estimate the monitoring system`s performance at medium interfaces (air-land, air-water) and for some evasive testing methods such as seismic decoupling. This report describes version 1.2 of IVSEM.

Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models.

Science.gov (United States)

Breimer, Gerben E; Haji, Faizal A; Bodani, Vivek; Cunningham, Melissa S; Lopez-Rios, Adriana-Lucia; Okrainec, Allan; Drake, James M

2017-02-01

The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model. Copyright © 2016 by the Congress of Neurological Surgeons

An Overview of Modeling Approaches Applied to Aggregation-Based Fleet Management and Integration of Plug-in Electric Vehicles †

DEFF Research Database (Denmark)

You, Shi; Hu, Junjie; Ziras, Charalampos

2016-01-01

The design and implementation of management policies for plug-in electric vehicles (PEVs) need to be supported by a holistic understanding of the functional processes, their complex interactions, and their response to various changes. Models developed to represent different functional processes...... and systems are seen as useful tools to support the related studies for different stakeholders in a tangible way. This paper presents an overview of modeling approaches applied to support aggregation-based management and integration of PEVs from the perspective of fleet operators and grid operators......, respectively. We start by explaining a structured modeling approach, i.e., a flexible combination of process models and system models, applied to different management and integration studies. A state-of-the-art overview of modeling approaches applied to represent several key processes, such as charging...

Modelling and optimal operation of a small-scale integrated energy based district heating and cooling system

International Nuclear Information System (INIS)

Jing, Z.X.; Jiang, X.S.; Wu, Q.H.; Tang, W.H.; Hua, B.

2014-01-01

This paper presents a comprehensive model of a small-scale integrated energy based district heating and cooling (DHC) system located in a residential area of hot-summer and cold-winter zone, which makes joint use of wind energy, solar energy, natural gas and electric energy. The model includes an off-grid wind turbine generator, heat producers, chillers, a water supply network and terminal loads. This research also investigates an optimal operating strategy based on Group Search Optimizer (GSO), through which the daily running cost of the system is optimized in both the heating and cooling modes. The strategy can be used to find the optimal number of operating chillers, optimal outlet water temperature set points of boilers and optimal water flow set points of pumps, taking into account cost functions and various operating constraints. In order to verify the model and the optimal operating strategy, performance tests have been undertaken using MATLAB. The simulation results prove the validity of the model and show that the strategy is able to minimize the system operation cost. The proposed system is evaluated in comparison with a conventional separation production (SP) system. The feasibility of investment for the DHC system is also discussed. The comparative results demonstrate the investment feasibility, the significant energy saving and the cost reduction, achieved in daily operation in an environment, where there are varying heating loads, cooling loads, wind speeds, solar radiations and electricity prices. - Highlights: • A model of a small-scale integrated energy based DHC system is presented. • An off-grid wind generator used for water heating is embedded in the model. • An optimal control strategy is studied to optimize the running cost of the system. • The designed system is proved to be energy efficient and cost effective in operation

Ride comfort optimization of a multi-axle heavy motorized wheel dump truck based on virtual and real prototype experiment integrated Kriging model

Directory of Open Access Journals (Sweden)

Bian Gong

2015-06-01

Full Text Available The optimization of hydro-pneumatic suspension parameters of a multi-axle heavy motorized wheel dump truck is carried out based on virtual and real prototype experiment integrated Kriging model in this article. The root mean square of vertical vibration acceleration, in the center of sprung mass, is assigned as the optimization objective. The constraints are the natural frequency, the working stroke, and the dynamic load of wheels. The suspension structure for the truck is the adjustable hydro-pneumatic suspension with ideal vehicle nonlinear characteristics, integrated with elastic and damping elements. Also, the hydraulic systems of two adjacent hydro-pneumatic suspension are interconnected. Considering the high complexity of the engineering model, a novel kind of meta-model called virtual and real prototype experiment integrated Kriging is proposed in this article. The interpolation principle and the construction of virtual and real prototype experiment integrated Kriging model were elucidated. Being different from traditional Kriging, virtual and real prototype experiment integrated Kriging combines the respective advantages of actual test and Computer Aided Engineering simulation. Based on the virtual and real prototype experiment integrated Kriging model, the optimization results, obtained by experimental verification, showed significant improvement in the ride comfort by 12.48% for front suspension and 11.79% for rear suspension. Compared with traditional Kriging, the optimization effect was improved by 3.05% and 3.38% respectively. Virtual and real prototype experiment integrated Kriging provides an effective way to approach the optimal solution for the optimization of high-complexity engineering problems.

KaBOB: ontology-based semantic integration of biomedical databases.

Science.gov (United States)

Livingston, Kevin M; Bada, Michael; Baumgartner, William A; Hunter, Lawrence E

2015-04-23

The ability to query many independent biological databases using a common ontology-based semantic model would facilitate deeper integration and more effective utilization of these diverse and rapidly growing resources. Despite ongoing work moving toward shared data formats and linked identifiers, significant problems persist in semantic data integration in order to establish shared identity and shared meaning across heterogeneous biomedical data sources. We present five processes for semantic data integration that, when applied collectively, solve seven key problems. These processes include making explicit the differences between biomedical concepts and database records, aggregating sets of identifiers denoting the same biomedical concepts across data sources, and using declaratively represented forward-chaining rules to take information that is variably represented in source databases and integrating it into a consistent biomedical representation. We demonstrate these processes and solutions by presenting KaBOB (the Knowledge Base Of Biomedicine), a knowledge base of semantically integrated data from 18 prominent biomedical databases using common representations grounded in Open Biomedical Ontologies. An instance of KaBOB with data about humans and seven major model organisms can be built using on the order of 500 million RDF triples. All source code for building KaBOB is available under an open-source license. KaBOB is an integrated knowledge base of biomedical data representationally based in prominent, actively maintained Open Biomedical Ontologies, thus enabling queries of the underlying data in terms of biomedical concepts (e.g., genes and gene products, interactions and processes) rather than features of source-specific data schemas or file formats. KaBOB resolves many of the issues that routinely plague biomedical researchers intending to work with data from multiple data sources and provides a platform for ongoing data integration and development and for

Models of Russia's Participation in Regional Economic Integration

Directory of Open Access Journals (Sweden)

Darya I. Ushkalova

2014-01-01

Full Text Available The article analyses models and mechanisms of Russia's participation in integration processes in Post-Soviet space in recent years. The article examines the model of integration of Customs Union Common Economic Space Eurasian Economic Union and particular mechanisms of its realization. It also examines key challenges to further development of integration in the frameworks of Eurasian Economic Union including exhausting of short-term and medium-term integration effects against a background of low level of economic cooperation and the lack of effective mechanism of interest coordination and decisionmaking similar to qualified majority. It concludes that deterioration of mutual trade dynamics in Customs Union is determined by fundamental factors, first of all, exhausting of medium-term integration effects which lead to extension of mutual trade immediately after Customs Union creation but do not change its qualitative characteristics in long-term outlook. The author shows an absence of significant long-term integration effects which were based on increase of domestic market capacity due to a modification of economic structure. It is founded that appearance of such long-term integration effects is possible only in the context of coalescence of national economies at the microlevel based on development of system of communications between enterprises including intrasectoral industrial cooperation. The article also analyses results of realization of Russia's strategy of interaction with states beyond Eurasian Economic Union based on open regionalism concept. The paper presents recommendation on perfection of tools of integration in and outside Eurasian Economic Union. In particular, creation of system of decentralized organizations is proposed, for the implementation of specific cooperation projects in selected areas, taking into account the multiplier effect of such a "point-aimed" action/

Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents.

Science.gov (United States)

Dias, Mark S; Sussman, Jeffrey S; Durham, Susan; Iantosca, Mark R

2013-11-01

Research suggests that there may be a growing disparity between the supply of and demand for both pediatric specialists and neurosurgeons. Whether pediatric neurosurgeons are facing such a disparity is disputable, but interest in pediatric neurosurgery (PNS) has waxed and waned as evidenced by the number of applicants for PNS fellowships. The authors undertook a survey to analyze current neurosurgical residents' perceptions of both benefits and deterrents to a pediatric neurosurgical career. All residents and PNS fellows in the United States and Canada during the academic year 2008-2009 were invited to complete a Web-based survey that assessed 1) demographic and educational information about residents and their residency training, particularly as it related to training in PNS; 2) residents' exposure to mentoring opportunities from pediatric neurosurgical faculty and their plans for the future; and 3) residents' perceptions about how likely 40 various factors were to influence their decision about whether to pursue a PNS career. Four hundred ninety-six responses were obtained: 89% of the respondents were male, 63% were married, 75% were in at least their 3rd year of postgraduate training, 61% trained in a children's hospital and 29% in a children's "hospital within a hospital," and 72% were in programs having one or more dedicated PNS faculty members. The residencies of 56% of respondents offered 6-11 months of PNS training and nearly three-quarters of respondents had completed 2 months of PNS training. During medical school, 92% had been exposed to neurosurgery and 45% to PNS during a clinical rotation, but only 7% identified a PNS mentor. Nearly half (43%) are considering a PNS career, and of these, 61% are definitely or probably considering post-residency fellowship. On the other hand, 68% would prefer an enfolded fellowship during residency. Perceived strengths of PNS included working with children, developing lasting relationships, wider variety of operations

Using integrated environmental modeling to automate a process-based Quantitative Microbial Risk Assessment

Science.gov (United States)

Integrated Environmental Modeling (IEM) organizes multidisciplinary knowledge that explains and predicts environmental-system response to stressors. A Quantitative Microbial Risk Assessment (QMRA) is an approach integrating a range of disparate data (fate/transport, exposure, an...

Improving wave forecasting by integrating ensemble modelling and machine learning

Science.gov (United States)

O'Donncha, F.; Zhang, Y.; James, S. C.

2017-12-01

Modern smart-grid networks use technologies to instantly relay information on supply and demand to support effective decision making. Integration of renewable-energy resources with these systems demands accurate forecasting of energy production (and demand) capacities. For wave-energy converters, this requires wave-condition forecasting to enable estimates of energy production. Current operational wave forecasting systems exhibit substantial errors with wave-height RMSEs of 40 to 60 cm being typical, which limits the reliability of energy-generation predictions thereby impeding integration with the distribution grid. In this study, we integrate physics-based models with statistical learning aggregation techniques that combine forecasts from multiple, independent models into a single "best-estimate" prediction of the true state. The Simulating Waves Nearshore physics-based model is used to compute wind- and currents-augmented waves in the Monterey Bay area. Ensembles are developed based on multiple simulations perturbing input data (wave characteristics supplied at the model boundaries and winds) to the model. A learning-aggregation technique uses past observations and past model forecasts to calculate a weight for each model. The aggregated forecasts are compared to observation data to quantify the performance of the model ensemble and aggregation techniques. The appropriately weighted ensemble model outperforms an individual ensemble member with regard to forecasting wave conditions.

The early maximum likelihood estimation model of audiovisual integration in speech perception

DEFF Research Database (Denmark)

Andersen, Tobias

2015-01-01

integration to speech perception along with three model variations. In early MLE, integration is based on a continuous internal representation before categorization, which can make the model more parsimonious by imposing constraints that reflect experimental designs. The study also shows that cross......Speech perception is facilitated by seeing the articulatory mouth movements of the talker. This is due to perceptual audiovisual integration, which also causes the McGurk−MacDonald illusion, and for which a comprehensive computational account is still lacking. Decades of research have largely......-validation can evaluate models of audiovisual integration based on typical data sets taking both goodness-of-fit and model flexibility into account. All models were tested on a published data set previously used for testing the FLMP. Cross-validation favored the early MLE while more conventional error measures...

Developing Integrated Care: Towards a development model for integrated care

NARCIS (Netherlands)

M.M.N. Minkman (Mirella)

2012-01-01

textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated

An integrated utility-based model of conflict evaluation and resolution in the Stroop task.

Science.gov (United States)

Chuderski, Adam; Smolen, Tomasz

2016-04-01

Cognitive control allows humans to direct and coordinate their thoughts and actions in a flexible way, in order to reach internal goals regardless of interference and distraction. The hallmark test used to examine cognitive control is the Stroop task, which elicits both the weakly learned but goal-relevant and the strongly learned but goal-irrelevant response tendencies, and requires people to follow the former while ignoring the latter. After reviewing the existing computational models of cognitive control in the Stroop task, its novel, integrated utility-based model is proposed. The model uses 3 crucial control mechanisms: response utility reinforcement learning, utility-based conflict evaluation using the Festinger formula for assessing the conflict level, and top-down adaptation of response utility in service of conflict resolution. Their complex, dynamic interaction led to replication of 18 experimental effects, being the largest data set explained to date by 1 Stroop model. The simulations cover the basic congruency effects (including the response latency distributions), performance dynamics and adaptation (including EEG indices of conflict), as well as the effects resulting from manipulations applied to stimulation and responding, which are yielded by the extant Stroop literature. (c) 2016 APA, all rights reserved).

Using models in Integrated Ecosystem Assessment of coastal areas

Science.gov (United States)

Solidoro, Cosimo; Bandelj, Vinko; Cossarini, Gianpiero; Melaku Canu, Donata; Libralato, Simone

2014-05-01

Numerical Models can greatly contribute to integrated ecological assessment of coastal and marine systems. Indeed, models can: i) assist in the identification of efficient sampling strategy; ii) provide space interpolation and time extrapolation of experiemtanl data which are based on the knowedge on processes dynamics and causal realtionships which is coded within the model, iii) provide estimates of hardly measurable indicators. Furthermore model can provide indication on potential effects of implementation of alternative management policies. Finally, by providing a synthetic representation of an ideal system, based on its essential dynamic, model return a picture of ideal behaviour of a system in the absence of external perturbation, alteration, noise, which might help in the identification of reference behaivuor. As an important example, model based reanalyses of biogeochemical and ecological properties are an urgent need for the estimate of the environmental status and the assessment of efficacy of conservation and environmental policies, also with reference to the enforcement of the European MSFD. However, the use of numerical models, and particularly of ecological models, in modeling and in environmental management still is far from be the rule, possibly because of a lack in realizing the benefits which a full integration of modeling and montoring systems might provide, possibly because of a lack of trust in modeling results, or because many problems still exists in the development, validation and implementation of models. For istance, assessing the validity of model results is a complex process that requires the definition of appropriate indicators, metrics, methodologies and faces with the scarcity of real-time in-situ biogeochemical data. Furthermore, biogeochemical models typically consider dozens of variables which are heavily undersampled. Here we show how the integration of mathematical model and monitoring data can support integrated ecosystem

Arbitrary modeling of TSVs for 3D integrated circuits

CERN Document Server

Salah, Khaled; El-Rouby, Alaa

2014-01-01

This book presents a wide-band and technology independent, SPICE-compatible RLC model for through-silicon vias (TSVs) in 3D integrated circuits. This model accounts for a variety of effects, including skin effect, depletion capacitance and nearby contact effects. Readers will benefit from in-depth coverage of concepts and technology such as 3D integration, Macro modeling, dimensional analysis and compact modeling, as well as closed form equations for the through silicon via parasitics. Concepts covered are demonstrated by using TSVs in applications such as a spiral inductor?and inductive-based

Design of model based LQG control for integrated building systems

NARCIS (Netherlands)

Yahiaoui, A.; Hensen, J.L.M.; Soethout, L.L.; Paassen, van A.H.C.

2006-01-01

The automation of the operation of integrated building systems requires using modern control techniques to enhance the quality of the building indoor environments. This paper describes the theatrical base and practical application of an optimal dynamic regulator using modelbased Linear Quadratic

Effects of neurosurgical treatment and severity of head injury on cognitive functioning, general health and incidence of mental disorders in patients with traumatic brain injury.

Science.gov (United States)

Rezaei, Sajjad; Asgari, Karim; Yousefzadeh, Shahrokh; Moosavi, Heshmat-Allah; Kazemnejad, Ehsan

2012-01-01

Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients' neuropsychiatric outcomes. This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire-28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ(2) Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive

TU-G-210-02: TRANS-FUSIMO - An Integrative Approach to Model-Based Treatment Planning of Liver FUS

Energy Technology Data Exchange (ETDEWEB)

Preusser, T. [Fraunhofer MEVIS & Jacobs University (Germany)

2015-06-15

Modeling can play a vital role in predicting, optimizing and analyzing the results of therapeutic ultrasound treatments. Simulating the propagating acoustic beam in various targeted regions of the body allows for the prediction of the resulting power deposition and temperature profiles. In this session we will apply various modeling approaches to breast, abdominal organ and brain treatments. Of particular interest is the effectiveness of procedures for correcting for phase aberrations caused by intervening irregular tissues, such as the skull in transcranial applications or inhomogeneous breast tissues. Also described are methods to compensate for motion in targeted abdominal organs such as the liver or kidney. Douglas Christensen – Modeling for Breast and Brain HIFU Treatment Planning Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Learning Objectives: Understand the role of acoustic beam modeling for predicting the effectiveness of therapeutic ultrasound treatments. Apply acoustic modeling to specific breast, liver, kidney and transcranial anatomies. Determine how to obtain appropriate acoustic modeling parameters from clinical images. Understand the separate role of absorption and scattering in energy delivery to tissues. See how organ motion can be compensated for in ultrasound therapies. Compare simulated data with clinical temperature measurements in transcranial applications. Supported by NIH R01 HL172787 and R01 EB013433 (DC); EU Seventh Framework Programme (FP7/2007-2013) under 270186 (FUSIMO) and 611889 (TRANS-FUSIMO)(TP); and P01 CA159992, GE, FUSF and InSightec (UV)

TU-G-210-02: TRANS-FUSIMO - An Integrative Approach to Model-Based Treatment Planning of Liver FUS

International Nuclear Information System (INIS)

Preusser, T.

2015-01-01

Modeling can play a vital role in predicting, optimizing and analyzing the results of therapeutic ultrasound treatments. Simulating the propagating acoustic beam in various targeted regions of the body allows for the prediction of the resulting power deposition and temperature profiles. In this session we will apply various modeling approaches to breast, abdominal organ and brain treatments. Of particular interest is the effectiveness of procedures for correcting for phase aberrations caused by intervening irregular tissues, such as the skull in transcranial applications or inhomogeneous breast tissues. Also described are methods to compensate for motion in targeted abdominal organs such as the liver or kidney. Douglas Christensen – Modeling for Breast and Brain HIFU Treatment Planning Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Learning Objectives: Understand the role of acoustic beam modeling for predicting the effectiveness of therapeutic ultrasound treatments. Apply acoustic modeling to specific breast, liver, kidney and transcranial anatomies. Determine how to obtain appropriate acoustic modeling parameters from clinical images. Understand the separate role of absorption and scattering in energy delivery to tissues. See how organ motion can be compensated for in ultrasound therapies. Compare simulated data with clinical temperature measurements in transcranial applications. Supported by NIH R01 HL172787 and R01 EB013433 (DC); EU Seventh Framework Programme (FP7/2007-2013) under 270186 (FUSIMO) and 611889 (TRANS-FUSIMO)(TP); and P01 CA159992, GE, FUSF and InSightec (UV)

Comparative analysis of the influence of creep of concrete composite beams of steel - concrete model based on Volterra integral equation

Directory of Open Access Journals (Sweden)

Partov Doncho

2017-01-01

Full Text Available The paper presents analysis of the stress-strain behaviour and deflection changes due to creep in statically determinate composite steel-concrete beam according to EUROCODE 2, ACI209R-92 and Gardner&Lockman models. The mathematical model involves the equation of equilibrium, compatibility and constitutive relationship, i.e. an elastic law for the steel part and an integral-type creep law of Boltzmann - Volterra for the concrete part considering the above mentioned models. On the basis of the theory of viscoelastic body of Maslov-Arutyunian-Trost-Zerna-Bažant for determining the redistribution of stresses in beam section between concrete plate and steel beam with respect to time 't', two independent Volterra integral equations of the second kind have been derived. Numerical method based on linear approximation of the singular kernel function in the integral equation is presented. Example with the model proposed is investigated.

SWIM (Soil and Water Integrated Model)

Energy Technology Data Exchange (ETDEWEB)

Krysanova, V; Wechsung, F; Arnold, J; Srinivasan, R; Williams, J

2000-12-01

The model SWIM (Soil and Water Integrated Model) was developed in order to provide a comprehensive GIS-based tool for hydrological and water quality modelling in mesoscale and large river basins (from 100 to 10,000 km{sup 2}), which can be parameterised using regionally available information. The model was developed for the use mainly in Europe and temperate zone, though its application in other regions is possible as well. SWIM is based on two previously developed tools - SWAT and MATSALU (see more explanations in section 1.1). The model integrates hydrology, vegetation, erosion, and nutrient dynamics at the watershed scale. SWIM has a three-level disaggregation scheme 'basin - sub-basins - hydrotopes' and is coupled to the Geographic Information System GRASS (GRASS, 1993). A robust approach is suggested for the nitrogen and phosphorus modelling in mesoscale watersheds. SWIM runs under the UNIX environment. Model test and validation were performed sequentially for hydrology, crop growth, nitrogen and erosion in a number of mesoscale watersheds in the German part of the Elbe drainage basin. A comprehensive scheme of spatial disaggregation into sub-basins and hydrotopes combined with reasonable restriction on a sub-basin area allows performing the assessment of water resources and water quality with SWIM in mesoscale river basins. The modest data requirements represent an important advantage of the model. Direct connection to land use and climate data provides a possibility to use the model for analysis of climate change and land use change impacts on hydrology, agricultural production, and water quality. (orig.)

Video clip transfer of radiological images using a mobile telephone in emergency neurosurgical consultations (3G Multi-Media Messaging Service).

Science.gov (United States)

Waran, Vicknes; Bahuri, Nor Faizal Ahmad; Narayanan, Vairavan; Ganesan, Dharmendra; Kadir, Khairul Azmi Abdul

2012-04-01

The purpose of this study was to validate and assess the accuracy and usefulness of sending short video clips in 3gp file format of an entire scan series of patients, using mobile telephones running on 3G-MMS technology, to enable consultation between junior doctors in a neurosurgical unit and the consultants on-call after office hours. A total of 56 consecutive patients with acute neurosurgical problems requiring urgent after-hours consultation during a 6-month period, prospectively had their images recorded and transmitted using the above method. The response to the diagnosis and the management plan by two neurosurgeons (who were not on site) based on the images viewed on a mobile telephone were reviewed by an independent observer and scored. In addition to this, a radiologist reviewed the original images directly on the hospital's Patients Archiving and Communication System (PACS) and this was compared with the neurosurgeons' response. Both neurosurgeons involved in this study were in complete agreement with their diagnosis. The radiologist disagreed with the diagnosis in only one patient, giving a kappa coefficient of 0.88, indicating an almost perfect agreement. The use of mobile telephones to transmit MPEG video clips of radiological images is very advantageous for carrying out emergency consultations in neurosurgery. The images accurately reflect the pathology in question, thereby reducing the incidence of medical errors from incorrect diagnosis, which otherwise may just depend on a verbal description.

Quantitative fluorescence angiography for neurosurgical interventions.

Science.gov (United States)

Weichelt, Claudia; Duscha, Philipp; Steinmeier, Ralf; Meyer, Tobias; Kuß, Julia; Cimalla, Peter; Kirsch, Matthias; Sobottka, Stephan B; Koch, Edmund; Schackert, Gabriele; Morgenstern, Ute

2013-06-01

Present methods for quantitative measurement of cerebral perfusion during neurosurgical operations require additional technology for measurement, data acquisition, and processing. This study used conventional fluorescence video angiography--as an established method to visualize blood flow in brain vessels--enhanced by a quantifying perfusion software tool. For these purposes, the fluorescence dye indocyanine green is given intravenously, and after activation by a near-infrared light source the fluorescence signal is recorded. Video data are analyzed by software algorithms to allow quantification of the blood flow. Additionally, perfusion is measured intraoperatively by a reference system. Furthermore, comparing reference measurements using a flow phantom were performed to verify the quantitative blood flow results of the software and to validate the software algorithm. Analysis of intraoperative video data provides characteristic biological parameters. These parameters were implemented in the special flow phantom for experimental validation of the developed software algorithms. Furthermore, various factors that influence the determination of perfusion parameters were analyzed by means of mathematical simulation. Comparing patient measurement, phantom experiment, and computer simulation under certain conditions (variable frame rate, vessel diameter, etc.), the results of the software algorithms are within the range of parameter accuracy of the reference methods. Therefore, the software algorithm for calculating cortical perfusion parameters from video data presents a helpful intraoperative tool without complex additional measurement technology.

Implementation of an integrated op-amp based chaotic neuron model and observation of its chaotic dynamics

International Nuclear Information System (INIS)

Jung, Jinwoo; Lee, Jewon; Song, Hanjung

2011-01-01

This paper presents a fully integrated circuit implementation of an operational amplifier (op-amp) based chaotic neuron model with a bipolar output function, experimental measurements, and analyses of its chaotic behavior. The proposed chaotic neuron model integrated circuit consists of several op-amps, sample and hold circuits, a nonlinear function block for chaotic signal generation, a clock generator, a nonlinear output function, etc. Based on the HSPICE (circuit program) simulation results, approximated empirical equations for analyses were formulated. Then, the chaotic dynamical responses such as bifurcation diagrams, time series, and Lyapunov exponent were calculated using these empirical equations. In addition, we performed simulations about two chaotic neuron systems with four synapses to confirm neural network connections and got normal behavior of the chaotic neuron such as internal state bifurcation diagram according to the synaptic weight variation. The proposed circuit was fabricated using a 0.8-μm single poly complementary metal-oxide semiconductor technology. Measurements of the fabricated single chaotic neuron with ±2.5 V power supplies and a 10 kHz sampling clock frequency were carried out and compared with the simulated results.

CTBT integrated verification system evaluation model supplement

International Nuclear Information System (INIS)

EDENBURN, MICHAEL W.; BUNTING, MARCUS; PAYNE, ARTHUR C. JR.; TROST, LAWRENCE C.

2000-01-01

Sandia National Laboratories has developed a computer based model called IVSEM (Integrated Verification System Evaluation Model) to estimate the performance of a nuclear detonation monitoring system. The IVSEM project was initiated in June 1994, by Sandia's Monitoring Systems and Technology Center and has been funded by the U.S. Department of Energy's Office of Nonproliferation and National Security (DOE/NN). IVSEM is a simple, ''top-level,'' modeling tool which estimates the performance of a Comprehensive Nuclear Test Ban Treaty (CTBT) monitoring system and can help explore the impact of various sensor system concepts and technology advancements on CTBT monitoring. One of IVSEM's unique features is that it integrates results from the various CTBT sensor technologies (seismic, in sound, radionuclide, and hydroacoustic) and allows the user to investigate synergy among the technologies. Specifically, IVSEM estimates the detection effectiveness (probability of detection), location accuracy, and identification capability of the integrated system and of each technology subsystem individually. The model attempts to accurately estimate the monitoring system's performance at medium interfaces (air-land, air-water) and for some evasive testing methods such as seismic decoupling. The original IVSEM report, CTBT Integrated Verification System Evaluation Model, SAND97-25 18, described version 1.2 of IVSEM. This report describes the changes made to IVSEM version 1.2 and the addition of identification capability estimates that have been incorporated into IVSEM version 2.0

Integral equation models for image restoration: high accuracy methods and fast algorithms

International Nuclear Information System (INIS)

Lu, Yao; Shen, Lixin; Xu, Yuesheng

2010-01-01

Discrete models are consistently used as practical models for image restoration. They are piecewise constant approximations of true physical (continuous) models, and hence, inevitably impose bottleneck model errors. We propose to work directly with continuous models for image restoration aiming at suppressing the model errors caused by the discrete models. A systematic study is conducted in this paper for the continuous out-of-focus image models which can be formulated as an integral equation of the first kind. The resulting integral equation is regularized by the Lavrentiev method and the Tikhonov method. We develop fast multiscale algorithms having high accuracy to solve the regularized integral equations of the second kind. Numerical experiments show that the methods based on the continuous model perform much better than those based on discrete models, in terms of PSNR values and visual quality of the reconstructed images

An integrated model of the lithium/thionyl chloride battery

Energy Technology Data Exchange (ETDEWEB)

Jungst, R.G.; Nagasubramanian, G.; Ingersoll, D.; O`Gorman, C.C.; Paez, T.L. [Sandia National Labs., Albuquerque, NM (United States); Jain, M.; Weidner, J.W. [Univ. of South Carolina, Columbia, SC (United States)

1998-06-08

The desire to reduce the time and cost of design engineering on new components or to validate existing designs in new applications is stimulating the development of modeling and simulation tools. The authors are applying a model-based design approach to low and moderate rate versions of the Li/SOCl{sub 2} D-size cell with success. Three types of models are being constructed and integrated to achieve maximum capability and flexibility in the final simulation tool. A phenomenology based electrochemical model links performance and the cell design, chemical processes, and material properties. An artificial neural network model improves computational efficiency and fills gaps in the simulation capability when fundamental cell parameters are too difficult to measure or the forms of the physical relationships are not understood. Finally, a PSpice-based model provides a simple way to test the cell under realistic electrical circuit conditions. Integration of these three parts allows a complete link to be made between fundamental battery design characteristics and the performance of the rest of the electrical subsystem.

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research.

Science.gov (United States)

Wali, Arvin R; Brandel, Michael G; Santiago-Dieppa, David R; Rennert, Robert C; Steinberg, Jeffrey A; Hirshman, Brian R; Murphy, James D; Khalessi, Alexander A

2018-05-01

OBJECTIVE Markov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research. METHODS The PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs. RESULTS A total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided. CONCLUSIONS As neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.

Modelling efficient innovative work: integration of economic and social psychological approaches

Directory of Open Access Journals (Sweden)

Babanova Yulia

2017-01-01

Full Text Available The article deals with the relevance of integration of economic and social psychological approaches to the solution of enhancing the efficiency of innovation management. The content, features and specifics of the modelling methods within each of approaches are unfolded and options of integration are considered. The economic approach lies in the generation of the integrated matrix concept of management of innovative development of an enterprise in line with the stages of innovative work and the use of the integrated vector method for the evaluation of the innovative enterprise development level. The social psychological approach lies in the development of a system of psychodiagnostic indexes of activity resources within the scope of psychological innovative audit of enterprise management and development of modelling methods for the balance of activity trends. Modelling the activity resources is based on the system of equations accounting for the interaction type of psychodiagnostic indexes. Integration of two approaches includes a methodological level, a level of empirical studies and modelling methods. There are suggested options of integrating the economic and psychological approaches to analyze available material and non-material resources of the enterprises’ innovative work and to forecast an optimal option of development based on the implemented modelling methods.

Integrating Cellular Metabolism into a Multiscale Whole-Body Model

Science.gov (United States)

Krauss, Markus; Schaller, Stephan; Borchers, Steffen; Findeisen, Rolf; Lippert, Jörg; Kuepfer, Lars

2012-01-01

Cellular metabolism continuously processes an enormous range of external compounds into endogenous metabolites and is as such a key element in human physiology. The multifaceted physiological role of the metabolic network fulfilling the catalytic conversions can only be fully understood from a whole-body perspective where the causal interplay of the metabolic states of individual cells, the surrounding tissue and the whole organism are simultaneously considered. We here present an approach relying on dynamic flux balance analysis that allows the integration of metabolic networks at the cellular scale into standardized physiologically-based pharmacokinetic models at the whole-body level. To evaluate our approach we integrated a genome-scale network reconstruction of a human hepatocyte into the liver tissue of a physiologically-based pharmacokinetic model of a human adult. The resulting multiscale model was used to investigate hyperuricemia therapy, ammonia detoxification and paracetamol-induced toxication at a systems level. The specific models simultaneously integrate multiple layers of biological organization and offer mechanistic insights into pathology and medication. The approach presented may in future support a mechanistic understanding in diagnostics and drug development. PMID:23133351

A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore

Directory of Open Access Journals (Sweden)

Siew Kwaon Lui

2014-01-01

Full Text Available Objective. Document acute neurosurgical and rehabilitation parameters of patients of all traumatic brain injury (TBI severities and determine whether early screening along with very early integrated TBI rehabilitation changes functional outcomes. Methods. Prospective study involving all patients with TBI admitted to a neurosurgical department of a tertiary hospital. They were assessed within 72 hours of admission by the rehabilitation team and received twice weekly rehabilitation reviews. Patients with further rehabilitation needs were then transferred to the attached acute inpatient TBI rehabilitation unit (TREATS and their functional outcomes were compared against a historical group of patients. Demographic variables, acute neurosurgical characteristics, medical complications, and rehabilitation outcomes were recorded. Results. There were 298 patients screened with an average age of 61.8±19.1 years. The most common etiology was falls (77.5%. Most patients were discharged home directly (67.4% and 22.8% of patients were in TREATS. The TREATS group functionally improved (P<0.001. Regression analysis showed by the intervention of TREATS, that there was a statistically significant FIM functional gain of 18.445 points (95% CI −30.388 to −0.6502, P=0.03. Conclusion. Our study demonstrated important epidemiological data on an unselected cohort of patients with TBI in Singapore and functional improvement in patients who further received inpatient rehabilitation.

Concept of development of integrated computer - based control system for 'Ukryttia' object

International Nuclear Information System (INIS)

Buyal'skij, V.M.; Maslov, V.P.

2003-01-01

The structural concept of Chernobyl NPP 'Ukryttia' Object's integrated computer - based control system development is presented on the basis of general concept of integrated Computer - based Control System (CCS) design process for organizing and technical management subjects.The concept is aimed at state-of-the-art architectural design technique application and allows using modern computer-aided facilities for functional model,information (logical and physical) models development,as well as for system object model under design

Integrating Behaviour in Software Models: An Event Coordination Notation

DEFF Research Database (Denmark)

Kindler, Ekkart

2011-01-01

One of the main problems in model-based software engineering is modelling behaviour in such a way that the behaviour models can be easily integrated with each other, with the structural software models and with pre-existing software. In this paper, we propose an event coordination notation (ECNO)...

Integrated Sensing and Controls for Coal Gasification - Development of Model-Based Controls for GE's Gasifier and Syngas Cooler

Energy Technology Data Exchange (ETDEWEB)

Aditya Kumar

2010-12-30

This report summarizes the achievements and final results of this program. The objective of this program is to develop a comprehensive systems approach to integrated design of sensing and control systems for an Integrated Gasification Combined Cycle (IGCC) plant, using advanced model-based techniques. In particular, this program is focused on the model-based sensing and control system design for the core gasification section of an IGCC plant. The overall approach consists of (i) developing a first-principles physics-based dynamic model of the gasification section, (ii) performing model-reduction where needed to derive low-order models suitable for controls analysis and design, (iii) developing a sensing system solution combining online sensors with model-based estimation for important process variables not measured directly, and (iv) optimizing the steady-state and transient operation of the plant for normal operation as well as for startup using model predictive controls (MPC). Initially, available process unit models were implemented in a common platform using Matlab/Simulink{reg_sign}, and appropriate model reduction and model updates were performed to obtain the overall gasification section dynamic model. Also, a set of sensor packages were developed through extensive lab testing and implemented in the Tampa Electric Company IGCC plant at Polk power station in 2009, to measure temperature and strain in the radiant syngas cooler (RSC). Plant operation data was also used to validate the overall gasification section model. The overall dynamic model was then used to develop a sensing solution including a set of online sensors coupled with model-based estimation using nonlinear extended Kalman filter (EKF). Its performance in terms of estimating key unmeasured variables like gasifier temperature, carbon conversion, etc., was studied through extensive simulations in the presence sensing errors (noise and bias) and modeling errors (e.g. unknown gasifier kinetics, RSC

Dealing with dissatisfaction in mathematical modelling to integrate QFD and Kano’s model

Science.gov (United States)

Retno Sari Dewi, Dian; Debora, Joana; Edy Sianto, Martinus

2017-12-01

The purpose of the study is to implement the integration of Quality Function Deployment (QFD) and Kano’s Model into mathematical model. Voice of customer data in QFD was collected using questionnaire and the questionnaire was developed based on Kano’s model. Then the operational research methodology was applied to build the objective function and constraints in the mathematical model. The relationship between voice of customer and engineering characteristics was modelled using linier regression model. Output of the mathematical model would be detail of engineering characteristics. The objective function of this model is to maximize satisfaction and minimize dissatisfaction as well. Result of this model is 62% .The major contribution of this research is to implement the existing mathematical model to integrate QFD and Kano’s Model in the case study of shoe cabinet.

DISPLACE: a dynamic, individual-based model for spatial fishing planning and effort displacement: Integrating underlying fish population models

DEFF Research Database (Denmark)

Bastardie, Francois; Nielsen, J. Rasmus; Miethe, Tanja

or to the alteration of individual fishing patterns. We demonstrate that integrating the spatial activity of vessels and local fish stock abundance dynamics allow for interactions and more realistic predictions of fishermen behaviour, revenues and stock abundance......We previously developed a spatially explicit, individual-based model (IBM) evaluating the bio-economic efficiency of fishing vessel movements between regions according to the catching and targeting of different species based on the most recent high resolution spatial fishery data. The main purpose...... was to test the effects of alternative fishing effort allocation scenarios related to fuel consumption, energy efficiency (value per litre of fuel), sustainable fish stock harvesting, and profitability of the fisheries. The assumption here was constant underlying resource availability. Now, an advanced...

The utilization of cranial models created using rapid prototyping techniques in the development of models for navigation training.

Science.gov (United States)

Waran, V; Pancharatnam, Devaraj; Thambinayagam, Hari Chandran; Raman, Rajagopal; Rathinam, Alwin Kumar; Balakrishnan, Yuwaraj Kumar; Tung, Tan Su; Rahman, Z A

2014-01-01

Navigation in neurosurgery has expanded rapidly; however, suitable models to train end users to use the myriad software and hardware that come with these systems are lacking. Utilizing three-dimensional (3D) industrial rapid prototyping processes, we have been able to create models using actual computed tomography (CT) data from patients with pathology and use these models to simulate a variety of commonly performed neurosurgical procedures with navigation systems. To assess the possibility of utilizing models created from CT scan dataset obtained from patients with cranial pathology to simulate common neurosurgical procedures using navigation systems. Three patients with pathology were selected (hydrocephalus, right frontal cortical lesion, and midline clival meningioma). CT scan data following an image-guidance surgery protocol in DIACOM format and a Rapid Prototyping Machine were taken to create the necessary printed model with the corresponding pathology embedded. The ability in registration, planning, and navigation of two navigation systems using a variety of software and hardware provided by these platforms was assessed. We were able to register all models accurately using both navigation systems and perform the necessary simulations as planned. Models with pathology utilizing 3D rapid prototyping techniques accurately reflect data of actual patients and can be used in the simulation of neurosurgical operations using navigation systems. Georg Thieme Verlag KG Stuttgart · New York.

Integrated modelling of crop production and nitrate leaching with the Daisy model.

Science.gov (United States)

Manevski, Kiril; Børgesen, Christen D; Li, Xiaoxin; Andersen, Mathias N; Abrahamsen, Per; Hu, Chunsheng; Hansen, Søren

2016-01-01

An integrated modelling strategy was designed and applied to the Soil-Vegetation-Atmosphere Transfer model Daisy for simulation of crop production and nitrate leaching under pedo-climatic and agronomic environment different than that of model original parameterisation. The points of significance and caution in the strategy are: •Model preparation should include field data in detail due to the high complexity of the soil and the crop processes simulated with process-based model, and should reflect the study objectives. Inclusion of interactions between parameters in a sensitivity analysis results in better account for impacts on outputs of measured variables.•Model evaluation on several independent data sets increases robustness, at least on coarser time scales such as month or year. It produces a valuable platform for adaptation of the model to new crops or for the improvement of the existing parameters set. On daily time scale, validation for highly dynamic variables such as soil water transport remains challenging. •Model application is demonstrated with relevance for scientists and regional managers. The integrated modelling strategy is applicable for other process-based models similar to Daisy. It is envisaged that the strategy establishes model capability as a useful research/decision-making, and it increases knowledge transferability, reproducibility and traceability.

Model-based Integration of Past & Future in TimeTravel

DEFF Research Database (Denmark)

Khalefa, Mohamed E.; Fischer, Ulrike; Pedersen, Torben Bach

2012-01-01

We demonstrate TimeTravel, an efficient DBMS system for seamless integrated querying of past and (forecasted) future values of time series, allowing the user to view past and future values as one joint time series. This functionality is important for advanced application domain like energy....... The main idea is to compactly represent time series as models. By using models, the TimeTravel system answers queries approximately on past and future data with error guarantees (absolute error and confidence) one order of magnitude faster than when accessing the time series directly. In addition...... it to answer approximate and exact queries. TimeTravel is implemented into PostgreSQL, thus achieving complete user transparency at the query level. In the demo, we show the easy building of a hierarchical model index for a real-world time series and the effect of varying the error guarantees on the speed up...

Advanced MR imaging for the optimal micro neurosurgical planning in patients with the congential spinal meningeal cysts

International Nuclear Information System (INIS)

Purvina, J.; Jansone, A.; Krumina, G.; Dzelzite, S.; Platkajis, A.; Ozolins, H.; Dzelzitis, J.

2001-01-01

The extramedullar meningeal cysts are congential anomalies of the spinal canal. The neurological manifestation - the syndromes of radicular pain and the dysfunctions of the pelvic organs are indicators for the neurosurgical treatment. The most complete classification of distinguish the different types of these anomalies is the Nabor's classification. The congential anomalies (malformations) are conventionally diagnosed by TC or conventional MR imaging techniques. These methods can't give a precise answer to the Nabor's classification. The new MR sequences offer the possibility to diagnose these anomalies more precisely. Purpose: to create a new MR protocol for a precise topical diagnostic of the meningeal cysts according to the contemporary embriogenetical, neurological and neurosurgical classification. Conclusions: For the optimal topographical visualisation of the congential spinal meningeal cysts MR in 3 orthogonal planes must be performed. The thin slice techniques with the specific parameters for better visualisation of the nerve roots are necessary. The thin slice, fat suppressed MR sequences are very important for the differential diagnosis of the extradural meningeal cysts from the dermoids, para- and infraspinal fat collections. They are very useful in choosing the optimal microneurosurgical way of the surgical treatment. (authors)

Integrated Agent-Based and Production Cost Modeling Framework for Renewable Energy Studies: Preprint

Energy Technology Data Exchange (ETDEWEB)

Gallo, Giulia

2015-10-07

The agent-based framework for renewable energy studies (ARES) is an integrated approach that adds an agent-based model of industry actors to PLEXOS and combines the strengths of the two to overcome their individual shortcomings. It can examine existing and novel wholesale electricity markets under high penetrations of renewables. ARES is demonstrated by studying how increasing levels of wind will impact the operations and the exercise of market power of generation companies that exploit an economic withholding strategy. The analysis is carried out on a test system that represents the Electric Reliability Council of Texas energy-only market in the year 2020. The results more realistically reproduce the operations of an energy market under different and increasing penetrations of wind, and ARES can be extended to address pressing issues in current and future wholesale electricity markets.

Integrated on-line accelerator modeling at CEBAF

International Nuclear Information System (INIS)

Bowling, B.A.; Shoaee, H.; Van Zeijts, J.; Witherspoon, S.; Watson, W.

1995-01-01

An on-line accelerator modeling facility is currently under development at CEBAF. The model server, which is integrated with the EPICS control system, provides coupled and 2nd-order matrices for the entire accelerator, and forms the foundation for automated model- based control and diagnostic applications. Four types of machine models are provided, including design, golden or certified, live, and scratch or simulated model. Provisions are also made for the use of multiple lattice modeling programs such as DIMAD, PARMELA, and TLIE. Design and implementation details are discussed. 2 refs., 4 figs

Integrated Modelling - the next steps (Invited)

Science.gov (United States)

Moore, R. V.

2010-12-01

modelling demonstrations and to achieve a critical mass of accessible linkable models. These models will be spread across the world and there will need to be a search mechanism to find them. If the benefits of integrated modelling are to become widely available, ways will have to be found to automate and hide the linking process. All the above will require considerable resources. It is proposed to build these resources by creating an international community of practice based upon the open source model. The talk will expand upon the research and development required.

Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases.

Science.gov (United States)

Dinevski, Nikolaj; Sarnthein, Johannes; Vasella, Flavio; Fierstra, Jorn; Pangalu, Athina; Holzmann, David; Regli, Luca; Bozinov, Oliver

2017-07-01

To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included (N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2-9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5-12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969-0.995, P = 0.008). The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI. Copyright © 2017 Elsevier Inc. All rights reserved.

Substantiating the Conceptual Model of Branding of the Integrated Business Structures

Directory of Open Access Journals (Sweden)

Nifatova Olena M.

2017-11-01

Full Text Available The article is aimed at researching the theoretical foundations of the concept of branding and forming a conceptual model of branding of the integrated business structures. The concept of branding of IBS is systematized and synthesized by three directions: overview of theories of management of integrated business structures, based on the principle of economic integration; overview of the brand management models based on the principle of brand-oriented management; overview of management approaches, the essence of which is synthesized in the aspect of application to the management of brands of the integrated business structures. Special attention is paid to the factors influencing the efficiency of the process of integration of business structures. Further development of modelling the process of integration branding in the IBS system is of great importance, as the brands of two unifying companies usually have their own identities, unique features within the terms of formation of the brand’s style and philosophy. In such a fundamental issue it is necessary to define the strategy of brand integration, i.e. whether it will be a single brand, a joint brand, a flexible brand or a completely new one.

Multimedia Based E-learning : Design and Integration of Multimedia Content in E-learning

Directory of Open Access Journals (Sweden)

Abdulaziz Omar Alsadhan

2014-05-01

Full Text Available The advancement in multimedia and information technologies also have impacted the way of imparting education. This advancement has led to rapid use of e learning systems and has enabled greater integration of multimedia content into e learning systems. This paper present a model for development of e learning systems based on multimedia content. The model is called “Multimedia based e learning” and is loosely based on waterfall software development model. This model consists of three distinct phases; Multimedia Content Modelling, Multimedia content Development, Multimedia content Integration. These three phases are further sub divided into 7 different activities which are analysis, design, technical requirements, content development, content production & integration, implementation and evaluation. This model defines a general framework that can be applied for the development of e learning systems across all disciplines and subjects.

Performance measurement, modeling, and evaluation of integrated concurrency control and recovery algorithms in distributed data base systems

Energy Technology Data Exchange (ETDEWEB)

Jenq, B.C.

1986-01-01

The performance evaluation of integrated concurrency-control and recovery mechanisms for distributed data base systems is studied using a distributed testbed system. In addition, a queueing network model was developed to analyze the two phase locking scheme in the distributed testbed system. The combination of testbed measurement and analytical modeling provides an effective tool for understanding the performance of integrated concurrency control and recovery algorithms in distributed database systems. The design and implementation of the distributed testbed system, CARAT, are presented. The concurrency control and recovery algorithms implemented in CARAT include: a two phase locking scheme with distributed deadlock detection, a distributed version of optimistic approach, before-image and after-image journaling mechanisms for transaction recovery, and a two-phase commit protocol. Many performance measurements were conducted using a variety of workloads. A queueing network model is developed to analyze the performance of the CARAT system using the two-phase locking scheme with before-image journaling. The combination of testbed measurements and analytical modeling provides significant improvements in understanding the performance impacts of the concurrency control and recovery algorithms in distributed database systems.

Using DRG to analyze hospital production: a re-classification model based on a linear tree-network topology

Directory of Open Access Journals (Sweden)

Achille Lanzarini

2014-09-01

Full Text Available Background: Hospital discharge records are widely classified through the Diagnosis Related Group (DRG system; the version currently used in Italy counts 538 different codes, including thousands of diagnosis and procedures. These numbers reflect the considerable effort of simplification, yet the current classification system is of little use to evaluate hospital production and performance.Methods: As the case-mix of a given Hospital Unit (HU is driven by its physicians’ specializations, a grouping of DRGs into a specialization-driven classification system has been conceived through the analysis of HUs discharging and the ICD-9-CM codes. We propose a three-folded classification, based on the analysis of 1,670,755 Hospital Discharge Cards (HDCs produced by Lombardy Hospitals in 2010; it consists of 32 specializations (e.g. Neurosurgery, 124 sub-specialization (e.g. skull surgery and 337 sub-sub-specialization (e.g. craniotomy.Results: We give a practical application of the three-layered approach, based on the production of a Neurosurgical HU; we observe synthetically the profile of production (1,305 hospital discharges for 79 different DRG codes of 16 different MDC are grouped in few groups of homogeneous DRG codes, a more informative production comparison (through process-specific comparisons, rather than crude or case-mix standardized comparisons and a potentially more adequate production planning (considering the Neurosurgical HUs of the same city, those produce a limited quote of the whole neurosurgical production, because the same activity can be realized by non-Neurosugical HUs.Conclusion: Our work may help to evaluate the hospital production for a rational planning of available resources, blunting information asymmetries between physicians and managers. 

BiGG Models: A platform for integrating, standardizing and sharing genome-scale models

DEFF Research Database (Denmark)

King, Zachary A.; Lu, Justin; Dräger, Andreas

2016-01-01

Genome-scale metabolic models are mathematically-structured knowledge bases that can be used to predict metabolic pathway usage and growth phenotypes. Furthermore, they can generate and test hypotheses when integrated with experimental data. To maximize the value of these models, centralized repo...

Integrability of the Rabi Model

International Nuclear Information System (INIS)

Braak, D.

2011-01-01

The Rabi model is a paradigm for interacting quantum systems. It couples a bosonic mode to the smallest possible quantum model, a two-level system. I present the analytical solution which allows us to consider the question of integrability for quantum systems that do not possess a classical limit. A criterion for quantum integrability is proposed which shows that the Rabi model is integrable due to the presence of a discrete symmetry. Moreover, I introduce a generalization with no symmetries; the generalized Rabi model is the first example of a nonintegrable but exactly solvable system.

Adaptive integral backstepping sliding mode control for opto-electronic tracking system based on modified LuGre friction model

Science.gov (United States)

Yue, Fengfa; Li, Xingfei; Chen, Cheng; Tan, Wenbin

2017-12-01

In order to improve the control accuracy and stability of opto-electronic tracking system fixed on reef or airport under friction and external disturbance conditions, adaptive integral backstepping sliding mode control approach with friction compensation is developed to achieve accurate and stable tracking for fast moving target. The nonlinear observer and slide mode controller based on modified LuGre model with friction compensation can effectively reduce the influence of nonlinear friction and disturbance of this servo system. The stability of the closed-loop system is guaranteed by Lyapunov theory. The steady-state error of the system is eliminated by integral action. The adaptive integral backstepping sliding mode controller and its performance are validated by a nonlinear modified LuGre dynamic model of the opto-electronic tracking system in simulation and practical experiments. The experiment results demonstrate that the proposed controller can effectively realise the accuracy and stability control of opto-electronic tracking system.

The use of simulation in neurosurgical education and training. A systematic review.

Science.gov (United States)

Kirkman, Matthew A; Ahmed, Maria; Albert, Angelique F; Wilson, Mark H; Nandi, Dipankar; Sevdalis, Nick

2014-08-01

There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date. The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations. Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18. The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.

CTBT integrated verification system evaluation model supplement

Energy Technology Data Exchange (ETDEWEB)

EDENBURN,MICHAEL W.; BUNTING,MARCUS; PAYNE JR.,ARTHUR C.; TROST,LAWRENCE C.

2000-03-02

Sandia National Laboratories has developed a computer based model called IVSEM (Integrated Verification System Evaluation Model) to estimate the performance of a nuclear detonation monitoring system. The IVSEM project was initiated in June 1994, by Sandia's Monitoring Systems and Technology Center and has been funded by the U.S. Department of Energy's Office of Nonproliferation and National Security (DOE/NN). IVSEM is a simple, ''top-level,'' modeling tool which estimates the performance of a Comprehensive Nuclear Test Ban Treaty (CTBT) monitoring system and can help explore the impact of various sensor system concepts and technology advancements on CTBT monitoring. One of IVSEM's unique features is that it integrates results from the various CTBT sensor technologies (seismic, in sound, radionuclide, and hydroacoustic) and allows the user to investigate synergy among the technologies. Specifically, IVSEM estimates the detection effectiveness (probability of detection), location accuracy, and identification capability of the integrated system and of each technology subsystem individually. The model attempts to accurately estimate the monitoring system's performance at medium interfaces (air-land, air-water) and for some evasive testing methods such as seismic decoupling. The original IVSEM report, CTBT Integrated Verification System Evaluation Model, SAND97-25 18, described version 1.2 of IVSEM. This report describes the changes made to IVSEM version 1.2 and the addition of identification capability estimates that have been incorporated into IVSEM version 2.0.

The Gold Coast Integrated Care Model

Directory of Open Access Journals (Sweden)

Martin Connor

2016-07-01

Full Text Available This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service.

The dynamics of multimodal integration: The averaging diffusion model.

Science.gov (United States)

Turner, Brandon M; Gao, Juan; Koenig, Scott; Palfy, Dylan; L McClelland, James

2017-12-01

We combine extant theories of evidence accumulation and multi-modal integration to develop an integrated framework for modeling multimodal integration as a process that unfolds in real time. Many studies have formulated sensory processing as a dynamic process where noisy samples of evidence are accumulated until a decision is made. However, these studies are often limited to a single sensory modality. Studies of multimodal stimulus integration have focused on how best to combine different sources of information to elicit a judgment. These studies are often limited to a single time point, typically after the integration process has occurred. We address these limitations by combining the two approaches. Experimentally, we present data that allow us to study the time course of evidence accumulation within each of the visual and auditory domains as well as in a bimodal condition. Theoretically, we develop a new Averaging Diffusion Model in which the decision variable is the mean rather than the sum of evidence samples and use it as a base for comparing three alternative models of multimodal integration, allowing us to assess the optimality of this integration. The outcome reveals rich individual differences in multimodal integration: while some subjects' data are consistent with adaptive optimal integration, reweighting sources of evidence as their relative reliability changes during evidence integration, others exhibit patterns inconsistent with optimality.

Integrative change model in psychotherapy: Perspectives from Indian thought.

Science.gov (United States)

Manickam, L S S

2013-01-01

Different psychotherapeutic approaches claim positive changes in patients as a result of therapy. Explanations related to the change process led to different change models. Some of the change models are experimentally oriented whereas some are theoretical. Apart from the core models of behavioral, psychodynamic, humanistic, cognitive and spiritually oriented models there are specific models, within psychotherapy that explains the change process. Integrative theory of a person as depicted in Indian thought provides a common ground for the integration of various therapies. Integrative model of change based on Indian thought, with specific reference to psychological concepts in Upanishads, Ayurveda, Bhagavad Gita and Yoga are presented. Appropriate psychological tools may be developed in order to help the clinicians to choose the techniques that match the problem and the origin of the dimension. Explorations have to be conducted to develop more techniques that are culturally appropriate and clinically useful. Research has to be initiated to validate the identified concepts.

Validity of Basic Electronic 1 Module Integrated Character Value Based on Conceptual Change Teaching Model to Increase Students Physics Competency in STKIP PGRI West Sumatera

Science.gov (United States)

Hidayati, A.; Rahmi, A.; Yohandri; Ratnawulan

2018-04-01

The importance of teaching materials in accordance with the characteristics of students became the main reason for the development of basic electronics I module integrated character values based on conceptual change teaching model. The module development in this research follows the development procedure of Plomp which includes preliminary research, prototyping phase and assessment phase. In the first year of this research, the module is validated. Content validity is seen from the conformity of the module with the development theory in accordance with the demands of learning model characteristics. The validity of the construct is seen from the linkage and consistency of each module component developed with the characteristic of the integrated learning model of character values obtained through validator assessment. The average validation value assessed by the validator belongs to a very valid category. Based on the validator assessment then revised the basic electronics I module integrated character values based on conceptual change teaching model.

Integrated Environmental Assessment Modelling