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Sample records for preliminary neurosurgery program

  1. Supplementary Educational Models in Canadian Neurosurgery Residency Programs.

    Science.gov (United States)

    Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R

    2017-03-01

    The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.

  2. Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training.

    Science.gov (United States)

    Piquer, José; Qureshi, Mubashir Mahmood; Young, Paul H; Dempsey, Robert J

    2015-06-01

    OBJECT A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013. METHODS Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar. RESULTS From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar. CONCLUSIONS Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

  3. Pediatric neurosurgery: pride and prejudice.

    Science.gov (United States)

    Winston, K R

    2000-02-01

    Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

  4. Academic Productivity of US Neurosurgery Residents as Measured by H-Index: Program Ranking with Correlation to Faculty Productivity.

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    Sarkiss, Christopher A; Riley, Kyle J; Hernandez, Christopher M; Oermann, Eric K; Ladner, Travis R; Bederson, Joshua B; Shrivastava, Raj K

    2017-03-29

    Engagement in research and academic productivity are crucial components in the training of a neurosurgeon. This process typically begins in residency training. In this study, we analyzed individual resident productivity as it correlated to publications across all Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgery training programs in an attempt to identify how programs have developed and fostered a research culture and environment. We obtained a list of current neurosurgery residents in ACGME-accredited programs from the American Association of Neurological Surgeons database. An expanded PubMed and Scopus search was conducted for each resident through the present time. We tabulated all articles attributed to each resident. We then categorized the publications based on each neurosurgical subspecialty while in residency. A spreadsheet-based statistical analysis was performed. This formulated the average number of resident articles, h-indices, and most common subspecialty categories by training program. We analyzed 1352 current neurosurgery residents in 105 programs. There were a total of 10 645 publications, of which 3985 were resident first-author publications during the period of study. The most common subspecialties among all resident publications were vascular (24.9%), spine (16.9%), oncology (16.1%), pediatric (5.6%), functional (4.9%), and trauma (3.8%). The average resident published 2.9 first-author papers with average of 38.0 first-author publications by total residents at each program (range 0-241). The average h-index per resident is 2.47 ± 3.25. When comparing previously published faculty h-index program rankings against our resident h-index rankings, there is a strong correlation between the 2 datasets with a clear delineation between Top-20 productivity and that of other programs (average h-index 4.2 vs 1.7, respectively, P < .001). Increasing program size leads to a clear increase in academic productivity on both the

  5. History of Neurosurgery in Palestine.

    Science.gov (United States)

    Darwazeh, Rami; Darwazeh, Mazhar; Sun, Xiaochuan

    2017-08-01

    Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. We collected information from various sources in either English or Arabic. The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  7. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  8. History of Korean Neurosurgery.

    Science.gov (United States)

    Hwang, Sung-nam

    2015-08-01

    The year 2012 was the 50th anniversary of the Korean Neurosurgical Society, and in 2013, the 15th World Congress of Neurosurgery took place in Seoul, Korea. Thus, it is an appropriate occasion to introduce the world to the history of the Korean Neurosurgical Society and the foundation, development, and growth of Korean neurosurgery. Historical materials and pictures were collected and reviewed from the history book and photo albums of the Korean Neurosurgical Society. During the last 50 years, the Korean Neurosurgical Society and Korean neurosurgery have developed and grown enormously not only in quantity but also in quality. In every aspect, the turning point from the old to the new era of the Korean Neurosurgical Society and Korean neurosurgery was the year 1980. Copyright © 2015. Published by Elsevier Inc.

  9. Computers and neurosurgery.

    Science.gov (United States)

    Shaikhouni, Ammar; Elder, J Bradley

    2012-11-01

    At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. Just before that era, the transistor was invented in the late 1940s, and the integrated circuit was invented in the late 1950s. During this time, the first automated, programmable computational machines were introduced. The rapid progress in the field of neurosurgery not only occurred hand in hand with the development of modern computers, but one also can state that modern neurosurgery would not exist without computers. The focus of this article is the impact modern computers have had on the practice of neurosurgery. Neuroimaging, neuronavigation, and neuromodulation are examples of tools in the armamentarium of the modern neurosurgeon that owe each step in their evolution to progress made in computer technology. Advances in computer technology central to innovations in these fields are highlighted, with particular attention to neuroimaging. Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. PRELIMINARY PROGRAMMED WHOLE—BODY COUNTER

    Institute of Scientific and Technical Information of China (English)

    张少东; 郑文忠; 等

    1995-01-01

    It is capable of giving the initial intakes of radionuclides and the assessment quantitites used in radiation protection according to its measured results of radionuclides in vivo.It is accomplished by providing the software of controlling,interface and internal dose estimation programs to the original iron cabin shielding whole-body counter.The preliminary application shows that its data processing is rapid and correct,and can meet the requirement of rapid internal radioactive contamination monitoring and diagnosing in case of lots of internal contamination subjects happened in nuclear accident.

  11. [Neurosurgery in the elderly patient: Geriatric neurosurgery].

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    González-Bonet, Luis Germán; Tarazona-Santabalbina, Francisco-José; Lizán Tudela, Luis

    2016-01-01

    Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  12. Simulation and resident education in spinal neurosurgery.

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    Bohm, Parker E; Arnold, Paul M

    2015-01-01

    A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.

  13. Neurosurgery and pregnancy

    Directory of Open Access Journals (Sweden)

    Rajkumar Subramanian

    2014-01-01

    Full Text Available Pregnant patients rarely present with neurosurgical emergencies, but can cause significant morbidity and mortality to the mother and the foetus. Physiological changes of pregnancy in relevance to neurosurgery, effects of anaesthetic agents on the foetus, common neurosurgical emergencies, and anaesthetic implications both from obstetric and neurosurgical point of view are discussed in this review.

  14. Robotics and neurosurgery.

    Science.gov (United States)

    Nathoo, Narendra; Pesek, Todd; Barnett, Gene H

    2003-12-01

    Ultimately, neurosurgery performed via a robotic interface will serve to improve the standard of a neurosurgeon's skills, thus making a good surgeon a better surgeon. In fact, computer and robotic instrumentation will become allies to the neurosurgeon through the use of these technologies in training, diagnostic, and surgical events. Nonetheless, these technologies are still in an early stage of development, and each device developed will entail its own set of challenges and limitations for use in clinical settings. The future operating room should be regarded as an integrated information system incorporating robotic surgical navigators and telecontrolled micromanipulators, with the capabilities of all principal neurosurgical concepts, sharing information, and under the control of a single person, the neurosurgeon. The eventual integration of robotic technology into mainstream clinical neurosurgery offers the promise of a future of safer, more accurate, and less invasive surgery that will result in improved patient outcome.

  15. The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra.

    Science.gov (United States)

    Dabdoub, Carlos F; Dabdoub, Carlos B

    2013-09-25

    The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19(th) century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country.

  16. Robotics in child neurosurgery.

    Science.gov (United States)

    Giorgi, C; Sala, R; Riva, D; Cossu, A; Eisenberg, H

    2000-11-01

    We felt there was a need for a new device with "minimal invasive" tracking hardware, to be used in image-guided neurosurgery, and the system we designed to fill this need is now presented. It combines precision of movement, stability and self-positioning capabilities together with optically tracked registration and procedural control within the structure of a surgical microscope. The results are reduced setup time and minimal "distraction" from the procedure itself, factors of special relevance in child neurosurgery. The system is composed of a six-axis industrial robot suitable for use in the operating room, carrying a surgical microscope. Three progressive scan-synchronized infrared cameras mounted around the lenses of the scope are used to register the patient's position and track surgical instruments with reference to the registered space. Orientation of the microscope during surgery is obtained with a six-axis joystick used as a microscope handle. The system has been clinically used in 14 cases, and it has proven itself to be reliable, providing the expected performance advantages. The implementation of a tracked ultrasound or endoscope intraoperative imaging source is also described.

  17. The history of neurosurgery at the University of Alabama at Birmingham.

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    Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N

    2014-10-01

    : The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.

  18. Laser applications in neurosurgery

    Science.gov (United States)

    Cerullo, Leonard J.

    1985-09-01

    The "false start" of the laser in neurosurgery should not be misconstrued as a denial of the inherent advantages of precision and gentleness in dealing with neural tissue. Rather, early investigators were frustrated by unrealistic expectations, cumbersome equipment, and a general ignorance of microtechnique. By the early 70s, microneurosurgery was well established, surgical laser equipment for free hand and microlinked application had been developed, and a more realistic view of the limitations of the laser had been established. Consequently, the late 70s really heralded the renaissance of the laser in neurosurgery. Since then, there has been an overwhelming acceptance of the tool in a variety of clinical situations, broadly categorized in five groups. 1)|Perhaps the most generally accepted area is in the removal of extra-axial tumors of the brain and spinal cord. These tumors, benign by histology but treacherous by location, do not present until a significant amount of neurological compensation has already occurred. The application of additional trauma to the neural tissue, whether by further tumor growth or surgical manipulation, frequently results in irreversible damage. Here, the ability of the laser to vaporize tissue, in a fairly hemostatic fashion, without mechanical or thermal damage to sensitive surrounding tissues, is essential. 2)|The ability to incise delicate neural tissue with minimal spread of thermal destruction to adjacent functioning tissue makes the laser the ideal instrument when tumors deep under the surface are encountered in the brain or spinal cord. Thus, the second group of applications is in the transgression of normal neural structures to arrive at deeper pathological tissue. 3)|The third area of benefit for the laser in neurosurgery has been in the performance of neuroablative procedures, calling for deliberate destruction of functioning neural tissue in a controlled fashion. Again, the precision and shape confinement of the destructive

  19. Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

    2016-09-01

    OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.029). CONCLUSIONS This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery

  20. Neurosurgery and clinical engineering.

    Science.gov (United States)

    Salcman, M; Samaras, G M

    1978-01-01

    Modern technology has profoundly altered the clinical practice of neurosurgery. For a wide variety of conditions, patients are being implanted with active and passive devices or treated with advanced microsurgical instrumentation. After surgery, such patients are sent to modern intensive-care units employing the latest advances in patient monitoring and computer technology. We contend that the responsibilities of the Clinical Engineer extend beyond simple installation and maintenance of equipment and systems. It is essential that he take part in the continuing education of non-technical personnel who must make use of the equipment in ways that are meaningful in the care of the patient and to the progress of clinical science. This point is illustrated by our experience with a neurosurgical intensive-care unit. It is also the thesis of this paper that the design and maintenance of increasingly sophisticated biomedical systems will benefit from the use of an interdisciplinary approach at the very inception of a project. This approach is illustrated by our current development of a multibeam microwave hyperthermia system for possible use in the treatment of brain tumors.

  1. Defining excellence in vascular neurosurgery.

    Science.gov (United States)

    Sanai, Nader; Spetzler, Robert F

    2010-01-01

    Success as a vascular neurosurgeon almost always begins with passion, an inherent love for the work that drives an insatiable desire for personal improvement. A personal definition of excellence in vascular neurosurgery includes several fundamental qualities: mastery of the basics, refinement of technique, advancement of technology, investigative study, advanced decision making, microsurgical innovation, a well-rounded surgical armamentarium, and a lifelong commitment to teaching. Ultimately, the reward for these efforts is the ability to influence generations to come, particularly as one follows the rising careers of former trainees, each redefining the term "excellence" in vascular neurosurgery.

  2. Artificial neural networks in neurosurgery.

    Science.gov (United States)

    Azimi, Parisa; Mohammadi, Hasan Reza; Benzel, Edward C; Shahzadi, Sohrab; Azhari, Shirzad; Montazeri, Ali

    2015-03-01

    Artificial neural networks (ANNs) effectively analyze non-linear data sets. The aimed was A review of the relevant published articles that focused on the application of ANNs as a tool for assisting clinical decision-making in neurosurgery. A literature review of all full publications in English biomedical journals (1993-2013) was undertaken. The strategy included a combination of key words 'artificial neural networks', 'prognostic', 'brain', 'tumor tracking', 'head', 'tumor', 'spine', 'classification' and 'back pain' in the title and abstract of the manuscripts using the PubMed search engine. The major findings are summarized, with a focus on the application of ANNs for diagnostic and prognostic purposes. Finally, the future of ANNs in neurosurgery is explored. A total of 1093 citations were identified and screened. In all, 57 citations were found to be relevant. Of these, 50 articles were eligible for inclusion in this review. The synthesis of the data showed several applications of ANN in neurosurgery, including: (1) diagnosis and assessment of disease progression in low back pain, brain tumours and primary epilepsy; (2) enhancing clinically relevant information extraction from radiographic images, intracranial pressure processing, low back pain and real-time tumour tracking; (3) outcome prediction in epilepsy, brain metastases, lumbar spinal stenosis, lumbar disc herniation, childhood hydrocephalus, trauma mortality, and the occurrence of symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid haemorrhage; (4) the use in the biomechanical assessments of spinal disease. ANNs can be effectively employed for diagnosis, prognosis and outcome prediction in neurosurgery.

  3. Syringe exchange programs in Brazil: preliminary assessment of 45 programs

    Directory of Open Access Journals (Sweden)

    Fonseca Elize Massard da

    2006-01-01

    Full Text Available The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP. After consulting national and regional networks of people working in projects/ programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.

  4. Syringe exchange programs in Brazil: preliminary assessment of 45 programs

    Directory of Open Access Journals (Sweden)

    Elize Massard da Fonseca

    2006-04-01

    Full Text Available The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP. After consulting national and regional networks of people working in projects/ programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.

  5. Modeling the complete Otto cycle: Preliminary version. [computer programming

    Science.gov (United States)

    Zeleznik, F. J.; Mcbride, B. J.

    1977-01-01

    A description is given of the equations and the computer program being developed to model the complete Otto cycle. The program incorporates such important features as: (1) heat transfer, (2) finite combustion rates, (3) complete chemical kinetics in the burned gas, (4) exhaust gas recirculation, and (5) manifold vacuum or supercharging. Changes in thermodynamic, kinetic and transport data as well as model parameters can be made without reprogramming. Preliminary calculations indicate that: (1) chemistry and heat transfer significantly affect composition and performance, (2) there seems to be a strong interaction among model parameters, and (3) a number of cycles must be calculated in order to obtain steady-state conditions.

  6. Simulating tumour removal in neurosurgery.

    Science.gov (United States)

    Radetzky, A; Rudolph, M

    2001-12-01

    In this article the software system ROBO-SIM is described. ROBO-SIM is a planning and simulation tool for minimally invasive neurosurgery. Different to the most other simulation tools, ROBO-SIM is able to use actual patient's datasets for simulation. Same as in real neurosurgery a planning step, which provides more functionality as up-to-date planning systems on the market, is performed before undergoing the simulated operation. The planning steps include the definition of the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track and doing virtual trepanations (virtual craniotomy). For use with an intra-operative active manipulator, which is guided by the surgeon during real surgery (robotic surgery), go- and non-go-areas can be defined. During operation, the robot restricts the surgeon from leaving these go-areas. After planning, an additional simulation system, which is understood as an extension to the planning step, is used to simulate whole surgical interventions directly on the patient's anatomy basing on the planning data and by using the same instruments as for the real intervention. First tests with ROBO-SIM are performed on a phantom developed for this purpose and on actual patient's datasets with ventricular tumours.

  7. Challenges in contemporary academic neurosurgery.

    Science.gov (United States)

    Black, Peter M

    2006-03-01

    Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

  8. Proscriptive Bayesian Programming and Maximum Entropy: a Preliminary Study

    Science.gov (United States)

    Koike, Carla Cavalcante

    2008-11-01

    Some problems found in robotics systems, as avoiding obstacles, can be better described using proscriptive commands, where only prohibited actions are indicated in contrast to prescriptive situations, which demands that a specific command be specified. An interesting question arises regarding the possibility to learn automatically if proscriptive commands are suitable and which parametric function could be better applied. Lately, a great variety of problems in robotics domain are object of researches using probabilistic methods, including the use of Maximum Entropy in automatic learning for robot control systems. This works presents a preliminary study on automatic learning of proscriptive robot control using maximum entropy and using Bayesian Programming. It is verified whether Maximum entropy and related methods can favour proscriptive commands in an obstacle avoidance task executed by a mobile robot.

  9. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    Science.gov (United States)

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

  10. The evolving role of the nurse practitioner in neurosurgery.

    Science.gov (United States)

    Rimel, R W; Langfitt, T W

    1980-12-01

    The authors examine the many important roles for the nurse practitioner in neurosurgery, including patient care in academic departments and private practice, and research and scholarship. The responsibilities of nurse practitioners in a hospital can be varied: they may take some responsibility for all patients on the neurosurgery service, or their assignment may be more specific, such as to the intensive care unit; or they may be assigned to all patients with a specified neurosurgical disorder, such as head injury of intractable pain. Nurse practitioners can become coordinators of clinical research programs, with responsibility for collecting and collating the data and assisting in data analysis and manuscript preparation. Detailed clinical protocols must be developed for nurse practitioners, and those protocols then become the basis for their employment and legal status. Licensure requirements vary greatly among states, and are continuing to change.

  11. NEUROSURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    In order to study the thrombolytic effects ofstrepokinase (r-SK), 28 male Wistar rats wasembolised in the carotid artery. Regionalcerebral blood now (rCBF) was reduced by64% with life indexes unchanged 30 min afterembolization. After perfusion with r-SK andhuman plasminogen r-SK reperfusion revealed

  12. NEUROSURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Two hundred and ten patients with hyper-tensive cerebral and cerebellar haemorrhagewere surgically treated with four patterns. Thepreoperative status graded as Ⅰ~Ⅴ stageswas improved among 151 cases, and 59 cases(28.0%) died. The authors concluded that indi-vidualized selection of available surgical pat-tern combined with CT findings according to

  13. Neurosurgery

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Using the rabbit model of middle cerebralartery occlusion, we dissected the brainmitochondia of which Na+, K+-ATPase, Ca2+,Mg2+-ATPase activities were determined bybiochemical method and the contents ofmalondialdehyde (MDA) were measured by

  14. NEUROSURGERY

    African Journals Online (AJOL)

    observed significant changes between two surveys conducted in Germany in 1991 and 1997, ... haemorrhage disease (SAH), traumatic brain injury (TBI), decompressive ... the North American. Spine Society, while specific areas of management were .... The characteristics of this relationship are shown in Table 4. A further ...

  15. The history of neurosurgery in Anatolia and Turkey: the Turkish Neurosurgical Society.

    Science.gov (United States)

    Solaroglu, Ihsan; Acar, Feridun; Bavbek, Murad; Ture, Ugur; Beskonakli, Ethem

    2013-01-01

    Although the history of neurosurgery in Anatolia goes back ten thousand years, modern surgery began in Turkey in 1890. Neurosurgery in Turkey began in the first half of the 20th century. However, general surgeons began applying neurosurgical techniques back in the late 19th century. Most of these applications included procedures for craniocerebral traumas and infections. Dr. Cemil Topuzlu (1868-1958) is the founder of modern surgery in Turkey. Dr. Abdulkadir Cahit Tuner became the first neurosurgeon with a degree in Turkey in 1923. The first neurosurgery department was established in Istanbul in 1923, and the first training program began in the late 1940s. Currently there are almost 1200 neurosurgeons in Turkey and 75 training clinics at university hospitals and Training and Research Hospitals of the Ministry of Health provide neurosurgery training. The current state of neurosurgery in Turkey is parallel to that of the advanced Western countries. Apart from the application of neurosurgical procedures, there have been many scientific studies from Turkish neurosurgeons contributing to the total body of literature in neurosurgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Renaissance Neurosurgery: Italy's Iconic Contributions.

    Science.gov (United States)

    Nanda, Anil; Khan, Imad Saeed; Apuzzo, Michael L

    2016-03-01

    Various changes in the sociopolitical milieu of Italy led to the increasing tolerance of the study of cadavers in the late Middle Ages. The efforts of Mondino de Liuzzi (1276-1326) and Guido da Vigevano (1280-1349) led to an explosion of cadaver-centric studies in centers such as Bologna, Florence, and Padua during the Renaissance period. Legendary scientists from this era, including Leonardo Da Vinci, Andreas Vesalius, Bartolomeo Eustachio, and Costanzo Varolio, furthered the study of neuroanatomy. The various texts produced during this period not only helped increase the understanding of neuroanatomy and neurophysiology but also led to the formalization of medical education. With increased understanding came new techniques to address various neurosurgical problems from skull fractures to severed peripheral nerves. The present study aims to review the major developments in Italy during the vibrant Renaissance period that led to major progress in the field of neurosurgery. Published by Elsevier Inc.

  17. The Importance of Exercise in the Well-Rounded Physician: Dialogue for the Inclusion of a Physical Fitness Program in Neurosurgery Resident Training.

    Science.gov (United States)

    Fargen, Kyle M; Spiotta, Alejandro M; Turner, Raymond D; Patel, Sunil

    2016-06-01

    Exercise, diet, and personal fitness programs are essentially lacking in modern graduate medical education. In the context of long hours and alternating shift and sleep cycles, the lack of exercise and poor dietary choices may have negative consequences on physician physical and mental health. This opinion piece aims to generate important dialogue regarding the scope of the problem, the literature supporting the health benefits of exercise, potential solutions to enhancing diet and exercise among resident trainees, and possible pitfalls to the adoption of exercise programs within graduate medical education.

  18. Smartphone use in neurosurgery? APP-solutely!

    OpenAIRE

    Michael Zaki; Doniel Drazin

    2014-01-01

    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on thei...

  19. A history of neurosurgery in Canada.

    Science.gov (United States)

    Weir, Bryce

    2011-03-01

    Canada existed for more than half a century before there were glimmerings of modern neurosurgical activity. Neurosurgery had advanced significantly in Europe and the United States prior to its being brought to Toronto and Montreal from American centers. The pioneers responsible for the rapid evolution in practice, teaching and research are described. The interplay of scientific, professional, demographic and economic forces with general historical trends has produced dramatic changes in the way that neurosurgery is now practiced.

  20. [Competency-based Neurosurgery Residency Programme].

    Science.gov (United States)

    Lobato, Ramiro D; Jiménez Roldan, Luis; Alen, José F; Castaño, Ana M; Munarriz, Pablo M; Cepeda, Santiago; Lagares, Alfonso

    2016-01-01

    A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal. Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period. It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations. Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques. Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually

  1. Clovis Vincent (1879-1947): founder of French neurosurgery and promoter of oncologic neurosurgery.

    Science.gov (United States)

    Karamanou, M; Androutsos, G; Lymperi, M; Stamboulis, E; Liappas, I; Lykouras, E

    2012-01-01

    The eminent neurologist Clovis Vincent decided to become neurosurgeon at an advanced age. His is considered the founder of French neurosurgery and the Europe's first neurosurgeon. He was mainly interested in pituitary tumors and his work on oncologic neurosurgery remains valuable.

  2. Developing an Undergraduate Teaching Assistant Program in Communication: Values, Curriculum, and Preliminary Assessment.

    Science.gov (United States)

    Socha, Thomas J.

    1998-01-01

    Describes a case study of a Communication Undergraduate Teaching Assistant (UTA) program and reports a limited, preliminary assessment of the teaching effectiveness of 25 UTAs. Concludes by identifying various benefits and drawbacks of such programs and offers recommendations for departments interested in developing similar programs. (RS)

  3. The development of neurosurgery at the National Hospital for Neurology and Neurosurgery, Queen Square, London, England.

    Science.gov (United States)

    Powell, Michael; Kitchen, Neil

    2007-11-01

    The National Hospital for Neurology and Neurosurgery, Queen Square, London is one of the oldest clinical neuroscience hospitals in the world. It was formed from the fusion of itself with the Maida Vale Hospital in 1948. More recently, in 1996, it was incorporated into the University College London Hospitals group. It has had many distinguished neurosurgeons on its staff, whose history from Sir Victor Horsley to the present is described with particular reference to the development of the specialty of neurosurgery. The current neurosurgical staff and future developments of neurosurgery at the hospital are also elucidated.

  4. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    Science.gov (United States)

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Stereotactic imaging in functional neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Hidehiro

    2012-07-01

    Background: The birth of stereotactic functional neurosurgery in 1947 was to a great extent dependent on the development of ventriculography. The last decades have witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders. Initially, these procedures were largely based on the same imaging technique that had been used since the birth of this technique, and that is still used in some centers. The introduction of new imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided new potentials, but also new challenges for accurate identification and visualisation of the targets in the basal ganglia and the thalamus with an urge to thoroughly evaluate and optimize the stereotactic targeting technique, as well as evaluate accurately in stereotactic space the location and extent of stereotactic Radiofrequency (RF) lesions and the position of deep brain stimulation (DBS) electrodes. Aims: To study the differences between CT and MRI regarding indirect atlas coordinates in thalamic and pallidal procedures and to evaluate and validate visualisation of the pallidum and the subthalamic nucleus in view of direct targeting irrespective of atlas-derived coordinates. Furthermore, to evaluate the contribution of RF parameters on the size of stereotactic lesions, as well as the impact of size and location on clinical outcome. Method: The coordinates in relation to the landmarks of the 3{sup rd} ventricle of the targets in the pallidum and ventrolateral thalamus were compared between CT and MRI in 34 patients. In another 48 patients direct visualization of the pallidum was evaluated and compared to indirect atlas based targeting. The possibility and versatility of visualizing the Subthalamic Nucleus (STN) on short acquisition MRI were evaluated in a multicentre study, and the use of alternative landmarks in identification of the STN was demonstrated in another study. In 46 patients CT and

  6. Publication misrepresentation among neurosurgery residency applicants: an increasing problem.

    Science.gov (United States)

    Kistka, Heather M; Nayeri, Arash; Wang, Li; Dow, Jamie; Chandrasekhar, Rameela; Chambless, Lola B

    2016-01-01

    OBJECT Misrepresentation of scholarly achievements is a recognized phenomenon, well documented in numerous fields, yet the accuracy of reporting remains dependent on the honor principle. Therefore, honest self-reporting is of paramount importance to maintain scientific integrity in neurosurgery. The authors had observed a trend toward increasing numbers of publications among applicants for neurosurgery residency at Vanderbilt University and undertook this study to determine whether this change was a result of increased academic productivity, inflated reporting, or both. They also aimed to identify application variables associated with inaccurate citations. METHODS The authors retrospectively reviewed the residency applications submitted to their neurosurgery department in 2006 (n = 148) and 2012 (n = 194). The applications from 2006 were made via SF Match and those from 2012 were made using the Electronic Residency Application Service. Publications reported as "accepted" or "in press" were verified via online search of Google Scholar, PubMed, journal websites, and direct journal contact. Works were considered misrepresented if they did not exist, incorrectly listed the applicant as first author, or were incorrectly listed as peer reviewed or published in a printed journal rather than an online only or non-peer-reviewed publication. Demographic data were collected, including applicant sex, medical school ranking and country, advanced degrees, Alpha Omega Alpha membership, and USMLE Step 1 score. Zero-inflated negative binomial regression was used to identify predictors of misrepresentation. RESULTS Using univariate analysis, between 2006 and 2012 the percentage of applicants reporting published works increased significantly (47% vs 97%, p misrepresentations (33% vs 45%) also increased. In 2012, applicants with a greater total of reported works (p Misrepresentation is more common in applicants from unranked US medical schools and those with a greater number of

  7. Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

    Science.gov (United States)

    Ament, Jared D; Kim, Timothy; Gold-Markel, Judah; Germano, Isabelle M; Dempsey, Robert; Weaver, John P; DiPatri, Arthur J; Andrews, Russell J; Sanchez, Mary; Hinojosa, Juan; Moser, Richard P; Glick, Roberta

    2017-08-01

    The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Frameless image-guided neurosurgery in motion

    NARCIS (Netherlands)

    Woerdeman, P.A.

    2008-01-01

    The general objective of this thesis was the enhancement of image-guidance system use by optimizing “man-machine” interaction in frameless image-guided neurosurgery. Part I. The application of frameless stereotaxy in the neurosurgical practice We aimed to compare three patient-to-image registration

  9. Smartphone use in neurosurgery? APP-solutely!

    Directory of Open Access Journals (Sweden)

    Michael Zaki

    2014-01-01

    Conclusions: There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  10. Modernity and the emerging futurism in neurosurgery.

    Science.gov (United States)

    Apuzzo, M L

    2000-03-01

    This article discusses the emergence of neurosurgery in its 'modern' form during the second half of the 20th century and presents the apertures to the 21st century that are apparent in establishing an evolving futurism in the field. Factors of primary positive impetus and challenges are discussed.

  11. Zero-gravity cloud physics laboratory: Experiment program definition and preliminary laboratory concept studies

    Science.gov (United States)

    Eaton, L. R.; Greco, E. V.

    1973-01-01

    The experiment program definition and preliminary laboratory concept studies on the zero G cloud physics laboratory are reported. This program involves the definition and development of an atmospheric cloud physics laboratory and the selection and delineations of a set of candidate experiments that must utilize the unique environment of zero gravity or near zero gravity.

  12. A relational database in neurosurgery.

    Science.gov (United States)

    Sicurello, F; Marchetti, M R; Cazzaniga, P

    1995-01-01

    This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions

  13. OSU TOMF Program Site Selection and Preliminary Concept Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Spadling, Steve [Oklahoma State Univ., Stillwater, OK (United States)

    2012-05-10

    The purpose of this report is to confirm the programmatic requirements for the new facilities, identify the most appropriate project site, and develop preliminary site and building concepts that successfully address the overall project goals and site issues. These new facilities will be designed to accommodate the staff, drivers and maintenance requirements for the future mixed fleet of passenger vehicles, Transit Style Buses and School Buses.

  14. National Evaluation of the Weatherization Assistance Program: Preliminary Evaluation Plan for Program Year 2006

    Energy Technology Data Exchange (ETDEWEB)

    Ternes, Mark P [ORNL; Schweitzer, Martin [ORNL; Tonn, Bruce Edward [ORNL; Schmoyer, Richard L [ORNL; Eisenberg, Joel Fred [ORNL

    2007-02-01

    federal, state, and local initiatives. For example, the use of computerized audits has increased, cooling and baseload measures have been added, weatherization approaches tailored to the unique construction characteristics of mobile homes have been developed, the weatherization of large multifamily buildings has expanded and become more sophisticated, the flexibility to improve 'energy-related' health and safety has been provided, and leveraging with utilities, other state programs, and owners of large multifamily buildings has increased considerably. The Department of Energy tasked ORNL with planning the new evaluation in light of its experience in conducting the previous national evaluation and the metaevaluations. This preliminary evaluation plan, developed by ORNL, documents how the new national evaluation will be performed. In the remaining portion of this section, the purpose and fundamental questions the evaluation will address are identified and how these questions were derived is discussed.

  15. Preliminary Technical Risk Analysis for the Geothermal Technologies Program

    Energy Technology Data Exchange (ETDEWEB)

    None

    2009-01-18

    This report explains the goals, methods, and results of a probabilistic analysis of technical risk for a portfolio of R&D projects in the DOE Geothermal Technologies Program (The Program). The analysis is a task by Princeton Energy Resources International, LLC, in support of the National Renewable Energy Laboratory on behalf of the Program. The main challenge in the analysis lies in translating R&D results to a quantitative reflection of technical risk for a key Program metric: levelized cost of energy (LCOE).

  16. Preliminary Technical Risk Analysis for the Geothermal Technologies Program

    Energy Technology Data Exchange (ETDEWEB)

    McVeigh, J.; Cohen, J.; Vorum, M.; Porro, G.; Nix, G.

    2007-03-01

    This report explains the goals, methods, and results of a probabilistic analysis of technical risk for a portfolio of R&D projects in the DOE Geothermal Technologies Program ('the Program'). The analysis is a task by Princeton Energy Resources International, LLC (PERI), in support of the National Renewable Energy Laboratory (NREL) on behalf of the Program. The main challenge in the analysis lies in translating R&D results to a quantitative reflection of technical risk for a key Program metric: levelized cost of energy (LCOE). This requires both computational development (i.e., creating a spreadsheet-based analysis tool) and a synthesis of judgments by a panel of researchers and experts of the expected results of the Program's R&D.

  17. Super-Efficient Refrigerator Program (SERP) evaluation volume 2: Preliminary impact and market transformation assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lee, A.D.; Conger, R.L.

    1996-08-01

    The Super Efficient Refrigerator Program (SERP) is a collaborative utility program intended to transform the market for energy-efficient and environmentally friendly refrigerators. It is one of the first examples of a large-scale {open_quotes}market transformation{close_quotes} energy efficiency program. This report documents the preliminary impact and market transformation evaluation of SERP ({open_quotes}the Program{close_quotes}). Pacific Northwest National Laboratory (PNNL) conducted this evaluation for the U.S. Department of Energy. This study focuses on the preliminary impact evaluation and market transformation assessment, but also presents limited process evaluation information. It is based on interviews with refrigerator dealers and manufacturers, interviews with utility participants, industry data, and information from the Program administrators. Results from this study complement those from prior process evaluation also conducted by PNNL. 42 refs., 5 figs., 4 tabs.

  18. Pediatric neurosurgery--a golden decade.

    Science.gov (United States)

    Ciurea, A V; Vasilescu, G; Nuteanu, L

    1999-11-01

    Pediatric neurosurgery, once an annex of general neurosurgery, has evolved into a well-defined and complex medical specialty. The last 10 years have witnessed major advances in documentation of the minute details of CNS diseases of childhood, refinement of the specific means of action and better adaptation of therapeutic efforts to the requirements of a developing organism. Pediatric neurosurgeons are now increasingly involved in beneficial cooperation within complex medical teams. This fact has by no means diminished the importance of pediatric neurosurgery; rather, in such settings it has proved to have better effects in the struggle for stable long-lasting good results of multi-modal treatments covering all pathological entities. Progress in neurological surgery for patients in the pediatric age group has emerged from the development of supranational scientific structures and from that of specific concepts exchanging channels, so that today pediatric neurosurgeons belong to an extremely specialized medical corps, working in harmony across geographical and socio-economic national features in the interests of humankind's young generation's health.

  19. Neurosurgery in Lebanon: History, Development, and Future Challenges.

    Science.gov (United States)

    Fares, Youssef; Fares, Jawad

    2017-03-01

    Lebanon stands out as the one of the first countries in the Middle East and the Arab world to practice the medical specialty of neurosurgery. In addition, Lebanon has one of the best reputations for neurosurgery in this region. This article documents the history and current status of Lebanese neurosurgery. Residency and fellowship trainings are also highlighted, and political, socioeconomic, and academic challenges for the future of the profession are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. 75 FR 16833 - Preliminary Revised 5-Year Outer Continental Shelf (OCS) Oil and Gas Leasing Program for 2007-2012

    Science.gov (United States)

    2010-04-02

    ... Minerals Management Service Preliminary Revised 5-Year Outer Continental Shelf (OCS) Oil and Gas Leasing... Revised 5-Year OCS Oil and Gas Leasing Program for 2007- 2012. This is the Preliminary Revised Program... relative environmental sensitivity analysis and the Secretary's revisions to the leasing schedule...

  1. Examining the Preliminary Efficacy of a Dating Violence Prevention Program for Hispanic Adolescents

    Science.gov (United States)

    Gonzalez-Guarda, Rosa Maria; Guerra, Jessica E.; Cummings, Amanda A.; Pino, Karen; Becerra, Maria M.

    2015-01-01

    The purpose of this study is to evaluate the preliminary efficacy of a dating violence (DV) prevention program for Cuban American adolescents ("JOVEN"/YOUTH: "Juntos Opuestos a la Violence Entre Novios"/Together Against Dating Violence). A randomized-controlled experimental design with a delayed condition was used to evaluate…

  2. Art, passion, and neurosurgery: the role of the Society of Neurological Surgeons in academic neurosurgery.

    Science.gov (United States)

    Dempsey, Robert J

    2011-11-01

    Neurosurgery is at a crossroads in a time of economic uncertainty. It is also a time of remarkable potential for innovation resulting in dramatic improvement in the way neurosurgeons care for patients and the quality of outcomes. Analysis of this key time point of neurosurgical history is drawn from reflections for a presidential address to the Society of Neurological Surgeons. It is the author's opinion that the best of academic neurosurgery must and will accept this challenge by developing not only the research but also the creativity and art of what neurosurgeons do for maximal patient benefit in research, educational, and clinical missions.

  3. F-35 Joint Strike Fighter: Preliminary Observations on Program Progress

    Science.gov (United States)

    2016-03-23

    operations, mission planning, supply - chain management , maintenance, and other processes. In the past, we have reported that ALIS software has not been... supply chain and is managing supplier quality initiatives to address shortfalls, according to officials. Our ongoing work shows that although the...analyzed total program funding requirements. GAO also collected and analyzed production and supply chain performance data, and interviewed DOD

  4. Preliminary Design of the Ada Programming Support Environment Configuration Manager.

    Science.gov (United States)

    1984-06-01

    October 1980. 62 ............................................... 10. Buxton , J. and V. H. Stenning, eds. "Stoneman," Requirements for Ada Programming...18. Stoner, Bill . Logicon. Course EE 5.45, "Software Acquisition," School of Engineering, Air Force Institute of Technology, Wright-Patterson AFB OH

  5. Parsing Combinatory Categorial Grammar with Answer Set Programming: Preliminary Report

    CERN Document Server

    Lierler, Yuliya

    2011-01-01

    Combinatory categorial grammar (CCG) is a grammar formalism used for natural language parsing. CCG assigns structured lexical categories to words and uses a small set of combinatory rules to combine these categories to parse a sentence. In this work we propose and implement a new approach to CCG parsing that relies on a prominent knowledge representation formalism, answer set programming (ASP) - a declarative programming paradigm. We formulate the task of CCG parsing as a planning problem and use an ASP computational tool to compute solutions that correspond to valid parses. Compared to other approaches, there is no need to implement a specific parsing algorithm using such a declarative method. Our approach aims at producing all semantically distinct parse trees for a given sentence. From this goal, normalization and efficiency issues arise, and we deal with them by combining and extending existing strategies. We have implemented a CCG parsing tool kit - AspCcgTk - that uses ASP as its main computational mean...

  6. One century after the description of the "sign": Joseph Babinski and his contribution to neurosurgery.

    Science.gov (United States)

    Lanzino, G; diPierro, C G; Laws, E R

    1997-04-01

    One hundred years ago, in 1896, Joseph Babinski published a preliminary report on "réflexe cutané plantaire" (cutaneous plantar reflex), which became widely known as the Babinski sign. However, Babinski did not view the description of the sign as his major achievement. Instead, he considered his greatest contribution to medicine to be his having "... indiqué la voie à Martel et à Vincent" (pointed the way to Thierry de Martel and Clovis Vincent, founders of French neurosurgery). Several of Babinski's manuscripts deal with neurosurgical problems. In 1900, 1 year before Alfred Fröhlich's description, Babinski gave the first account of the adiposogenital syndrome and its relation to pituitary-hypothalamic disorder. Many other original contributions ensued. These include a report on the relief of papilledema by surgical decompression in 1901, the successful removal (in collaboration with de Martel) of an intracranial meningioma in 1909, the description (again with de Martel) of a cerebellopontine angle tumor treated by surgical excision with good result in 1925, and several manuscripts concerning diagnosis and treatment of compressive spinal cord lesions. Babinski's dream to establish a department of neurosurgery became a reality shortly after his death. The Hôpital de la Pitie in Paris, where Babinski did most of his work, established the first French department of neurosurgery chaired by Babinski's pupil, Vincent.

  7. Herbert Olivecrona: founder of Swedish neurosurgery.

    Science.gov (United States)

    Ljunggren, B

    1993-01-01

    Herbert Olivecrona (1891-1980) singlehandedly founded Swedish neurosurgery. At the International Congress in Neurology in Bern in August, 1931, Harvey Cushing invited the cream of the world's medical society to a private banquet. Among the 28 specially invited guests was Herbert Olivecrona. At 40 years old, Olivecrona took his seat with pioneers such as Otfrid Foerster, Percival Bailey, Hugh Cairns, Geoffrey Jefferson, and Sir Charles Sherrington. This suggests that Cushing was impressed by the Swedish aristocrat's didactic deeds when he visited the Serafimer Hospital in Stockholm 2 years earlier. During the mid-1920's, the radiologist Erik Lysholm greatly improved the technique of ventriculography and, challenged by Olivecrona, his diagnostic neuroradiology became of superior quality. In the early 1930's, utilizing technical innovations of his own, Lysholm became a master at demonstrating and localizing posterior fossa tumors, which Olivecrona then operated on. Olivecrona's clinic became the mecca to which many scholars, thirsting for more knowledge, went on a pilgrimage. The international reputation of the clinic was founded, not on epoch-making discoveries, but by the resolute and practical application of methods already launched elsewhere and the exemplary organization that Olivecrona had established in collaboration with Lysholm. In spite of hardships and primitive working conditions, the clinic at the Serafimer Hospital gradually developed into the ideal prototype for a modern neurosurgical department. Olivecrona trained many colorful personalities who later were to lay the foundation for neurosurgery in their home countries; these included Wilhelm Tönnis of Germany, Edvard Busch of Denmark, and Aarno Snellman of Finland. Olivecrona was a true pioneer who made major contributions in practically all fields of conventional neurosurgery.

  8. Smartphone use in neurosurgery? APP-solutely!

    Science.gov (United States)

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. Results: The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. Conclusions: There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps. PMID:25101208

  9. Smartphone use in neurosurgery? APP-solutely!

    Science.gov (United States)

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  10. Genealogy of training in vascular neurosurgery.

    Science.gov (United States)

    Chowdhry, Shakeel A; Spetzler, Robert F

    2014-02-01

    Remarkable advances and changes in the landscape of neurovascular disease have occurred recently. Concurrently, a paradigm shift in training and resident education is underway. This crossroad of unique opportunities and pressures necessitates creative change in the training of future vascular neurosurgeons to allow incorporation of surgical advances, new technology, and supplementary treatment modalities in a setting of reduced work hours and increased public scrutiny. This article discusses the changing landscape in neurovascular disease treatment, followed by the recent changes in resident training, and concludes with our view of the future of training in vascular neurosurgery.

  11. Mythological and Prehistorical Origins of Neurosurgery.

    Science.gov (United States)

    Nanda, Anil; Filis, Andreas; Kalakoti, Piyush

    2016-05-01

    Mythology has a cultural appeal, and the description of some neurosurgical procedures in the Hindu, Greek, Egyptian, and Chinese mythology has a bearing to the origins of our professions. The traces to some of our modern-day practices also can be linked back to the ancient prehistoric eras of the Siberian, Persian, and the Andean region. In this historical perspective, we briefly dwell into individual accounts through the prism of different cultures to highlight the development of neurosurgery in mythology and prehistoric era.

  12. Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis

    OpenAIRE

    Wang, Vincent Y.; Chin, Cynthia T.; Lu, Daniel C.; Smith, Justin S.; Chou, Dean

    2010-01-01

    Free-hand thoracic pedicle screw placement is becoming more prevalent within neurosurgery residency training programs. This technique implements anatomic landmarks and tactile palpation without fluoroscopy or navigation to place thoracic pedicle screws. Because this technique is performed by surgeons in training, we wished to analyze the rate at which these screws were properly placed by residents by retrospectively reviewing the accuracy of resident-placed free-hand thoracic pedicle screws u...

  13. The present and future of quality measures and public reporting in neurosurgery.

    Science.gov (United States)

    Bekelis, Kimon; McGirt, Matthew J; Parker, Scott L; Holland, Christopher M; Davies, Jason; Devin, Clinton J; Atkins, Tyler; Knightly, Jack; Groman, Rachel; Zyung, Irene; Asher, Anthony L

    2015-12-01

    Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare's Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet "generic" quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care

  14. Experimental new automatic tools for robotic stereotactic neurosurgery: towards "no hands" procedure of leads implantation into a brain target.

    Science.gov (United States)

    Mazzone, P; Arena, P; Cantelli, L; Spampinato, G; Sposato, S; Cozzolino, S; Demarinis, P; Muscato, G

    2016-07-01

    The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic "no hands" surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized "large white" pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery.

  15. Using Electronic Noses to Detect Tumors During Neurosurgery

    Science.gov (United States)

    Homer, Margie L.; Ryan, Margaret A.; Lara, Liana M.; Kateb, Babak; Chen, Mike

    2008-01-01

    It has been proposed to develop special-purpose electronic noses and algorithms for processing the digitized outputs of the electronic noses for determining whether tissue exposed during neurosurgery is cancerous. At present, visual inspection by a surgeon is the only available intraoperative technique for detecting cancerous tissue. Implementation of the proposal would help to satisfy a desire, expressed by some neurosurgeons, for an intraoperative technique for determining whether all of a brain tumor has been removed. The electronic-nose technique could complement multimodal imaging techniques, which have also been proposed as means of detecting cancerous tissue. There are also other potential applications of the electronic-nose technique in general diagnosis of abnormal tissue. In preliminary experiments performed to assess the viability of the proposal, the problem of distinguishing between different types of cultured cells was substituted for the problem of distinguishing between normal and abnormal specimens of the same type of tissue. The figure presents data from one experiment, illustrating differences between patterns that could be used to distinguish between two types of cultured cancer cells. Further development can be expected to include studies directed toward answering questions concerning not only the possibility of distinguishing among various types of normal and abnormal tissue but also distinguishing between tissues of interest and other odorous substances that may be present in medical settings.

  16. Minimalism in Art, Medical Science and Neurosurgery.

    Science.gov (United States)

    Ökten, Ali İhsan

    2016-12-21

    The word ''minimalism'' is a word derived from French the word ''minimum''. Whereas the lexical meaning of minimum is ''the least or the smallest quantity necessary for something'', its expression in mathematics can be described as ''the lowest step a variable number can descend, least, minimal''. Minimalism, which advocates an extreme simplicity of the artistic form, is a current in modern art and music whose origins go to 1960s and which features simplicity and objectivity. Although art, science and philosophy are different disciplines, they support each other from time to time, sometimes they intertwine and sometimes they copy each other. A periodic schools or teaching in one of them can take the others into itself, so, they proceed on their ways empowering each other. It is also true for the minimalism in art and the minimal invasive surgical approaches in science. Concepts like doing with less, avoiding unnecessary materials and reducing the number of the elements in order to increase the effect in the expression which are the main elements of the minimalism in art found their equivalents in medicine and neurosurgery. Their equivalents in medicine or neurosurgery have been to protect the physical integrity of the patient with less iatrogenic injury, minimum damage and the same therapeutic effect in the most effective way and to enable the patient to regain his health in the shortest span of time.

  17. Virtual endoscopy in neurosurgery: a review.

    Science.gov (United States)

    Neubauer, André; Wolfsberger, Stefan

    2013-01-01

    Virtual endoscopy is the computerized creation of images depicting the inside of patient anatomy reconstructed in a virtual reality environment. It permits interactive, noninvasive, 3-dimensional visual inspection of anatomical cavities or vessels. This can aid in diagnostics, potentially replacing an actual endoscopic procedure, and help in the preparation of a surgical intervention by bridging the gap between plain 2-dimensional radiologic images and the 3-dimensional depiction of anatomy during actual endoscopy. If not only the endoscopic vision but also endoscopic handling, including realistic haptic feedback, is simulated, virtual endoscopy can be an effective training tool for novice surgeons. In neurosurgery, the main fields of the application of virtual endoscopy are third ventriculostomy, endonasal surgery, and the evaluation of pathologies in cerebral blood vessels. Progress in this very active field of research is achieved through cooperation between the technical and the medical communities. While the technology advances and new methods for modeling, reconstruction, and simulation are being developed, clinicians evaluate existing simulators, steer the development of new ones, and explore new fields of application. This review introduces some of the most interesting virtual reality systems for endoscopic neurosurgery developed in recent years and presents clinical studies conducted either on areas of application or specific systems. In addition, benefits and limitations of single products and simulated neuroendoscopy in general are pointed out.

  18. Near-term hybrid vehicle program, phase 1. Appendix C: Preliminary design data package

    Science.gov (United States)

    1979-01-01

    The design methodology, the design decision rationale, the vehicle preliminary design summary, and the advanced technology developments are presented. The detailed vehicle design, the vehicle ride and handling and front structural crashworthiness analysis, the microcomputer control of the propulsion system, the design study of the battery switching circuit, the field chopper, and the battery charger, and the recent program refinements and computer results are presented.

  19. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Self-retaining retractor for neurosurgery. 882...-retaining retractor for neurosurgery. (a) Identification. A self-retaining retractor for neurosurgery is a self-locking device used to hold the edges of a wound open during neurosurgery. (b) Classification...

  20. Overview of intraoperative MRI in neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Shiino, Akihiko; Matsuda, Masayuki [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  1. Life and Medical Ethics in Pediatric Neurosurgery

    Science.gov (United States)

    YAMASAKI, Mami

    2017-01-01

    Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child’s condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents’ religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future. PMID:28025426

  2. Interstitial laser thermotherapy in neurosurgery: a review.

    Science.gov (United States)

    Menovsky, T; Beek, J F; van Gemert, M J; Roux, F X; Bown, S G

    1996-01-01

    One of the most recent laser treatment modalities in neurosurgery is interstitial laser thermotherapy (ILTT). In this review, experimental and clinical studies concerning intracranial ILTT are discussed. Two methods for intra-operative control of the laser induced lesions are described; i.e., computer-controlled power delivery, using a thermocouple that is positioned interstitially at the periphery of the tumour to maintain the desired temperature at that point, and MRI, to visualise the extent of the thermal lesions induced by ILTT. The results show that ILTT using a Nd: YAG laser is easy and relatively effective in the treatment of small deep-seated brain tumours with minimal risk and complications. This review is concluded with suggestions for further improvement of this treatment modality.

  3. The internal medicine specialist and neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Pizzini

    2013-05-01

    Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.

  4. Evolving virtual reality simulation in neurosurgery.

    Science.gov (United States)

    Schirmer, Clemens M; Mocco, J; Elder, J Bradley

    2013-10-01

    Virtual reality (VR) applications promise the safe, efficacious, and valid replication of scenarios encountered in modern neurosurgery, and a number of navigation- or dissection-related and endovascular simulators have been successfully deployed in the last 2 decades. Concurrently, neurosurgical training is changing, and VR simulations are expected to play a part in future training. To give an overview of currently available neurosurgical VR applications in the spectrum of desired applications and the outlook of the requirements to be met by future applications. The available literature was analyzed using structured Medline and PubMed searches. Relevant articles were retrieved and reviewed. When quantitative results were available, effect sizes were collated or estimated to check for publication bias. There has been a significant increase in publications concerning the use of VR in neurosurgery in the last 22 years (P < .001). Thirty-eight of 117 publications (32%) identified reported data regarding the use of a simulator by practitioners; 35 of these were reported as positive trials (92%). Twenty-two of 38 studies (58%) reported quantitative data with mostly small positive effect sizes (median, 1.41; interquartile range, 1.08-2). The use of VR simulators in endovascular surgery has the most robust basis, with 65% of studies reporting quantitative outcomes. Current neurosurgical VR applications focus on basic procedural skill acquisition and are valid and efficacious adjuncts to neurosurgical training. In the future, the development of complex procedural simulators, teamwork, and focus on validated measures will lead to robust framework of the use of VR over the entire career of a neurosurgeon.

  5. Preliminary assessment report for Waiawa Gulch, Installation 15080, Pearl City, Oahu, Hawaii. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Hawaii Army National Guard (HIARNG) property near Pearl City, Oahu, Hawaii. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the Waiawa Gulch property, phase I of the Department of Defense Installation Restoration Program (IRP).

  6. 3D printing in neurosurgery: A systematic review.

    Science.gov (United States)

    Randazzo, Michael; Pisapia, Jared M; Singh, Nickpreet; Thawani, Jayesh P

    2016-01-01

    The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints.

  7. Clinical application of keyhole techniques in minimally invasive neurosurgery

    Institute of Scientific and Technical Information of China (English)

    LAN Qing

    2006-01-01

    @@ With the development of modern neuroimaging and the improvement of surgical instruments or devices as well as operative skills, minimally invasive neurosurgery has been progressing rapidly with great changes in surgical concepts and methods.1 Based on these changes, anatomic research has been carried out to explore new surgical approaches dealing with anticipated microtrauma. These approaches have made or been making things possible. Keyhole microsurgery has evolved into an important subject of modern minimally invasive neurosurgery.

  8. The development and preliminary effectiveness of a nursing case management e-learning program.

    Science.gov (United States)

    Liu, Wen-I; Chu, Kuo-Chung; Chen, Shing-Chia

    2014-07-01

    The purpose of this article was to describe the development and preliminary effectiveness of a digital case management education program. The e-learning program was built through the collaboration of a nurse educator and an informatics professor. The program was then developed according to the following steps: (1) building a visual interface, (2) scripting each unit, (3) preparing the course material and assessment tests, (4) using teaching software to record audio and video courses, (5) editing the audio recordings, (6) using instructional media or hyperlinks to finalize the interactions, (7) creating the assessment and obtaining feedback, and (8) testing the overall operation. The digital program consisted of five learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. Forty nurses participated in this study and fully completed the questionnaires both before and after the program. The knowledge and confidence levels in the experimental group were significantly higher over time than those of the comparison group. The results supported the use of educational technology to provide a more flexible and effective presentation method for continuing education programs.

  9. Cognitive Vocal Program applied to individuals with signals presbylarynx: preliminary results.

    Science.gov (United States)

    Nemr, Katia; Souza, Glaucia Verena Sampaio de; Simões-Zenari, Marcia; Tsuji, Domingos Hiroshi; Hachiya, Adriana; Cordeiro, Gislaine Ferro; Nunes, Guilherme Pecoraro; Dajer, María Eugenia

    2014-01-01

    To propose and verify the feasibility of a vocal program intervention in patients with presbylarynx signs with or without vocal complaints. Among 20 elder participants of the current research, 3 female patients with median age of 67 years were chosen for the pilot study. Laryngological examination, vocal recording with CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) protocol, and Screening Protocol of Risk of Dysphonia (SPRD) were conducted before and after the program intervention. They joined the Cognitive Vocal Program for presbyphonia based on the genetic epistemology by Jean Piaget associated with vocal techniques based on scientific literature. This program is structured with six sessions and each one of them is focused in different aspects of vocal production. After the program intervention, some aspects such as loudness, coordination between breathing and speaking, accuracy in articulatory movements, jitter, and harmonics-to-noise ratio improved with parameters within the expected range for the age group. Three female participants were observed for better vocal quality, higher fundamental frequency, and better maximum phonation time. In two cases, tension related to loudness elevation and better scores on SPRD was observed. Using by high-speed laryngeal image, we also observed reduction of presbylarynx signs, and remarkable improvement in glottis closure competence and mucosal wave movement of the patients with and without vocal complaints. The preliminary results suggest encouraging prospects for the proposal with improvement in the aspects analyzed. This program was well designed and did not require any further adjustments.

  10. Preliminary Mark-18A (Mk-18A) Target Material Recovery Program Product Acceptance Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, Sharon M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Patton, Bradley D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-09-01

    The Mk-18A Target Material Recovery Program (MTMRP) was established in 2015 to preserve the unique materials, e.g. 244Pu, in 65 previously irradiated Mk-18A targets for future use. This program utilizes existing capabilities at SRS and Savannah River National Laboratory (SRNL) to process targets, recover materials from them, and to package the recovered materials for shipping to ORNL. It also utilizes existing capabilities at ORNL to receive and store the recovered materials, and to provide any additional processing of the recovered materials or residuals required to prepare them for future beneficial use. The MTMRP is presently preparing for the processing of these valuable targets which is expected to begin in ~2019. As part of the preparations for operations, this report documents the preliminary acceptance criteria for the plutonium and heavy curium materials to be recovered from the Mk-18A targets at SRNL for transport and storage at ORNL. These acceptance criteria were developed based on preliminary concepts developed for processing, transporting, and storing the recovered Mk-18A materials. They will need to be refined as these concepts are developed in more detail.

  11. Preliminary nuclear safety assessment of the NEPST (Topaz 2) space reactor program

    Science.gov (United States)

    Marshall, A. C.

    The United States (US) Strategic Defense Initiative Organization (SDIO) decided to investigate the possibility of launching a Russian Topaz 2 space nuclear power system. A preliminary nuclear safety assessment was conducted to determine whether or not a space mission could be conducted safely and within budget constraints. As part of this assessment, a safety policy and safety functional requirements were developed to guide both the safety assessment and future Topaz 2 activities. A review of the Russian flight safety program was conducted and documented. Our preliminary nuclear safety assessment included a number of deterministic analyses, such as the following: neutronic analysis of normal and accident configurations, an evaluation of temperature coefficients of reactivity, a reentry and disposal analysis, an analysis of postulated launch abort impact accidents, and an analysis of postulated propellant fire and explosion accidents. Based on the assessment to date, it appears that it will be possible to safely launch the Topaz 2 system in the US with a modification to preclude water flooded criticality. A full scale safety program is now underway.

  12. Effectiveness of Chronic Disease Self-management Program in Japan: preliminary report of a longitudinal study.

    Science.gov (United States)

    Yukawa, Keiko; Yamazaki, Yoshihiko; Yonekura, Yuki; Togari, Taisuke; Abbott, Fusae K; Homma, Mieko; Park, Minjeong; Kagawa, Yumi

    2010-12-01

    This is the preliminary report of a study to evaluate the effectiveness of the Chronic Disease Self-management Program in Japan by comparing changes in health outcomes at the baseline and 3-month and 6-month follow-ups. The program is a patient-centered educational program for the self-management of chronic conditions. The study's participants were recruited from among the attendees of the program workshops. During the study period (August 2006 to May 2007), 18 workshops were held and 128 attendees agreed to participate in the study. The health outcomes that were measured included health status, self-management behaviors, utilization of health services, self-efficacy, satisfaction with daily living, and clinical indicators. These indicators were further analyzed by disease type: diabetes, rheumatic disease, and cardiovascular disease/dyslipidemia. The findings indicated statistically significant positive changes in health distress, coping with symptoms, stretching exercises, communication with the physician, and satisfaction with daily living. The positive changes were especially remarkable among the groups with diabetes and rheumatic disease. These findings suggest that the Chronic Disease Self-management Program can be effective for Japanese people with chronic conditions.

  13. Navigation system for neurosurgery with PC platform.

    Science.gov (United States)

    Akatsuka, Y; Shibasaki, T; Saito, A; Kosaka, A; Matsuzaki, H; Asano, T; Furuhashi, Y

    2000-01-01

    This paper presents a navigation system for a surgical microscope and an endoscope which can be used for neurosurgery. In this system, a wireframe model of a target tumor and other significant anatomical landmarks are superimposed in real-time onto live video images taken from the microscope and the endoscope. The wireframe model is generated from a CT/MRI slice images. Overlaid images are simultaneously displayed in the same monitor using the picture-in-picture function so that the surgeon can concentrate on the single monitor during the surgery. The system measures the position and orientation of the patient using specially designed non-contact sensing devices mounted on the microscope and the endoscope. Based on this real-time measurement, the system displays other useful information about the navigation as well as the rendered wireframe. The accuracy of registration between the wireframe model and the actual live view is less than 2 mm. We tested this system in actual surgery several times, and verified its performance and effectiveness.

  14. Prophylactic antibiotics and anticonvulsants in neurosurgery.

    Science.gov (United States)

    Ratilal, B; Sampaio, C

    2011-01-01

    The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

  15. Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery.

    Science.gov (United States)

    Aldave, Guillermo; Hansen, Daniel; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

    2017-04-01

    OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value skills. The learning curves

  16. The history of neurosurgery at the University of Sao Paulo

    Directory of Open Access Journals (Sweden)

    Manoel Jacobsen Teixeira

    2014-03-01

    Full Text Available The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

  17. Neurosurgery and Music; Effect of Wolfgang Amadeus Mozart.

    Science.gov (United States)

    Gasenzer, Elena Romana; Kanat, Ayhan; Neugebauer, Edmund

    2017-06-01

    The nervous system works like a great orchestra. Specifically, the music of Mozart with its "Mozart effect" is appropriate to use in neurosurgery. We investigated the relationship between Mozart's music and neurosurgery. We used digital catalogs like "PubMed" and the libraries of universities. Key words were "Wolfgang Amadeus Mozart" and "neurosurgery and music." In the first half of the 20th century, performing neurosurgery on some musicians, such as Maurice Ravel, Josef Hassid, and George Gershwin, resulted in a fatal outcome. The cause of this is probably that neurosurgery had not been developed yet in the first half of the 20th century. In the past 3 decades, the neurosurgical operations of musicians show that musicians have rich associations among auditory, somatic, and sensorial systems. It is clear that we have much to learn from studies about music and brain function that derive from our surgical experiences with patients. The neuronal plasticity of musicians' brains may be different from that of nonmusicians' brains. Musicians with enhanced motor skills have greater capacity for plasticity because of enriched interhemispheric connections. Listening to music and the effect of Mozart in neurosurgical practice, intensive care, or rehabilitation were documented in many studies. As authors, we mean something different: Its effectiveness should be studied. We concluded that in current neurosurgical practice, Mozart has an effect. More research and clinical studies are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Augmented reality in neurosurgery: a systematic review.

    Science.gov (United States)

    Meola, Antonio; Cutolo, Fabrizio; Carbone, Marina; Cagnazzo, Federico; Ferrari, Mauro; Ferrari, Vincenzo

    2016-05-07

    Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.

  19. Neurosurgery and elderly: analysis through the years.

    Science.gov (United States)

    Chibbaro, Salvatore; Di Rocco, F; Makiese, O; Mirone, G; Marsella, M; Lukaszewicz, A C; Vicaut, E; Turner, B; Hamdi, S; Spiriev, T; Di Emidio, P; Pirracchio, R; Payen, D; George, B; Bresson, D

    2010-04-01

    The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.

  20. Preliminary assessment report for Redmond Army National Guard Facility, Installation 53120, Redmond, Washington. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Ketels, P.; Aggarwal, P.

    1993-08-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Washington Army National Guard (WAARNG) property in Redmond, Washington. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the Redmond ARNG property, Phase I of the Department of Defense Installation Restoration Program. The environmentally significant operations (ESOs) associated with the property are (1) supply/storage of hazardous materials, (2) weapons cleaning, (3) the underground storage tanks (USTs), and (4) the use of herbicides. These ESOs are no longer active because of the closure of OMS 10 activities in 1988.

  1. Euler Technology Assessment program for preliminary aircraft design employing SPLITFLOW code with Cartesian unstructured grid method

    Science.gov (United States)

    Finley, Dennis B.

    1995-01-01

    This report documents results from the Euler Technology Assessment program. The objective was to evaluate the efficacy of Euler computational fluid dynamics (CFD) codes for use in preliminary aircraft design. Both the accuracy of the predictions and the rapidity of calculations were to be assessed. This portion of the study was conducted by Lockheed Fort Worth Company, using a recently developed in-house Cartesian-grid code called SPLITFLOW. The Cartesian grid technique offers several advantages for this study, including ease of volume grid generation and reduced number of cells compared to other grid schemes. SPLITFLOW also includes grid adaptation of the volume grid during the solution convergence to resolve high-gradient flow regions. This proved beneficial in resolving the large vortical structures in the flow for several configurations examined in the present study. The SPLITFLOW code predictions of the configuration forces and moments are shown to be adequate for preliminary design analysis, including predictions of sideslip effects and the effects of geometry variations at low and high angles of attack. The time required to generate the results from initial surface definition is on the order of several hours, including grid generation, which is compatible with the needs of the design environment.

  2. Cancer Prevention Interdisciplinary Education Program at Purdue University: Overview and Preliminary Results

    Science.gov (United States)

    Teegarden, Dorothy; Lee, Ji-Yeon; Adedokun, Omolola; Childress, Amy; Parker, Loran Carleton; Burgess, Wilella; Nagel, Julie; Knapp, Deborah W.; Lelievre, Sophie; Agnew, Christopher R.; Shields, Cleveland; Leary, James; Adams, Robin; Jensen, Jakob D.

    2012-01-01

    Cancer prevention is a broad field that crosses many disciplines; therefore, educational efforts to enhance cancer prevention research focused on interdisciplinary approaches to the field are greatly needed. In order to hasten progress in cancer prevention research, the Cancer Prevention Internship Program (CPIP) at Purdue University was designed to develop and test an interdisciplinary curriculum for undergraduate and graduate students. The hypothesis was that course curriculum specific to introducing interdisciplinary concepts in cancer prevention would increase student interest in and ability to pursue advanced educational opportunities (e.g., graduate school, medical school). Preliminary results from the evaluation of the first year which included 10 undergraduate and 5 graduate students suggested that participation in CPIP is a positive professional development experience, leading to a significant increase in understanding of interdisciplinary research in cancer prevention. In its first year, the CPIP project has created a successful model for interdisciplinary education in cancer prevention research. PMID:21533583

  3. Effects of an aquatic exercise program on inhibitory control in children with ADHD: a preliminary study.

    Science.gov (United States)

    Chang, Yu-Kai; Hung, Chiao-Ling; Huang, Chung-Ju; Hatfield, Bradley D; Hung, Tsung-Min

    2014-05-01

    The purpose of this preliminary study was to examine whether an aquatic exercise intervention that involves both aerobic and coordinative exercises influences restraint inhibition in children with ADHD. Thirty participants were assigned to either an aquatic exercise or a wait-list control group. Participants were assessed by Go/Nogo Task and motor ability prior to and after an 8-week exercise intervention (twice per week, 90 min per session) or a control intervention. Significant improvements in accuracy associated with the Nogo stimulus and the coordination of motor skills were observed over time in the exercise group compared with the control group. Only main effects of group were found for reaction time and accuracy associated with the Go stimulus. These findings suggest that an exercise program that involves both quantitative and qualitative exercise characteristics facilitates the restraint inhibition component of behavioral inhibition in children with ADHD.

  4. The legacy of nanotechnology: revolution and prospects in neurosurgery.

    Science.gov (United States)

    Khawaja, Ayaz Mahmood

    2011-01-01

    Nanotechnology has been an ever-growing field since the discovery of carbon fullerenes, and is being assimilated progressively into a variety of other disciplines including medical science. The association with neurosurgery had initially been less well characterized compared to other organ systems, but has recently offered promising future potential for a wide range of utilities including new therapeutic options for Glioblastoma Multiforme, neurprotection against oxidative stress, nerve nanorepair, nanodiagnosis of Alzheimer's disease, nanoimaging with nanoparticles and quantum dots, nanomanipulation of CNS with surgical nanobots, and nanoneuromodulation with nanofibres & nanowires. This article examines such potentials as well as others, of the utility of nanotechnology in Neurosurgery.

  5. Reconfigurable MRI-guided robotic surgical manipulator: prostate brachytherapy and neurosurgery applications.

    Science.gov (United States)

    Su, Hao; Iordachita, Iulian I; Yan, Xiaoan; Cole, Gregory A; Fischer, Gregory S

    2011-01-01

    This paper describes a modular design approach for robotic surgical manipulator under magnetic resonance imaging (MRI) guidance. The proposed manipulator provides 2 degree of freedom (DOF) Cartesian motion and 2-DOF pitch and yaw motion. Primarily built up with dielectric materials, it utilizes parallel mechanism and is compact in size to fit into the limited space of close-bore MRI scanner. It is ideal for needle based surgical procedures which usually require positioning and orientation control for accurate imaging plane alignment. Specifically, this mechanism is easily reconfigurable to over constrained manipulator structure which provides 2-DOF Cartesian motion by simple structure modification. This modular manipulator integrated with different end-effector modules is investigated for prostate brachytherapy and neurosurgery applications as preliminary evaluation.

  6. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

    Science.gov (United States)

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

    2015-09-01

    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  7. A Preliminary Study: Do Alternative Certification Route Programs Develop the Necessary Skills and Knowledge in Assistive Technology?

    Science.gov (United States)

    Bell, Sherry Mee; Cihak, David F.; Judge, Sharon

    2010-01-01

    A large number of special education teachers in the United States are prepared in alternative certification programs and insufficient empirical information exists regarding their knowledge of assistive technology. The purpose of this study was to conduct a preliminary investigation of alternatively licensed special education teachers' knowledge,…

  8. 76 FR 148 - Medicaid Program; Final FY 2009 and Preliminary FY 2011 Disproportionate Share Hospital...

    Science.gov (United States)

    2011-01-03

    ... and Preliminary FY 2011 Disproportionate Share Hospital Allotments, and Final FY 2009 and Preliminary FY 2011 Institutions for Mental Diseases Disproportionate Share Hospital Limits AGENCY: Centers for... share disproportionate share hospital (DSH) allotments for Federal FY (FY) 2009 and the preliminary...

  9. Intraoperative 3D Ultrasonography for Image-Guided Neurosurgery

    NARCIS (Netherlands)

    Letteboer, Marloes Maria Johanna

    2004-01-01

    Stereotactic neurosurgery has evolved dramatically in recent years from the original rigid frame-based systems to the current frameless image-guided systems, which allow greater flexibility while maintaining sufficient accuracy. As these systems continue to evolve, more applications are found, and i

  10. 3D printing in neurosurgery: A systematic review

    Science.gov (United States)

    Randazzo, Michael; Pisapia, Jared M.; Singh, Nickpreet; Thawani, Jayesh P.

    2016-01-01

    Background: The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. Methods: An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Results: Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints. PMID:27920940

  11. In touch with robotics: neurosurgery for the future.

    Science.gov (United States)

    Nathoo, Narendra; Cavuşoğlu, M Cenk; Vogelbaum, Michael A; Barnett, Gene H

    2005-03-01

    The introduction of multiple front-end technologies during the past quarter century has generated an emerging futurism for the discipline of neurological surgery. Driven primarily by synergistic developments in science and engineering, neurosurgery has always managed to harness the potential of the latest technical developments. Robotics represents one such technology. Progress in development of this technology has resulted in new uses for robotic devices in our discipline, which are accompanied by new potential dangers and inherent risks. The recent surge in robot-assisted interventions in other disciplines suggests that this technology may be considered one of a spectrum of frontier technologies poised to fuel the development of neurosurgery and consolidate the era of minimalism. On a more practical level, if the introduction of robotics in neurosurgery proves beneficial, neurosurgeons will need to become facile with this technology and learn to harness its potential so that the best surgical results may be achieved in the least invasive manner. This article reviews the role of robotic technology in the context of neurosurgery.

  12. Water balance disorders after neurosurgery: The triphasic response revisited

    NARCIS (Netherlands)

    E.J. Hoorn (Ewout); R. Zietse (Robert)

    2010-01-01

    textabstractWater balance disorders after neurosurgery are well recognized, but detailed reports of the triphasic response are scarce. We describe a 55-year-old woman, who developed the triphasic response with severe hyper- and hyponatraemia after resection of a suprasellar meningioma. The case illu

  13. Robot-assisted microscope for neurosurgery.

    Science.gov (United States)

    Giorgi, C; Eisenberg, H; Costi, G; Gallo, E; Garibotto, G; Casolino, D S

    1995-01-01

    We describe the implementation of a robotic arm connected to a neurosurgical operative microscope. A force feedback sensor drives the motors of the arm in response to the positioning of the microscope by the surgeon. Computer graphic techniques allow tracking of the current position of the microscope within the volumetric reconstruction of the brain. The integration of the prototype into the neurosurgical operating room is currently being evaluated. Preliminary comments on this experimental phase are offered.

  14. Reaching mothers in Swaziland: preliminary findings of a child survival program.

    Science.gov (United States)

    Hornik, R; Sankar, P

    1985-01-01

    The Swaziland Diarrheal Disease Control campaign, a collaboration of the Ministry of Health of Swaziland, the Combatting Childhood Communicable Diseases project, and the Agency for International Development (AID) Communication for Child Survival (HEALTHCOM) Project, was based on earlier work in Swaziland as well as the previous health communications programs in Honduras and Gambia. As in the other programs, it relied on a combination of mass media and face-to-face channels in an effort to change practices related to the treatment of diarrheal disease. The preparatory phase of the campaign was initiated in April 1984; the formal campaign ran from September 1984 through March 1985. The campaign involved 3 components: radio programs to be developed in an intensive radio workshop and broadcast on current development programs carried on the national radio system; printed materials including a flyer with mixing instructions and posters for display at health clinics and elsewhere; and workshops to train the health staff, other extension personnel, and local volunteers in treatment of diarrheal diseases, including use of oral rehydration therapy (ORT) for dehydration. The campaign focused on a few objectives, specifically: acceptance of a home-mixed water/sugar/salt (WSS) solution as a treatment for diarrheal dehydration; continued feeding during episodes of diarrhea; and feeding with special foods after diarrheal episodes. The campaign particularly emphasized the introduction of a new formula for mixing the solution -- 1 liter of water, 8 soda bottlecapfuls of sugar, and 1/2 capful of salt. The evaluation reveals preliminary results suggesting that the campaign achieved noteworthy success, particularly in rates of adoption of recommended practices. Data sources included before and after campaign surveys, each with 450 rural mothers chosen through national random sampling procedures, and a diarrheal disease registry kept by 20 clinics which listed more than 10,000 children

  15. Facial emotional recognition in schizophrenia: preliminary results of the virtual reality program for facial emotional recognition

    Directory of Open Access Journals (Sweden)

    Teresa Souto

    2013-01-01

    Full Text Available BACKGROUND: Significant deficits in emotional recognition and social perception characterize patients with schizophrenia and have direct negative impact both in inter-personal relationships and in social functioning. Virtual reality, as a methodological resource, might have a high potential for assessment and training skills in people suffering from mental illness. OBJECTIVES: To present preliminary results of a facial emotional recognition assessment designed for patients with schizophrenia, using 3D avatars and virtual reality. METHODS: Presentation of 3D avatars which reproduce images developed with the FaceGen® software and integrated in a three-dimensional virtual environment. Each avatar was presented to a group of 12 patients with schizophrenia and a reference group of 12 subjects without psychiatric pathology. RESULTS: The results show that the facial emotions of happiness and anger are better recognized by both groups and that the major difficulties arise in fear and disgust recognition. Frontal alpha electroencephalography variations were found during the presentation of anger and disgust stimuli among patients with schizophrenia. DISCUSSION: The developed program evaluation module can be of surplus value both for patient and therapist, providing the task execution in a non anxiogenic environment, however similar to the actual experience.

  16. Examining the Preliminary Efficacy of a Dating Violence Prevention Program for Hispanic Adolescents

    Science.gov (United States)

    Gonzalez-Guarda, Rosa Maria; Guerra, Jessica E.; Cummings, Amanda A.; Pino, Karen; Becerra, Maria M.

    2017-01-01

    The purpose of this study is to evaluate the preliminary efficacy of a dating violence (DV) prevention program for Cuban American adolescents (JOVEN/YOUTH: Juntos Opuestos a la Violence Entre Novios/Together Against Dating Violence). A randomized-controlled experimental design with a delayed condition was used to evaluate the effects on DV victimization and perpetration (N = 82). Self-administrated assessments were completed at baseline, 1 week, 3 months, and 12 months after the intervention to assess for psychological victimization and perpetration and physical and sexual victimization and perpetration. Effect sizes were estimated, and generalized estimating equations were generated to test intervention effects over time and potential gender interactions. The intervention had medium to strong effects on DV victimization and perpetration for male participants but not for females. However, intervention effects were not statistically significant over time. More research is needed to enhance intervention effects of JOVEN on DV outcomes and to evaluate these effects among a larger and more diverse sample. PMID:26260135

  17. An 8-week reactive balance training program in older healthy adults:A preliminary investigation

    Institute of Scientific and Technical Information of China (English)

    Max R. Paquette; Yuhua Li; Joseph Hoekstra; Joshua Bravo

    2015-01-01

    Background:This preliminary study examined the effects of an 8-week supervised reactive balance training program on reaction time (RT) and foot speed, static balance and balance confidence in healthy older adults compared to an exercise control group. Methods:Twenty-five older adults were randomly assigned to a reactive balance training group (QuickBoard;n=12;71.0 ± 8.6 years) or a stationary cycling group (control; n = 13; 70.2 ± 6.0 years). Both groups were tested for foot RT foot speed, static balance, and balance confidence at baseline, 4-week, 8-week, and 4-week follow-up. Results: Results indicated significant improvements in QuickBoard foot RT and speed in both groups with greater improvements in the QuickBoard group. However, no group difference was found in static balance performance. Conclusion: Although the improvements in RT and foot speed may be beneficial for fall and trip prevention, the implications of the current findings for trip avoidance and performance of daily tasks are unclear.

  18. Preliminary Results From NASA's Space Solar Power Exploratory Research and Technology Program

    Science.gov (United States)

    Howell, Joe T.; Mankins, John C.

    2000-01-01

    Large solar power satellite (SPS) systems that might provide base load power into terrestrial markets were examined extensively in the 1970s by the US Department of Energy (DOE) and the National Aeronautics and Space Administration (NASA). Following a hiatus of about 15 years, the subject of space solar power (SSP) was reexamined by NASA from 1995-1997 in the "fresh look" study, and during 1998 in an SSP "concept definition study". As a result of these efforts, during 1999-2000, NASA has been conducting the SSP Exploratory Research and Technology (SERT) program. The goal of the SERT activity has been to conduct preliminary strategic technology research and development to enable large, multi-megawatt SSP systems and wireless power transmission (WPT) for government missions and commercial markets (in-space and terrestrial). In pursuing that goal, the SERT: (1) refined and modeled systems approaches for the utilization of SSP concepts and technologies, ranging from the near-term (e.g., for space science, exploration and commercial space applications) to the far-term (e.g., SSP for terrestrial markets), including systems concepts, architectures, technology, infrastructure (e.g. transportation), and economics; (2) conducted technology research, development and demonstration activities to produce "proof-of-concept" validation of critical SSP elements for both nearer and farther-term applications; and (3) engendered the beginnings of partnerships (nationally and internationally) that could be expanded, as appropriate, to pursue later SSP technology and applications. Through these efforts, the SERT should allow better informed future decisions regarding further SSP and related technology research and development investments by both NASA and prospective partners, and guide further definition of technology roadmaps - including performance objectives, resources and schedules, as well as "multi-purpose" applications (e.g., commerce, science, and government). This paper

  19. Compact multi-spectral imaging system for dermatology and neurosurgery

    Science.gov (United States)

    Noordmans, Herke Jan; de Roode, Rowland; Verdaasdonk, Rudolf

    2007-03-01

    A compact multi-spectral imaging system is presented as diagnostic tool in dermatology and neurosurgery. Using an electronically tunable filter, a sensitive high resolution digital camera, 140 spectral images from 400 nm up to 720 nm are acquired in 40 s. Advanced image processing algorithms are used to enable interactive acquisition, viewing, image registration and image analysis. Experiments in the department of dermatology and neurosurgery show that multispectral imaging reveals much more detail than conventional medical photography or a surgical microscope, as images can be reprocessed to enhance the view on e.g. tumor boundaries. Using a hardware-based interactive registration algorithm, multi-spectral images can be aligned to correct for motion occurred during image acquisition or to compare acquisitions from different moments in time. The system shows to be a powerful diagnostics tool for medical imaging in the visual and near IR range.

  20. Minimally invasive neurosurgery: the technical platform for translational medicine

    Institute of Scientific and Technical Information of China (English)

    ZHAO Ji-zong

    2009-01-01

    @@ Translational medicine, normally refers to a process for transitioning from the initial lab discovery to the patient's bedside with minimal disconnect and offers a comprehensive review of statistical design and methodology. It has been advocated repeatedly by worldwide medical scientists as the new prospect highlighting the transition for scientific achievements from laboratory results to clinical application in recent years. As for neurosurgery, it is generally acknowledged that it has been improving in basic research and clinical practice by bounds and leaps; however, the achievements in basic and clinical neurosurgical studies seem to be parallel with no intersection for mutual interaction.Minimally invasive neurosurgery is aimed at serving as the intersection platform for translational medicine.

  1. Cerenkov and radioluminescence imaging of brain tumor specimens during neurosurgery

    Science.gov (United States)

    Spinelli, Antonello Enrico; Schiariti, Marco P.; Grana, Chiara M.; Ferrari, Mahila; Cremonesi, Marta; Boschi, Federico

    2016-05-01

    We presented the first example of Cerenkov luminescence imaging (CLI) and radioluminescence imaging (RLI) of human tumor specimens. A patient with a brain meningioma localized in the left parietal region was injected with 166 MBq of Y90-DOTATOC the day before neurosurgery. The specimens of the tumor removed during surgery were imaged using both CLI and RLI using an optical imager prototype developed in our laboratory. The system is based on a cooled electron multiplied charge coupled device coupled with an f/0.95 17-mm C-mount lens. We showed for the first time the possibility of obtaining CLI and RLI images of fresh human brain tumor specimens removed during neurosurgery.

  2. Three-dimensional, computer simulated navigation in endoscopic neurosurgery

    Directory of Open Access Journals (Sweden)

    Roberta K. Sefcik, BHA

    2017-06-01

    Conclusion: Three-dimensional, frameless neuronavigation systems are useful in endoscopic neurosurgery to assist in the pre-operative planning of potential trajectories and to help localize the pathology of interest. Neuronavigation appears to be accurate to <1–2 mm without issues related to brain shift. Further work is necessary in the investigation of the effect of neuronavigation on operative time, cost, and patient-centered outcomes.

  3. Historical perspective on neurosurgery in Germany after World War II.

    Science.gov (United States)

    Collmann, Hartmut; Vitzthum, Hans-Ekkehart

    2008-11-01

    AFTER THE COLLAPSE of the Third Reich, the specialty of neurosurgery in Germany, although well developed in the late 1930s, had to start anew, and for decades to come, had to deal with the physical and political consequences of World War II. Because of the division of the country, neurosurgery developed separately in the two independent states. In West Germany, the evolution was promoted by a few personalities who represented different schools according to their own training: these "surgical neurologists" emphasized the neurological basis of neurosurgery and were represented by Traugott Riechert and the students of Otfrid Foerster, such as Arist Stender and Hans Kuhlendahl. In contrast, the "neurological surgeons" stressed their origins in general surgery. Their main proponent was Wilhelm Tönnis, who gained particular merit for promoting neurosurgical teaching, the development of new neurosurgical units, and the recognition of neurosurgery as an autonomous specialty. In East Germany, progress was delayed by a weak economy and a repressive political system. Yet several excellent neurosurgeons won international recognition, predominantly Georg Merrem, who came from the school of Fedor Krause. Following a worldwide trend, the number of neurosurgical units in West Germany increased dramatically from 18 in 1950 to 85 in 1988. In 2006, in the unified nation, 1200 certified neurosurgeons in 138 hospital departments and 75 private practices served 82 million people. Since its founding in 1949, the German Neurosurgical Society has promoted the idea of reconciliation and has focused on international collaboration in both science and education. This idea, shared by other European nations, eventually gave rise to the European Association of Neurosurgical Societies. At present, escalating costs in the health sector pose a problem to neurosurgical services and have led to reconsiderations about their structure and financing.

  4. [Changing the teaching of neurosurgery with information technology].

    Science.gov (United States)

    Moreau, Jean-Jacques; Caire, François; Kalamarides, Michel; Mireau, Etienne; Dauger, Frédéric; Coignac, Marie-Jo; Charlin, Bernard

    2009-10-01

    A digital campus is a distance learning site that uses the potential of information and communication technologies to disseminate and improve educational services. This website, with open and free access, is built from free software with Web 2.0 technology. It is hosted at the University of Limoges. It functions as a digital library, containing scanned books, slide shows, more than 200 hours of recorded courses and round tables accessible by streaming video. The site is indexed according to the users' needs, by level of knowledge, specialty, keywords, and supplementary MeSH terms. The campus is organized as the College of Neurosurgery (http://college.neurochirurgie.fr). The durability of this type of training (in existence for 9 years now) is made possible by a powerful and committed consortium: the French Society of Neurosurgery, which has created high-quality intellectual and scientific resources, the University of Limoges, the Dupuytren University Hospital Center in Limoges, the region of Limousin, and the French-language Virtual Medical University, which have provided logistic and financial support. To target appropriate levels at various users, we distinguished four groups: medical students, neurosurgery students, neurosurgeons (continuing medical education), and students in allied health fields. All areas of neurosurgery are concerned. All the courses, including tests for self-evaluation and scientific meetings (organized with information and communication technologies) are digitally recorded for the site. The principles that make it possible for a medical discipline to organize around an online project are: a pedagogical conception of projects built in the form of models reusable by other health specialties; a stronghold within professional societies of the relevant specialties able to create high-quality intellectual and scientific resources; an organization by educational levels that can be extended transversally to other health disciplines; and free

  5. Neurosurgery at the Radcliffe Infirmary, Oxford: a history.

    Science.gov (United States)

    Aziz, T Z; Adams, C B

    1995-09-01

    Neurosurgery started in Oxford in 1938. In this article, we commence the story of Oxford neurosurgery with Thomas Willis and trace the historical thread through William Osler, Charles Sherrington, John Fulton, and Harvey Cushing to Hugh Cairns. The department in Oxford is renowned for the training of neurosurgeons. The initial stimulus for this was the abundance of neurosurgical and neurological expertise in Oxford during World War II with Cairns, and this tradition continued with Joe Pennybacker and his successors. The large and ever increasing work load ensures trainees a wide exposure to challenging neurosurgical problems. An increasing emphasis placed on research has resulted in the creation of two posts; each consists of half-time clinical neurosurgery and half-time research. Hugh Cairns organized the department along "Cushing lines." This organization still exists, allowing us to treat a large number of patients with relatively few beds and an average length of patient stay less than 6 days. We look to the future with confidence.

  6. Image-guided neurosurgery--state of the art and outlook.

    Science.gov (United States)

    Samii, M; Brinker, T; Samii, A

    1999-09-03

    The surgical possibilities of image guided neurosurgery are presented and critically reviewed. Image guided neurosurgery may enable neurosurgeons to work more precisely than before, and thus reduce mortality and morbidity. However, before the technology achieves widespread acceptance, technical standards must be developed, the intraoperative localisation technology improved, and clinical indications and the cost/benefit ratio clarified. Nevertheless, image guided neurosurgery appears to herald an exciting future in which virtual reality and robotic surgery will emerge as modern techniques.

  7. Ocean Thermal Energy Conversion power system development. Phase I: preliminary design. Final report. [ODSP-3 code; OTEC Steady-State Analysis Program

    Energy Technology Data Exchange (ETDEWEB)

    1978-12-04

    The following appendices are included; Dynamic Simulation Program (ODSP-3); sample results of dynamic simulation; trip report - NH/sub 3/ safety precautions/accident records; trip report - US Coast Guard Headquarters; OTEC power system development, preliminary design test program report; medium turbine generator inspection point program; net energy analysis; bus bar cost of electricity; OTEC technical specifications; and engineer drawings. (WHK)

  8. Preliminary assessment report for Fort William Henry Harrison, Montana Army National Guard, Helena, Montana. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    DuWaldt, J.; Meyer, T.

    1993-07-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at a Montana Army National Guard (MTARNG) property near Helena, Montana. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the Fort William Henry Harrison property, requirements of the Department of Defense Installation Restoration Program.

  9. Improving Phonological Awareness in Parents of Children at Risk of Literacy Difficulties: A Preliminary Evaluation of the Boost Program

    Directory of Open Access Journals (Sweden)

    Mark E. Boyes

    2017-09-01

    Full Text Available BackgroundPhonological awareness is an important skill underpinning the development of early literacy. Given the central role of parents in supporting the development of children’s early literacy skills, and that poor parental phonological awareness is associated with poorer child literacy outcomes, it is possible that improving parent phonological awareness may aid literacy development for at-risk children. This study is a preliminary evaluation of a program aiming to improve phonological awareness skills of parents in low socioeconomic status communities, and also provide these parents with strategies to support their child’s literacy development.MethodsAfter completing the program, participants were asked if it had helped them learn about how to assist their child’s reading and spelling, whether they planned on using the resources provided, and if they would be likely to attend a future workshop building on the Boost program. Phonological awareness measures (rhyme, syllable, and phoneme level, and measures of overall confidence in performance on the phonological awareness tasks, were administered both before and after attending the program.ResultsAlmost all parents indicated that the program helped with learning how to assist their child’s reading and spelling, that they would use the resources provided, and would likely attend a future workshop. Significant increases in pre- to post-program phonological awareness scores were obtained at the rhyme and phoneme level.ConclusionThe program and associated resources appear acceptable to parents in communities with high rates of literacy problems and improved parents’ phonological awareness skills. However, findings are preliminary and further evaluation using more rigorous methodologies and testing whether improvements in parents’ phonological awareness translate into better literacy outcomes for children is needed.

  10. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

    Science.gov (United States)

    Enchev, Yavor

    2015-01-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons’ self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  11. Preliminary Efficacy of a Cognitive-Behavioral Treatment Program for Anxious Youth with Autism Spectrum Disorders

    Science.gov (United States)

    White, Susan W.; Ollendick, Thomas; Scahill, Lawrence; Oswald, Donald; Albano, Anne Marie

    2009-01-01

    Anxiety is a commonly occurring psychiatric concern in adolescents with autism spectrum disorders (ASD). This pilot study examined the preliminary efficacy of a manual-based intervention targeting anxiety and social competence in four adolescents with high-functioning ASD. Anxiety and social functioning were assessed at baseline, midpoint,…

  12. Required Preliminary Administrative Service Credential Program Culminating Activities in California NCATE Accredited Universities

    Science.gov (United States)

    Wildman, Louis

    2014-01-01

    The purpose of this effort is to share information about the variety of culminating activities used in the acquisition of the California Preliminary Administrative Services Credential. Knowledge of these varying culminating activities and related practices has not previously been readily available. The culminating activities among California's…

  13. Progression of stages 3b–5 chronic kidney disease—Preliminary results of Taiwan National Pre-ESRD Disease Management Program in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chun-Mei Lin

    2013-12-01

    Conclusion: Even though we cannot conclude with certainty that the Taiwan pre-ESRD disease management program is beneficial in slowing the progression of CKD stages 3b–5, our preliminary results seem to suggest this trend. Furthermore, the program may be improved by integrating it with other programs, such as those on diabetes and hypertension, thus making it a more patient-centered, multidisciplinary program.

  14. Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery : What's the evidence?

    NARCIS (Netherlands)

    Liu, Weiming; Neidert, Marian Christoph; Groen, Rob J. M.; Woernle, Christoph Michael; Grundmann, Hajo

    To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the

  15. Eloquent Brain, Ethical Challenges: Functional Brain Mapping in Neurosurgery.

    Science.gov (United States)

    Klein, Eran

    2015-06-01

    Functional brain mapping is an increasingly relied upon tool in presurgical planning and intraoperative decision making. Mapping allows personalization of structure-function relationships when surgical or other treatment of pathology puts eloquent functioning like language or vision at risk. As an innovative technology, functional brain mapping holds great promise but also raises important ethical questions. In this article, recent work in neuroethics on functional imaging and functional neurosurgery is explored and applied to functional brain mapping. Specific topics discussed in this article are incidental findings, responsible innovation, and informed consent.

  16. Dr. Lenke Horvath (1917-1991): Creator of Pediatric Neurosurgery in Romania.

    Science.gov (United States)

    Mohan, Dumitru; Moisa, Horatiu Alexandru; Nica, Dan Aurel; Ciurea, Alexandru Vlad

    2016-04-01

    The development of neurosurgery as an independent specialty took place with great difficulty in Romania. In this respect, the most revered personalities are those of Professor Alexandru Moruzzi (1900-1957) (in Iasi) and Professor Dimitrie Bagdasar (1893-1946) (in Bucharest), who are the fathers of modern neurosurgery in Romania. Professor Bagdasar was schooled in Professor Harvey Cushing's clinic in Boston and is credited with creating the first completely independent neurosurgical unit in Romania. His legacy was carried on with honor by Professor Constantin Arseni (1912-1994), who, in 1975, tasked Dr. Lenke Horvath (1917-1991) with creating the first autonomous pediatric neurosurgery unit in Bucharest. This article is a small tribute to the founder of pediatric neurosurgery in Romania and one of the female pioneer neurosurgeons, who, by personal example of dedication and hard work, radically changed medical thinking and neurosurgery in Romania.

  17. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

    Science.gov (United States)

    Sherrod, Brandon A.; Rocque, Brandon G.

    2017-01-01

    Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

  18. Preliminary In-Flight Loads Analysis of In-Line Launch Vehicles using the VLOADS 1.4 Program

    Science.gov (United States)

    Graham, J. B.; Luz, P. L.

    1998-01-01

    To calculate structural loads of in-line launch vehicles for preliminary design, a very useful computer program is VLOADS 1.4. This software may also be used to calculate structural loads for upper stages and planetary transfer vehicles. Launch vehicle inputs such as aerodynamic coefficients, mass properties, propellants, engine thrusts, and performance data are compiled and analyzed by VLOADS to produce distributed shear loads, bending moments, axial forces, and vehicle line loads as a function of X-station along the vehicle's length. Interface loads, if any, and translational accelerations are also computed. The major strength of the software is that it enables quick turnaround analysis of structural loads for launch vehicles during the preliminary design stage of its development. This represents a significant improvement over the alternative-the time-consuming, and expensive chore of developing finite element models. VLOADS was developed as a Visual BASIC macro in a Microsoft Excel 5.0 work book on a Macintosh. VLOADS has also been implemented on a PC computer using Microsoft Excel 7.0a for Windows 95. VLOADS was developed in 1996, and the current version was released to COSMIC, NASA's Software Technology Transfer Center, in 1997. The program is a copyrighted work with all copyright vested in NASA.

  19. A Master-Slave Haptic System for Neurosurgery

    Directory of Open Access Journals (Sweden)

    Vanni Zanotto

    2011-01-01

    Full Text Available In recent years, new surgical tools have been designed to improve treatment results and lower patient trauma. Nevertheless, the dexterity and accuracy required for the positioning of new tools are often unreachable, if surgeons are not assisted by suitable systems. Significant advantages are derived from the introduction of computer and robot technologies. For that reason, the interaction between robotic systems and surgeons today is producing new interest worldwide both in medical and engineering fields. In particular, medical robotics has found fruitful ground in neurosurgical applications, since the high functional density of the central nervous system requires strict accuracy constraints on tool positioning. As a matter of fact, the major benefits of robots, such as precision, accuracy and repeatability, make them ideal as neurosurgeons’ assistants. This paper presents a master-slave haptic robotic system for minimally invasive neurosurgery, which can aid surgeons in performing safer and more accurate stereotactic neurosurgical treatments. The design of the proposed system is based on LANS (Linear Actuator for NeuroSurgery, which has been developed by our Research Group. Experimental test aimed at showing the added value of the DAANS system over its predecessor, the effectiveness of conformational caps and of the added rotational degree of freedom are scheduled for the upcoming months.

  20. Feasibility study of an interactive multimedia electronic problem solving treatment program for depression: a preliminary uncontrolled trial.

    Science.gov (United States)

    Berman, Margit I; Buckey, Jay C; Hull, Jay G; Linardatos, Eftihia; Song, Sueyoung L; McLellan, Robert K; Hegel, Mark T

    2014-05-01

    Computer-based depression interventions lacking live therapist support have difficulty engaging users. This study evaluated the usability, acceptability, credibility, therapeutic alliance and efficacy of a stand-alone multimedia, interactive, computer-based Problem Solving Treatment program (ePST™) for depression. The program simulated live treatment from an expert PST therapist, and delivered 6 ePST™ sessions over 9weeks. Twenty-nine participants with moderate-severe symptoms received the intervention; 23 completed a minimally adequate dose of ePST™ (at least 4 sessions). Program usability, acceptability, credibility, and therapeutic alliance were assessed at treatment midpoint and endpoint. Depressive symptoms and health-related functioning were assessed at baseline, treatment midpoint (4weeks), and study endpoint (10weeks). Depression outcomes and therapeutic alliance ratings were also compared to previously published research on live PST and computer-based depression therapy. Participants rated the program as highly usable, acceptable, and credible, and reported a therapeutic alliance with the program comparable to that observed in live therapy. Depressive symptoms improved significantly over time. These findings also provide preliminary evidence that ePST™ may be effective as a depression treatment. Larger clinical trials with diverse samples are indicated.

  1. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Directory of Open Access Journals (Sweden)

    Phan PN

    2016-03-01

    Full Text Available Pho NH Phan,1 Keyur Patel,2 Amar Bhavsar,3 Vikas Acharya4 1Warwick Medical School, University of Warwick, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, 4Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK Abstract: Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies – this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in

  2. Manual for Replication of the Mother-Child Home Program. (Preliminary Version, for Field-Testing).

    Science.gov (United States)

    Levenstein, Phyllis; And Others

    Information to assist local institutions in operating Mother-Child Programs i s provided in this manual as part of the Verbal Interaction Project. Following an introduction, the manual discusses the following topics: (1) Ingredients and Procedures of a Mother-Child Program, (2) Major Program Components, (3) Administrative and Other Practical…

  3. A Bystander Bullying Psychoeducation Program with Middle School Students: A Preliminary Report

    Science.gov (United States)

    Midgett, Aida; Doumas, Diana; Sears, Dara; Lundquist, Amanda; Hausheer, Robin

    2015-01-01

    This study evaluated the effectiveness of a brief, stand-alone bystander bullying psychoeducation program for middle school students. The purpose of the program was to train students to take action as peer advocates. Pre- and post-tests indicated that after completing the 90-minute psychoeducation program, students reported an increase in their…

  4. A retrospective case series of computer-controlled total intravenous anaesthesia in dogs presented for neurosurgery

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2004-06-01

    Full Text Available This article describes the anaesthetic management and use of total intravenous anaesthesia (TIVA for neurosurgery in 4 dogs. Propofol in conjunction with morphine was used for the maintenance of anaesthesia. Anaesthesia was induced with either thiopentone or propofol. The program Stelpump (a target-controlled infusion program was run on a laptop and connected to a syringe driver via an RS 232 cable. The program was found to be reliable and safe for the administration of TIVA in dogs. Invasive monitoring was required in order to monitor cardiovascular changes during surgery. Ventilation was controlled to maintain the end-tidal carbon dioxide below 40 mm Hg. The anaesthesia was characterised by haemodynamic stability. The haemodynamic stability was probably the result of the choice of TIVA and balanced anaesthesia. Intracranial pressure and oedema was controlled with dexamethasone, mannitol and ventilatory management either in combination or alone. Three dogs survived to hospital discharge and 1 dog was euthanased 2 weeks later due to tumour metastasis. The development and characterisation of the anaesthetic effects of TIVA needs to be elucidated in order to provide clinicians with rational guidelines for the appropriate use of TIVA in veterinary medicine.

  5. Experimental and clinical standards, and evolution of lasers in neurosurgery.

    Science.gov (United States)

    Devaux, B C; Roux, F X

    1996-01-01

    From initial experiments of ruby, argon and CO2 lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters--wavelength, fluence and mode--and on the exposed tissues optical and thermal properties--water and haemoglobin content, thermal conductivity and specific heat. CO2 and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 microns and 1.32 microns Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopic tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage. The choice of a laser in a

  6. Preliminary assessment report for Florence Military Reservation, Installation 04080, Florence, Arizona. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Arizona Army National Guard property near Florence, Arizona. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. Florence Military Reservation is a 5,655-acre site located in the southern portion of Arizona, about 65 mi southeast of Phoenix, in the county of Pinal. Florence Military Reservation includes Unit Training Equipment Site (UTES) 1, an artillery firing range, and ammunition storage. The subject of this PA is the UTES. The environmentally significant operations associated with the UTES property are (1) vehicle maintenance and refueling, (2) supply/storage of materials, and (3) the vehicle washrack.

  7. A new national service learning program in the Netherlands : preliminary evidence

    NARCIS (Netherlands)

    Bekkers, René

    2009-01-01

    Since 2006, the Department of Education in the Netherlands encourages the introduction of service learning programs at the level of secondary education. The goal of the programs is to promote civic-mindedness: civic engagement, awareness of values and norms, and active citizenship. Past studies of

  8. A new national service learning program in the Netherlands : preliminary evidence

    NARCIS (Netherlands)

    Bekkers, René

    2009-01-01

    Since 2006, the Department of Education in the Netherlands encourages the introduction of service learning programs at the level of secondary education. The goal of the programs is to promote civic-mindedness: civic engagement, awareness of values and norms, and active citizenship. Past studies of t

  9. A new national service learning program in the Netherlands : preliminary evidence

    NARCIS (Netherlands)

    Bekkers, René

    2009-01-01

    Since 2006, the Department of Education in the Netherlands encourages the introduction of service learning programs at the level of secondary education. The goal of the programs is to promote civic-mindedness: civic engagement, awareness of values and norms, and active citizenship. Past studies of t

  10. An Exploratory Study for MLK (Martin Luther King) Program Improvement. Preliminary Report.

    Science.gov (United States)

    Bournazos, Kimon

    A highly necessary step in the institution of programs for educating and preparing minority youth for the world is periodic evaluation to make certain that the quality of the program is at such a level that the needs of the participants are properly served. One hundred twenty-eight students answered a 44-item questionnaire concerning their…

  11. Success in Preschool Learning Related to Formal and Open-Framework Programs: A Preliminary Report.

    Science.gov (United States)

    Lawton, Joseph T.

    1978-01-01

    Two types of educational programs for young children were examined, the formal based on Ausebel's learning theory and the open-framework based on Piaget's theory of intellectual development. The formal program resulted in improved performance on both classification and conservation tasks. (MF)

  12. The prognostic value of histopathology on lingual nerve neurosensory recovery after micro-neurosurgery

    DEFF Research Database (Denmark)

    Hørberg, Mette; Reibel, Jesper; Kragelund, Camilla

    2016-01-01

    OBJECTIVE: Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery. MATERIALS AND METHODS: Retrospective...... case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation...

  13. Preliminary assessment report for Army Aviation Support Facility No. 3, Installation 13307, Hunter Army Airfield, Savannah, Georgia. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Kolpa, R.; Smith, K.

    1993-07-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Georgia Army National Guard property located on Hunter Army Airfield (HAA) near Savannah, Georgia, known as Army Aviation Support Facility (AASF) No. 3. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, types and quantities of hazardous substances utilized, the nature and amounts of wastes generated or stored at the facility, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the AASF No. 3 property, requirements of the Department of Defense Installation Restoration Program (IRP). The scope of this assessment is limited to the facilities and past activities contained within the area now occupied by AASF No. 3. However, this assessment report is intended to be read in conjunction with a previous IRP assessment of HAA completed in 1992 (USATHAMA 1992) and to provide comprehensive information on AASF No. 3 for incorporation with information contained in that previous assessment for the entirety of HAA.

  14. Preliminary assessment report for Army Aviation Support Facility No. 3, Installation 13307, Hunter Army Airfield, Savannah, Georgia. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Kolpa, R.; Smith, K.

    1993-07-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Georgia Army National Guard property located on Hunter Army Airfield (HAA) near Savannah, Georgia, known as Army Aviation Support Facility (AASF) No. 3. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, types and quantities of hazardous substances utilized, the nature and amounts of wastes generated or stored at the facility, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the AASF No. 3 property, requirements of the Department of Defense Installation Restoration Program (IRP). The scope of this assessment is limited to the facilities and past activities contained within the area now occupied by AASF No. 3. However, this assessment report is intended to be read in conjunction with a previous IRP assessment of HAA completed in 1992 (USATHAMA 1992) and to provide comprehensive information on AASF No. 3 for incorporation with information contained in that previous assessment for the entirety of HAA.

  15. The incidentaloma of the pituitary gland: Is neurosurgery required

    Energy Technology Data Exchange (ETDEWEB)

    Reincke, M.; Allolio, B.; Saeger, W.; Menzel, J.; Winkelmann, W. (Univ. of Cologne (West Germany))

    1990-05-23

    The authors describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up. The results suggest that the incidentaloma of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

  16. [Intraoperative monitoring of oxygen tissue pressure: Applications in vascular neurosurgery].

    Science.gov (United States)

    Arikan, Fuat; Vilalta, Jordi; Torne, Ramon; Chocron, Ivette; Rodriguez-Tesouro, Ana; Sahuquillo, Juan

    2014-01-01

    Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Neurosurgery in Würzburg until World War II.

    Science.gov (United States)

    Arnold, H; Collmann, H

    2012-01-01

    The institution of German neurosurgery as an autonomous surgical specialty, starting in Würzburg in 1934, is closely linked to the names of Fritz König and Wilhelm Tönnis. They were acting at a time when the global economic crisis and a consolidating Nazi dictatorship caused a cascade of alarming changes in political and social life. On the one hand it is fascinating to see how the restless work and energy of Tönnis managed to build up the first independent neurosurgical unit in Germany and to tighten efficient international connections all over the world within a few years. On the other hand-from a present-day perspective-it is difficult to understand how his strive towards a specialist's success, in contrast to that of Otfrid Foerster, was barely affected by the threatening political development, until the Second World War stopped his plans and ideas for many years.

  18. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

    Science.gov (United States)

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G

    2013-01-01

    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  19. Preliminary results on molecular modeling of asphaltenes using structure elucidation programs in conjunction with molecular simulation programs

    Energy Technology Data Exchange (ETDEWEB)

    Kowalewski, I.; Vandenbroucke, M.; Huc, A.Y.; Taylor, M.J.; Faulon, J.L. [Institut Francais du Petrole, Rueil-Malmaison (France). Division Geologie-Geochimie

    1996-01-01

    Molecular modeling using structure elucidation programs in conjunction with molecular simulation programs has been performed on asphaltene molecules, the heaviest fraction of crude oil, in order to obtain a chemical model allowing the tentative study of their physicochemical properties. Boscan asphaltenes (Venezuela) derived from a marine source rock have been analysed. The different steps of this molecular modeling are described. First, a 3-D chemical representation of Boscan asphaltene is defined from an analytical data set. Second, the results of molecular dynamic simulations indicate that only a few stable conformations are possible due to the high reticulation of the model of the asphaltene unit obtained. 42 refs., 6 figs., 9 tabs.

  20. Emergency neurosurgery in Darwin: still the generalist surgeons' responsibility.

    Science.gov (United States)

    Luck, Tara; Treacy, Peter John; Mathieson, Matthew; Sandilands, Jessica; Weidlich, Stephanie; Read, David

    2015-09-01

    Royal Darwin Hospital (RDH) is the only major hospital for the 'Top End' of Northern Territory and Western Australia. As retrieval distances exceed 2600 km, resident generalist surgeons undertake all emergency neurosurgery. Retrospective clinical study from RDH records and review of prospectively collected datasets from RDH Intensive Care Unit and National Critical Care Trauma Response Centre for all emergency neurosurgery patients between 2008 and 2013. Data were obtained from 161 patients with 167 admissions (73% male, 39% indigenous) who underwent 195 procedures (33 per year), including burr hole, craniotomy, cerebral and posterior fossa craniectomy, elevation fracture and ventricular drain. Trauma accounted for 68%, with alcohol as a known factor in 57%. Subdural haematoma (SDH) accounted for 53%. Severity of head injury at presentation correlated with outcome (R(2) = 0.12, P 24 h (P = 0.023) and specific diagnoses of acute SDH (P = 0.006), acute-on-chronic SDH (P = 0.053) and infection (P = 0.052). Indigenous patients were younger (40 versus 55 years, P < 0.001) and more likely to have alcohol as a factor in trauma cases (71% versus 49%, P = 0.027). Time from injury to hospital was high for accidents at a remote location (12.9 versus 1.3 h, P < 0.001); however, Glasgow Outcome Scales (P = 0.13) were no different to accident at metropolitan Darwin. General surgeons at RDH perform a wide range of emergency neurosurgical procedures primarily for trauma. Factors contributing to poor outcomes included remote location of trauma and delay in reaching the hospital. Outcomes at 3 months appear acceptable. © 2015 Royal Australasian College of Surgeons.

  1. Image Fusion for Radiosurgery, Neurosurgery and Hypofractionated Radiotherapy.

    Science.gov (United States)

    Inoue, Hiroshi K; Nakajima, Atsushi; Sato, Hiro; Noda, Shin-Ei; Saitoh, Jun-Ichi; Suzuki, Yoshiyuki

    2015-03-01

    Precise target detection is essential for radiosurgery, neurosurgery and hypofractionated radiotherapy because treatment results and complication rates are related to accuracy of the target definition. In skull base tumors and tumors around the optic pathways, exact anatomical evaluation of cranial nerves are important to avoid adverse effects on these structures close to lesions. Three-dimensional analyses of structures obtained with MR heavy T2-images and image fusion with CT thin-sliced sections are desirable to evaluate fine structures during radiosurgery and microsurgery. In vascular lesions, angiography is most important for evaluations of whole structures from feeder to drainer, shunt, blood flow and risk factors of bleeding. However, exact sites and surrounding structures in the brain are not shown on angiography. True image fusions of angiography, MR images and CT on axial planes are ideal for precise target definition. In malignant tumors, especially recurrent head and neck tumors, biologically active areas of recurrent tumors are main targets of radiosurgery. PET scan is useful for quantitative evaluation of recurrences. However, the examination is not always available at the time of radiosurgery. Image fusion of MR diffusion images with CT is always available during radiosurgery and useful for the detection of recurrent lesions. All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment. Follow-up images are also able to register on this CT. Exact target changes, including volume, are possible in this fusion system. The purpose of this review is to describe the usefulness of image fusion for 1) skull base, 2) vascular, 3) recurrent target detection, and 4) follow-up analyses in radiosurgery, neurosurgery and hypofractionated radiotherapy.

  2. The incidence of postoperative meningitis in neurosurgery: An institutional experience

    Directory of Open Access Journals (Sweden)

    Dwarakanath Srinivas

    2011-01-01

    Full Text Available Introduction : Meningitis is the most dreaded cause of morbidity and mortality in neurosurgical patients. The reported incidence of postoperative meningitis is quite varied 0.5-8%. Material and Methods : The study cohort included all the patients who underwent neurosurgery at the department of neurosurgery, National Institute of Mental Health and Neurological Sciences, Bangalore, India over a period of seven years (2001 - 2007. Patients with culture positive meningitis were included for analysis. The incidence of postoperative meningitis was analyzed depending on the type of surgery performed and the microbiological profile of the organisms, and their sensitivity pattern. Results : Of the 18,092 patients who underwent neurosurgical procedures during the study period, 415 patients developed infection. The overall incidence of meningitis was 2.2%. The incidence of meningitis was high (7.7% in patients who had a pre-existing infection like post-pyogenic meningitis or tuberculosis hydrocephalus. The procedure mainly performed in this subgroup was shunt. The most common organisms causing meningitis were non-lactose fermenting Gram-negative bacillus followed by Pseudomonas and Klebsiella species. The methicillin-resistant Staphylococcus aureus strains were isolated in 2.6% of the patients. Ninety-one strains were multi-drug resistant, among which four strains were resistant to all antibiotics tested. The overall mortality in patients with meningitis was 5%. Conclusion : Meningitis remains one of the most dreaded complications of neurosurgical procedures and is common in patients with preexisting infection. Gram-negative organisms are the most common causative pathogens of postoperative meningitis.

  3. Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.

    Science.gov (United States)

    Vakharia, Vejay N; Vakharia, Nilesh N; Hill, Ciaran S

    2016-04-01

    Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Numerical simulations of clinical focused ultrasound functional neurosurgery

    Science.gov (United States)

    Pulkkinen, Aki; Werner, Beat; Martin, Ernst; Hynynen, Kullervo

    2014-04-01

    A computational model utilizing grid and finite difference methods were developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13% lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13% smaller in the anterior-posterior direction and 22 ± 14% smaller in the inferior-superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the

  5. Preliminary design study of a quiet, high flow fan (QHF) stage. [turbofans - quiet engine program

    Science.gov (United States)

    Walker, C. L.; Kisner, L. S.; Delaney, R. A.; Beguhn, A. A.; Frye, D. E.

    1974-01-01

    Concepts selected to reduce fan generated noise in a turbofan are presented. Near-sonic flow at the fan inlet to reduce upstream propagated noise and the use of long-chord vanes to reduce downstream noise is discussed. The near-sonic condition at the rotor inlet plane was achieved by designing for high specific mass flow and by maintaining the high flow at reduced power by variable stators and variable fan exhaust nozzle. The long-chord vanes reduce response to unsteady flow. The acoustic design showed that long-chord stators would significantly reduce turbofan source noise and that other stator design parameters have no appreciable effect on noise for the spacing and chord length of the turbofan design. Four rig flow paths studied in the aerodynamic preliminary design are discussed. Noise prediction results indicate that a turbofan powered aircraft would be under federal air regulations levels without any acoustic treatment.

  6. Preliminary assessment report for Camp Carroll Training Center, Installation 02045, Anchorage, Alaska. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Krokosz, M.; Sefano, J.

    1993-08-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Alaska Army National Guard property known as Camp Carroll Training Center, located on the Fort Richardson Army facility near Anchorage, Alaska. Preliminary assessments of federal facilities are being conducted to compile the information necessary for the completion of preremedial activities and to provide a basis for establishing, corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, types and quantities of hazardous substances used, the nature and amounts of wastes generated or stored at the facility, and potential pathways by which contamination could affect public health and the environment. The primary environmentally significant operations (ESOs) associated with the property are (1) the Alaska Air National Guard storage area behind Building S57112 (Organizational Maintenance Shop [OMS] 6); (2) the state of Alaska maintenance facility and the soil/tar-type spill north of the state of Alaska maintenance facility; (3) the waste storage area adjacent to OMS 6; (4) the contaminated area from leaking underground storage tanks (USTs) and the oil-water separator; and (5) soil staining in the parking area at the Camp Carroll Headquarters Building. Camp Carroll appears to be in excellent condition from an environmental standpoint, and current practices are satisfactory. Argonne recommends that the Alaska Department of Military Affairs consider remediation of soil contamination associated with all storage areas, as well as reviewing the practices of other residents of the facility. Argonne also recommends that the current methods of storing waste material behind Building S57112 (OMS 6) be reviewed for alternatives.

  7. Impact of an educational program on the quality of life of patients with lymphedema: A preliminary evaluation.

    Science.gov (United States)

    Blaise, Sophie; Satger, Bernadette; Pernod, Gilles; Richaud, Cécile; Villemur, Béatrice; Carpentier, Patrick H

    2017-09-01

    We report on the preliminary evaluation of a well-designed program, Living with Lymphedema. This longitudinal cohort study assessed patients' quality of life using questionnaires. Our main objective was to evaluate the satisfaction of the patients and their adherence to the program. This was done using a specific questionnaire of satisfaction as well as by noting patients' adherence to the program (number of patients attending all three consultations). The secondary objective was to assess the effect of the program on the patient's quality of life. The assessment criteria were the evolution of the Medical Outcomes Study 36-Item Short Form Health Survey and EuroQol questionnaire scores between the first (C1) and third (C3) consultations. The Living with Lymphedema program targeted all patients with lymphedema in the Grenoble (France) conurbation and within the GRANTED health care network that includes vascular medicine specialists, primary care physicians, physical therapists, and dietitians in the Alpine region of France. All studied patients were ambulatory patients. The GRANTED network took care only of the educational aspect of the disease. All patients with primary or secondary lymphedema were offered the Living with Lymphedema program, whatever their age and the location of the lymphedema (upper or lower limbs). The collection of patient data conformed to the ethical and administrative regulations of the regional health authority. Grenoble Institutional Review Board (CPP Sud-Est V; No. 5891) approval for the study was specifically obtained for this evaluation on December 24, 2012. The program was built around one-to-one consultations, group workshops, and more specialized appointments. It was complementary to the routine medical care received by the patient (not evaluated in this study). It proposed three individual "educational" consultations, seven group workshops, and two specialized consultations with a dietitian. All the consultations or workshops were

  8. “Getting Ready for School:” A Preliminary Evaluation of a Parent-Focused School-Readiness Program

    Directory of Open Access Journals (Sweden)

    Kimberly G. Noble

    2012-01-01

    Full Text Available Children from disadvantaged backgrounds tend to start school with fewer school readiness skills than their more advantaged peers. Emergent literacy and math skills play an important role in this gap. The family is essential in helping children build these skills, and the active involvement of families is crucial to the success of any intervention for young children. The Getting Ready for School (GRS program is a parent-focused curriculum designed to help parents equip their children with the skills and enthusiasm necessary for learning when they start school. Parents meet in weekly workshops led by a trained facilitator and implement the curriculum at home with their children. The objective of this pilot study was to assess the promise of the GRS intervention in children participating in an urban Head Start program and to explore parents' responses to the intervention. We hypothesized that participation in GRS would improve school readiness in literacy and math skills, relative to participation in business-as-usual Head Start. Four Head Start classrooms (two randomly selected “intervention” and two “comparison” classrooms participated in this study. Preliminary analyses suggest that GRS improves school readiness over and above a Head Start-as-usual experience. Implications for early childhood programs and policies are discussed.

  9. An economic evaluation of Columbia River anadromous fish programs: A preliminary study

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This paper evaluates the economics of the Columbia River anadromous fish programs. The paper begins with a description of the Columbia River watershed and discusses...

  10. Acceleration risk in student fighter pilots: preliminary analysis of a management program.

    Science.gov (United States)

    Galvagno, Samuel M; Massa, Thomas V; Price, Scott C

    2004-12-01

    Despite advances in G-protection, F-16 student pilots continue to demonstrate G-performance inadequacies. The G-Risk Indicator Management (GRIM) Program was introduced at Luke Air Force Base in 2000 to facilitate early detection of G-related problems and to aid in the establishment of tailored ground training programs designed to enhance a student's performance under G. Assessment of anthropomorphic data, previous G-performance, anaerobic fitness, and centrifuge qualification scores comprise the initial assessment in the GRIM Program. Observations from these assessments are used to qualitatively determine the level of risk for the student. In the absence of any historical controls, no conclusions could be drawn with regards to the overall efficiency of the GRIM program. Significant differences were found between groups for anaerobic test scores, centrifuge scores, and gradebook comments. The results from this non-experimental study suggest the need for future studies to better determine the validity of G-risk indicators.

  11. Preliminary examination of a couple-based eating disorder prevention program.

    Science.gov (United States)

    Ramirez, Ana L; Perez, Marisol; Taylor, Aaron

    2012-06-01

    The purpose of the current study was to investigate a new dissonance-based prevention program that is based on the dual pathway model of eating disorders within the context of an individual's romantic relationship. A total of 209 dating couples participated in a couple-based prevention program or an assessment-only condition and completed measures of body dissatisfaction, thin-ideal internalization, disordered eating, negative affect, and relationship satisfaction at two time points (approximately one week apart) and approximately half of the sample completed 1-month follow-up measures. The prevention program significantly reduced several key risk factors for eating disorders such as environmental pressures to be thin, internalization of the thin and athletic ideals, state body dissatisfaction, and actual-ideal body discrepancy. Initial support was found for the inclusion of couples in eating disorder prevention programs as a successful way of addressing the thin ideal and its detrimental effects for women.

  12. Early detection of ovarian cancer: preliminary results of the Yale Early Detection Program.

    OpenAIRE

    Schwartz, P. E.; Chambers, J. T.; Taylor, K. J.; Pellerito, J.; Hammers, L.; Cole, L. A.; Yang-Feng, T L; Smith, P; Mayne, S T; Makuch, R.

    1991-01-01

    Eighty-four women at high risk for ovarian cancer by having first-degree relatives with epithelial ovarian cancer participated in a newly established, early ovarian cancer detection program at Yale University. Participants were to be evaluated with physical examinations and circulating tumor markers at entry and every six months thereafter. Endovaginal ultrasound and color Doppler flow studies were to be performed at three and nine months following entry into the program. In addition, women w...

  13. A Cybernetic Approach to Acquisition System Program Office Management: Preliminary Concepts and Procedures

    Science.gov (United States)

    1990-09-01

    of Eliyahu Goldratt , to the USAF acquisition System Program Office (SPO). An extensive review of the literature was conducted, and the theories of...Harvard Business School Press, 1988. 11. Goldratt . Eliyahu M. and Jeff Fox. The Goal. Crouton-on-Hudson NY: North River Press, 1986. 12. Goldratt ...analysis espoused by Stafford Beer, in concert with the Theory of Constraints of Eliyahu Goldratt , to the USAF acquisition System Program Office (SPO). Ai

  14. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre

    2011-06-01

    Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome.

  15. Systems management support for ERCDC study of undergrounding and berm containment. Interim report. Preliminary program assessment and follow-on program development

    Energy Technology Data Exchange (ETDEWEB)

    1977-08-01

    Interim results of a study being conducted with respect to the technological aspects of the costs and benefits of underground nuclear power plant construction in direct support of the California Energy Commission's legislative mandate in this area are presented. The program was directed towards problem scoping, methodology evaluation, program definition and planning for subsequent, more detailed investigations of underground facility designs and their potential advantages and disadvantages. The material presented describes the results of (a) systems analyses which were conducted to determine logical requirements for determination of those elements of a nuclear power plant which should be constructed underground; (b) bounding estimates of incremental plant costs for a variety of underground concepts; (c) applicable prior experience in underground facility design and construction which could be used to identify potential sources of strength and weaknessees of underground nuclear power plants; (d) estimates of seismic environments for underground construction in California; (e) preliminary descriptions of underground reactor accident scenarios; (f) bounding estimates of the consequences of such accidents, in terms of comparisons of relative emissions of radioactivity with respect to similar accidents for surface-sited nuclear power plants and (g) results of analyses of several other important technological aspects of the problem. A description is also provided of the program development work performed to provide planning and criteria for subsequent investigations to determine: (a) definitive underground nuclear power plant designs and costs, and (b) estimates of accident consequences in underground nuclear power plants.

  16. Systems management support for ERCDC study of undergrounding and berm containment. Interim report. Preliminary program assessment and follow-on program development

    Energy Technology Data Exchange (ETDEWEB)

    1977-08-01

    Interim results of a study being conducted with respect to the technological aspects of the costs and benefits of underground nuclear power plant construction in direct support of the California Energy Commission's legislative mandate in this area are presented. The program was directed towards problem scoping, methodology evaluation, program definition and planning for subsequent, more detailed investigations of underground facility designs and their potential advantages and disadvantages. The material presented describes the results of (a) systems analyses which were conducted to determine logical requirements for determination of those elements of a nuclear power plant which should be constructed underground; (b) bounding estimates of incremental plant costs for a variety of underground concepts; (c) applicable prior experience in underground facility design and construction which could be used to identify potential sources of strength and weaknessees of underground nuclear power plants; (d) estimates of seismic environments for underground construction in California; (e) preliminary descriptions of underground reactor accident scenarios; (f) bounding estimates of the consequences of such accidents, in terms of comparisons of relative emissions of radioactivity with respect to similar accidents for surface-sited nuclear power plants and (g) results of analyses of several other important technological aspects of the problem. A description is also provided of the program development work performed to provide planning and criteria for subsequent investigations to determine: (a) definitive underground nuclear power plant designs and costs, and (b) estimates of accident consequences in underground nuclear power plants.

  17. ISLAMIC MICROFINANCE AND POVERTY ALLEVIATION PROGRAM: PRELIMINARY RESEARCH FINDINGS FROM INDONESIA

    Directory of Open Access Journals (Sweden)

    Yasushi Suzuki

    2016-06-01

    Full Text Available Poverty should be defined, measured, and scrutinized its root causes from a multi-dimension perspectives. Therefore, in designing and implementation of poverty alleviation program, it should consider economic factors, social and political contexts surrounding the poor. Sen (1982; 1999 views poverty as a multifaceted world and ethical dimension essentially should be placed underpinning it as a vital economic problem. The paper takes the stance that the poor themselves have potential capacity to alleviate their condition in resolving poverty trap. Community development program is one of the strategies to deal with the poverty problem. Islamic microfinance can play an important role in combating poverty dilemma especially in Muslim majority population communities. Through the approach proposed by Bigg and Satterthwaite (2005 with strengthening local organizations and community development programs, Islamic microfinance should engage a strategic partnership with the Masjid and Islamic charity institutions (zakat and waqf organization. This strategic alliance will result more integrated programs and also capacity building of the institutions involved. This paper aims to contribute a grass root model in the purpose of combating poverty in the framework of Islamic economic system. =========================================== Kemiskinan harus didefinisikan, diukur, dan diteliti akar penyebabnya dari berbagai perspektif. Oleh karena itu, dalam merancang dan mengimplementasikan program pengentasan kemiskinan, faktor-faktor ekonomi, konteks sosial dan politik yang mengelilingi kemiskinan juga harus dipertimbangkan. Sen (1982; 1999 memandang kemiskinan sebagai sebuah dunia yang kompleks, dan dimensi dasar etika harus ditempatkan sebagai sebuah masalah ekonomi yang vital. Peneliti sendiri dalam hal ini berpandangan bahwa orang-orang miskin pada dasarnya punya kapasitas yang memadai untuk keluar dari garis kemiskinan. Salah satunya adalah dengan program

  18. Seeking tools for image fusion between computed tomography, structural and functional magnetic resonance methods for applications in neurosurgery

    Directory of Open Access Journals (Sweden)

    Liana Guerra Sanches da Rocha

    2012-06-01

    Full Text Available Objective: To evaluate tools for the fusion of images generatedby tomography and structural and functional magnetic resonanceimaging. Methods: Magnetic resonance and functional magneticresonance imaging were performed while a volunteer who hadpreviously undergone cranial tomography performed motor andsomatosensory tasks in a 3-Tesla scanner. Image data were analyzedwith different programs, and the results were compared. Results:We constructed a flow chart of computational processes that allowedmeasurement of the spatial congruence between the methods. Therewas no single computational tool that contained the entire set offunctions necessary to achieve the goal. Conclusion: The fusion ofthe images from the three methods proved to be feasible with the useof four free-access software programs (OsiriX, Register, MRIcro andFSL. Our results may serve as a basis for building software that willbe useful as a virtual tool prior to neurosurgery.

  19. Preliminary Assessment of the Hanford Tank Waste Feed Acceptance and Product Qualification Programs

    Energy Technology Data Exchange (ETDEWEB)

    Herman, C. C.; Adamson, Duane J.; Herman, D. T.; Peeler, David K.; Poirier, Micheal R.; Reboul, S. H.; Stone, M. E.; Peterson, Reid A.; Chun, Jaehun; Fort, James A.; Vienna, John D.; Wells, Beric E.

    2013-04-01

    The U.S. Department of Energy Office of Environmental Management (EM) is engaging the national laboratories to provide the scientific and technological rigor to support EM program and project planning, technology development and deployment, project execution, and assessment of program outcomes. As an early demonstration of this new responsibility, Savannah River National Laboratory (SRNL) and Pacific Northwest National Laboratory (PNNL) have been chartered to implement a science and technology program addressing Hanford Tank waste feed acceptance and product qualification. As a first step, the laboratories examined the technical risks and uncertainties associated with the planned waste feed acceptance and qualification testing for Hanford tank wastes. Science and technology gaps were identified for work associated with 1) feed criteria development with emphasis on identifying the feed properties and the process requirements, 2) the Tank Waste Treatment and Immobilization Plant (WTP) process qualification program, and 3) the WTP HLW glass product qualification program. Opportunities for streamlining the accetpance and qualification programs were also considered in the gap assessment. Technical approaches to address the science and technology gaps and/or implement the opportunities were identified. These approaches will be further refined and developed as strong integrated teams of researchers from national laboratories, contractors, industry, and academia are brought together to provide the best science and technology solutions. Pursuing the identified approaches will have immediate and long-term benefits to DOE in reducing risks and uncertainties associated with tank waste removal and preparation, transfers from the tank farm to the WTP, processing within the WTP Pretreatment Facility, and in producing qualified HLW glass products. Additionally, implementation of the identified opportunities provides the potential for long-term cost savings given the anticipated

  20. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery.

    Science.gov (United States)

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Lagman, Carlito; Tenn, Stephen; Demos, Joanna V; Lee, Seung J; Bui, Timothy T; Barnette, Natalie E; Bhatt, Nikhilesh S; Ung, Nolan; Bari, Ausaf; Martin, Neil A; Yang, Isaac

    2017-01-01

    Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Preliminary Investigation

    Science.gov (United States)

    Misurell, Justin R.; Springer, Craig; Tryon, Warren W.

    2011-01-01

    This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem…

  2. Acceptability and Preliminary Outcomes of a Peer-Led Depression Prevention Intervention for African American Adolescents and Young Adults in Employment Training Programs

    Science.gov (United States)

    Tandon, Darius; Mendelson, Tamar; Mance, GiShawn

    2011-01-01

    This study examines the acceptability and preliminary outcomes from an open trial of a depression prevention intervention for low-income African American adolescents and young adults in employment training programs. The sample (N=42) consisted of predominately African American adolescents and young adults (mean age=19.1) exhibiting subclinical…

  3. Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Preliminary Investigation

    Science.gov (United States)

    Misurell, Justin R.; Springer, Craig; Tryon, Warren W.

    2011-01-01

    This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem…

  4. Smoking cessation intervention within the framework of a lung cancer screening program: preliminary results and clinical perspectives from the "Cosmos-II" Trial.

    Science.gov (United States)

    Filippo, Lococo; Principe, Rosastella; Cesario, Alfredo; Apolone, Giovanni; Carleo, Francesco; Ialongo, Pasquale; Veronesi, Giulia; Cardillo, Giuseppe

    2015-02-01

    Data coming from the literature investigating the effectiveness and interaction between smoking cessation (SC) and lung cancer screening (LCScr) are still sparse and inconsistent. Herein, we report the preliminary results from the ongoing lung cancer screening trial ("Cosmos-II") focusing our analysis on the inter-relationship between the SC program and the LCScr.

  5. [Implementation of a psychological support program for children with cancer in Poland. Preliminary report].

    Science.gov (United States)

    Samardakiewicz, M; Kowalczyk, J; Antonowicz, M; Budzińska-Skowronska, U; Boguslawska-Jaworska, J; Mazurowa, M; Mazur, A; Rokicka-Milewska, R; Bukowska-Posadzy, A; Kołecki, P; Maroczkaniec, E; Slazak, D; Sońta-Jakimczyk, D; Szweda, E; Armata, J; Budziński, W; Balcerska, A

    2000-01-01

    Intensive chemotherapy programme in children with cancer may result in psychological mal adjustment. Treatment facilities as well as psychological support are of great importance to minimize these side effects. In 1998 the programme of psychological support was introduced in 7 Polish paediatric haematology / oncology centres. Psychological adjustment of patients treated in each centre was examined 5 yrs after the termination of therapy. At the same time children with new diagnosis of cancer were monitored psychologically along with the psychological support programme. Psychological status of each patient was examined with the following tests: Cattell's questionnaires (CPQ, HSPQ), Manifest Anxiety Scale, Spielberger's inventories (STAI, STAIC), Wechsler Intelligence Scale. The programme of psychological support was based on guidelines of SIOP Psychosocial Committee and included such elements as informing about diagnosis and treatment, explaining any doubt, maintaining an open communication, educational care in the periods of treatment, encouraging to activity even during periods of discomfort. The analysis showed that most of the participating centres could only provide some elements of the support programme. The main problem was to convince medical staff to inform children on diagnosis and treatment plans. Preliminary results of the study indicate that full psychological support for children with cancer and their families from the beginning of therapy can result in improvement in psychological adjustment. During the ensuing period, patients and their parents appreciate the possibilities to contact a psychologist.

  6. Preliminary Effects of the Incredible Years Teacher Training Program on Classroom Management Skills

    Science.gov (United States)

    Murray, Desiree W.; Murr, Natalie; Rabiner, David L.

    2012-01-01

    The overall purpose of this IES-funded Goal 3 study, now entering its third year, is to evaluate the efficacy of Incredible Years Teacher program (IYT) for improving K-2 students' academic achievement, attention, and social-emotional competence. The authors will also examine the extent to which classroom behavior mediates the relationship between…

  7. Nursing Student Performance, 1986-1993: Preliminary Findings. Program Evaluation PE93-1.

    Science.gov (United States)

    Boughan, Karl

    A study was conducted at Prince George's Community College (PGCC), in Maryland, to evaluate nursing student performance from point of admission to the taking of the National Council Licensure Examination (NCLEX). A sample of 853 students who enrolled in the nursing program entry course between fall 1986 and spring 1992 were surveyed to determine…

  8. A Preliminary Outcome Study of an Outpatient Treatment Program for Gamblers.

    Science.gov (United States)

    Blackman, Sheldon; And Others

    The Gamblers Treatment Clinic (GTC) opened in 1982 as a New York State Office of Mental Health Demonstration Program. The basic premise of the GTC is that excessive gambling is a disorder of impulse control. Treatment, conducted in the community in a time-limited fashion, attempts to uncover the underlying dynamics that precipitate disorders of…

  9. The "RAPID" Cognitive-Behavioral Therapy Program for Inattentive Children: Preliminary Findings

    Science.gov (United States)

    Young, Susan

    2013-01-01

    Objective: The objectives of the current study were to ascertain feasibility and acceptability of directly delivering a cognitive-behavioral therapy (CBT) group intervention for inattentive children in a school setting, to examine the reliability of the RATE-C Questionnaires that accompany the program, and to determine whether they can be used to…

  10. English Program Review at Coastline Community College, Fountain Valley, California. [A Preliminary Report, October 1988.

    Science.gov (United States)

    Yglesias, Kenneth D., Comp.; Fry, Marilyn, Comp.

    Prepared as part of the program review process at California's Coastline Community College (CCC), this report describes and evaluates CCC's English Department, highlighting problems and successes from 1976 to 1987. Part I offers a narrative account of: (1) the changes that took place in the department between 1976 and 1987, focusing on early…

  11. Preliminary evaluation of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain

    NARCIS (Netherlands)

    De Blecourt, A. C. E.; Schiphorst Preuper, H. R.; Van der Schans, C. P.; Groothoff, J. W.; Reneman, M. F.

    2008-01-01

    Purpose. To describe the outcome of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain. Methods. Study design: exploratory retrospective cohort study. The study sample consisted of a cohort of 70 children and adolescents ( age: 8 - 21 years) wi

  12. Preliminary Examination of Adolescent Spending in a Contingency Management-Based Smoking-Cessation Program

    Science.gov (United States)

    Cavallo, Dana A.; Nich, Charla; Schepis, Ty S.; Smith, Anne E.; Liss, Thomas B.; McFetridge, Amanda K.; Krishnan-Sarin, Suchitra

    2010-01-01

    Contingency management (CM) utilizing monetary incentives is efficacious in enhancing abstinence in an adolescent smoking-cessation program, but how adolescents spend their money has not been examined. We assessed spending habits of 38 adolescent smokers in a CM-based smoking-cessation project prior to quitting and during treatment using a…

  13. Preliminary evaluation of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain

    NARCIS (Netherlands)

    De Blecourt, A. C. E.; Schiphorst Preuper, H. R.; Van der Schans, C. P.; Groothoff, J. W.; Reneman, M. F.

    2008-01-01

    Purpose. To describe the outcome of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain. Methods. Study design: exploratory retrospective cohort study. The study sample consisted of a cohort of 70 children and adolescents ( age: 8 - 21 years) wi

  14. Assessment of Primary Representational Systems with Neurolinguistic Programming: Examination of Preliminary Literature.

    Science.gov (United States)

    Dorn, Fred J.; And Others

    1983-01-01

    Reviews the inconsistent findings of studies on neurolinguistic programing and recommends some areas that should be examined to verify various claims. Discusses methods of assessing client's primary representational systems, including predicate usage and eye movements, and suggests that more reliable methods of assessing PRS must be found. (JAC)

  15. A mindfulness-based program for improving quality of life among hematopoietic stem cell transplantation survivors: feasibility and preliminary findings.

    Science.gov (United States)

    Grossman, Paul; Zwahlen, Diana; Halter, Jorg P; Passweg, Jakob R; Steiner, Claudia; Kiss, Alexander

    2015-04-01

    Health-related quality of life (HRQoL) is often substantially reduced among individuals who have undergone hematopoietic stem cell transplantation (HSCT), and incidences of depression, fatigue, and anxiety are elevated. We examined effects of a mindfulness-based intervention (MBI) compared to psycho-oncological telephone consultation upon HRQoL, depression, anxiety, and fatigue among HSCT survivors. Sixty-two medically stable patients participated in the study; they had completed HSCT ≥6 months previously. Thirty-two were randomly assigned to intervention arms, and 30 were offered their treatment preference. MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, post-intervention and 3 months follow-up. Primary outcome was HRQoL. Depression, fatigue, anxiety, and personal goal attainment were secondary measures. Non-completion of interventions was low in both groups (9 %, MBI; 7 % control). Employing intention-to-treat analysis, MBI, compared with comparison procedure, improved HRQoL and reduced depression and anxiety at post-intervention (p's benefits were modest. These findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for HSCT survivors; findings also suggest improved HRQoL and well-being as a consequence of MBI. Nevertheless, this is a preliminary study; a larger trial with more prolonged intervention phase is warranted.

  16. Results of Ponseti Brasil Program: Multicentric Study in 1621 Feet: Preliminary Results.

    Science.gov (United States)

    Nogueira, Monica P; Queiroz, Ana C D B F; Melanda, Alessandro G; Tedesco, Ana P; Brandão, Antonio L G; Beling, Claudio; Violante, Francisco H; Brandão, Gilberto F; Ferreira, Laura F A; Brambila, Leandro S; Leite, Leopoldina M; Zabeu, Jose L; Kim, Jung H; Fernandes, Kalyana E; Arima, Marcia A S; Aguilar, Maria D P Q; Farias Filho, Orlando C D; Oliveira Filho, Oscar B D A; Pinho, Solange D S; Moulin, Paulo; Volpi, Reinaldo; Fox, Mark; Greenwald, Miles F; Lyle, Brandon; Morcuende, Jose A

    The Ponseti method has been shown to be the most effective treatment for congenital clubfoot. The current challenge is to establish sustainable national clubfoot treatment programs that utilize the Ponseti method and integrate it within a nation's governmental health system. The Brazilian Ponseti Program (Programa Ponseti Brasil) has increased awareness of the utility of the Ponseti method and has trained >500 Brazilian orthopaedic surgeons in it. A group of 18 of those surgeons had been able to reproduce the Ponseti clubfoot treatment, and compiled their initial results through structured spreadsheet. The study compiled 1040 patients for a total of 1621 feet. The average follow-up time was 2.3 years with an average correction time of approximately 3 months. Patients required an average of 6.40 casts to achieve correction. This study demonstrates that good initial correction rates are reproducible after training; from 1040 patients only 1.4% required a posteromedial release. Level IV.

  17. Site Study Plan for Aesthetics, Deaf Smith County Site, Texas: Environmental Field Program: Preliminary draft

    Energy Technology Data Exchange (ETDEWEB)

    1987-06-01

    The Aesthetic Site Study Plan describes a field program consisting of identification of the visually affected area; determination of scenic quality, visual sensitivity, and visual management classes of the site and vicinity; and analysis of the level of visual contrast that would be created by the project. Field ratings of scenic quality, visual sensitivity, and visual contrast will be supplemented by a public perception survey designed to incorporate the views of the public. This plan describes the need for the study, the study design, data management and use, schedule for proposed activities, and quality assurance program. This study will provide data needed to satisfy requirements contained in, or derived from, SRPO Requirement Document (SRP-RD). 35 refs., 6 figs., 2 tabs.

  18. Early detection of ovarian cancer: preliminary results of the Yale Early Detection Program.

    Science.gov (United States)

    Schwartz, P. E.; Chambers, J. T.; Taylor, K. J.; Pellerito, J.; Hammers, L.; Cole, L. A.; Yang-Feng, T. L.; Smith, P.; Mayne, S. T.; Makuch, R.

    1991-01-01

    Eighty-four women at high risk for ovarian cancer by having first-degree relatives with epithelial ovarian cancer participated in a newly established, early ovarian cancer detection program at Yale University. Participants were to be evaluated with physical examinations and circulating tumor markers at entry and every six months thereafter. Endovaginal ultrasound and color Doppler flow studies were to be performed at three and nine months following entry into the program. In addition, women were encouraged to follow American Cancer Society guidelines for mammography. Stool was checked for occult blood. Endometrial sampling was offered to post-menopausal women. No participant has developed an ovarian cancer since entering the program. One woman has been diagnosed to have breast cancer. False-positive levels of circulating tumor markers (CA 125, 4/84 [4.8 percent]; lipid-associated sialic acid in plasma, 13/84 [15.5 percent]; NB/70K, 4/84 [4.8 percent]; and urinary gonadotropin fragment, 1/65 [1.5 percent]) were observed on entry into the program. Low resistive indices (less than 0.5) were documented in 8/91 (8.8 percent) ovaries studied by the color Doppler flow technique. One participant underwent a laparotomy based on a false-positive endovaginal ultrasound examination. Tests now being employed in community practice have a high likelihood of being associated with false-positive results. Therapeutic interventions based on isolated abnormal tumor markers or ultrasound studies obtained from women with family histories of ovarian cancer may lead to inappropriate surgery. It is necessary for cancer centers to develop expertise in ovarian cancer detection techniques to advise physicians in their geographic areas appropriately about the significance of the abnormal screening test. PMID:1810101

  19. Empirical Tests and Preliminary Results with the Krakatoa Tool for Full Static Program Verification

    Directory of Open Access Journals (Sweden)

    Ramírez-de León Edgar Darío

    2014-10-01

    Full Text Available XJML (Ramírez et al., 2012 is a modular external platform for Verification and Validation of Java classes using the Java Modeling Language (JML through contracts written in XML. One problem faced in the XJML development was how to integrate Full Static Program Verification (FSPV. This paper presents the experiments and results that allowed us to define what tool to embed in XJML to execute FSPV.

  20. Towards the development of a spring-based continuum robot for neurosurgery

    Science.gov (United States)

    Kim, Yeongjin; Cheng, Shing Shin; Desai, Jaydev P.

    2015-03-01

    Brain tumor is usually life threatening due to the uncontrolled growth of abnormal cells native to the brain or the spread of tumor cells from outside the central nervous system to the brain. The risks involved in carrying out surgery within such a complex organ can cause severe anxiety in cancer patients. However, neurosurgery, which remains one of the more effective ways of treating brain tumors focused in a confined volume, can have a tremendously increased success rate if the appropriate imaging modality is used for complete tumor removal. Magnetic resonance imaging (MRI) provides excellent soft-tissue contrast and is the imaging modality of choice for brain tumor imaging. MRI combined with continuum soft robotics has immense potential to be the revolutionary treatment technique in the field of brain cancer. It eliminates the concern of hand tremor and guarantees a more precise procedure. One of the prototypes of Minimally Invasive Neurosurgical Intracranial Robot (MINIR-II), which can be classified as a continuum soft robot, consists of a snake-like body made of three segments of rapid prototyped plastic springs. It provides improved dexterity with higher degrees of freedom and independent joint control. It is MRI-compatible, allowing surgeons to track and determine the real-time location of the robot relative to the brain tumor target. The robot was manufactured in a single piece using rapid prototyping technology at a low cost, allowing it to disposable after each use. MINIR-II has two DOFs at each segment with both joints controlled by two pairs of MRI-compatible SMA spring actuators. Preliminary motion tests have been carried out using vision-tracking method and the robot was able to move to different positions based on user commands.

  1. A telerehabilitation program improves postural control in multiple sclerosis patients: a Spanish preliminary study.

    Science.gov (United States)

    Ortiz-Gutiérrez, Rosa; Cano-de-la-Cuerda, Roberto; Galán-del-Río, Fernando; Alguacil-Diego, Isabel María; Palacios-Ceña, Domingo; Miangolarra-Page, Juan Carlos

    2013-10-31

    Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received monitored telerehabilitation treatment via videoconference using the Xbox 360® and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session).The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test) was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available.

  2. A Telerehabilitation Program Improves Postural Control in Multiple Sclerosis Patients: A Spanish Preliminary Study

    Directory of Open Access Journals (Sweden)

    Rosa Ortiz-Gutiérrez

    2013-10-01

    Full Text Available Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25 received physiotherapy treatment twice a week (40 min per session. Experimental group (n = 25 received monitored telerehabilitation treatment via videoconference using the Xbox 360® and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session.The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available.

  3. Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery.

    Science.gov (United States)

    Wong, Judith M; Ziewacz, John E; Ho, Allen L; Panchmatia, Jaykar R; Kim, Albert H; Bader, Angela M; Thompson, B Gregory; Du, Rose; Gawande, Atul A

    2012-11-01

    As part of a project to devise evidence-based safety interventions for specialty surgery, we sought to review current evidence concerning the frequency of adverse events in open cerebrovascular neurosurgery and the state of knowledge regarding methods for their reduction. 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. The authors performed a PubMed search using search terms "cerebral aneurysm", "cerebral arteriovenous malformation", "intracerebral hemorrhage", "intracranial hemorrhage", "subarachnoid hemorrhage", and "complications" or "adverse events." Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the reported adverse events. The review revealed hemorrhage-related hyperglycemia (incidence rates ranging from 27% to 71%) and cerebral salt-wasting syndromes (34%-57%) to be the most common perioperative adverse events related to subarachnoid hemorrhage (SAH). Next in terms of frequency was new cerebral infarction associated with SAH, with a rate estimated at 40%. Many techniques are advocated for use during surgery to minimize risk of this development, including intraoperative neurophysiological monitoring, but are not universally used due to surgeon preference and variable availability of appropriate staffing and equipment. The comparative effectiveness of using or omitting monitoring technologies has not been evaluated. The incidence of perioperative seizure related to vascular neurosurgery is unknown, but reported seizure rates from observational studies range from 4% to 42%. There are no standard guidelines for the use of seizure prophylaxis in these patients, and there remains a need for prospective studies to support such

  4. Establishing a generic training programme for future junior doctors: a role for neurosurgery within the framework of clinical neurosciences.

    OpenAIRE

    Nadarajah, Ramesh; Amin, Amit; Aldlyami, Ehabb; Kang, Niel; Wong, James Min-Leong; Selway, Richard; Gullan, Richard

    2005-01-01

    INTRODUCTION: To describe the opinion of junior doctors in neurosurgery in the UK and Eire about future reforms to training, and to relate this to the establishment of a generic neurosciences training programme. METHODS: A postal questionnaire survey of neurosurgery units in UK and Eire (36 units). All senior house officers (SHOs) taking part in a neurosurgery on-call rota during the 6 months between February and August 2003 (n=236); 190 respondents (response rate 81% overall, 90% neurosurger...

  5. Perception of hearing protectors by workers that participate in hearing preservation programs: a preliminary study.

    Science.gov (United States)

    Gonçalves, Cláudia Giglio de Oliveira; Lüders, Débora; Guirado, Débora Simões; Albizu, Evelyn Joice; Marques, Jair Mendes

    2015-01-01

    To evaluate and compare the workers' perception of comfort and use aspects regarding two types of hearing protectors (shell and earplug), in three units from a lumbering company, with different implantation times for Hearing Preservation Programs. This is a cross-sectional study comparing 440 workers' perception of hearing protectors, from three companies in Paraná State (Brazil), with different times for Hearing Preservation Programs. Two closed questionnaires were applied (9 and 10 questions, respectively), with a scale of answers varying from 1 to 5 (Likert's scale) regarding the perception of the comfort of hearing protectors. Then, audiometry results were analyzed. About 17.5% presented audiogram examinations with alterations. With regard to the questionnaire about the comfort perception, the importance of noise attenuation (mean of 4.25) was the most relevant aspect, followed by communication possibility (mean of 4.15). In the protector assessment, Unit A with more Hearing Preservation Program time presented better scores for both the worker's perception of important aspects regarding hearing protector and for the assessment of the used hearing protector. There was a significant difference on communication difficulty with the use of a hearing protector among workers with normal and altered audiograms (p=0.0371). With regard to the global comfort in the comparison of workers using the shell-type hearing protector with those using insert-type hearing protectors, there was no difference (p=0.2264), irrespective of the type of the unit. In general, the unit workers presented a good perception of the important aspects about the hearing protection use of both types of hearing protectors.

  6. New Approach in Fibromyalgia Exercise Program: A Preliminary Study Regarding the Effectiveness of Balance Training.

    Science.gov (United States)

    Kibar, Sibel; Yıldız, Hatice Ecem; Ay, Saime; Evcik, Deniz; Ergin, Emine Süreyya

    2015-09-01

    To determine the effectiveness of balance exercises on the functional level and quality of life (QOL) of patients with fibromyalgia syndrome (FMS) and to investigate the circumstances associated with balance disorders in FMS. Randomized controlled trial. Physical medicine and rehabilitation clinic. Patients (N=57) (age range, 18-65y) with FMS were randomly assigned into 2 groups. Group 1 was given flexibility and balance exercises for 6 weeks, whereas group 2 received only a flexibility program as the control group. Functional balance was measured by the Berg Balance Scale (BBS), and dynamic and static balance were evaluated by a kinesthetic ability trainer (KAT) device. Fall risk was assessed with the Hendrich II fall risk model. The Nottingham Health Profile, Fibromyalgia Impact Questionnaire (FIQ), and Beck Depression Inventory (BDI) were used to determine QOL and functional and depression levels, respectively. Assessments were performed at baseline and after the 6-week program. In group 1, statistically significant improvements were observed in all parameters (P.05). When comparing the 2 groups, there were significant differences in group 1 concerning the KAT static balance test (P=.017) and FIQ measurements (P=.005). In the correlation analysis, the BDI was correlated with the BBS (r=-.434) and Hendrich II results (r=.357), whereas body mass index (BMI) was correlated with the KAT static balance measurements (r=.433), BBS (r=-.285), and fall frequency (r=.328). A 6-week balance training program had a beneficial effect on the static balance and functional levels of patients with FMS. We also observed that depression deterioration was related to balance deficit and fall risk. Higher BMI was associated with balance deficit and fall frequency. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Use of Web 2.0 Social Media Platforms to Promote Community-Engaged Research Dialogs: A Preliminary Program Evaluation.

    Science.gov (United States)

    Valdez Soto, Miguel; Balls-Berry, Joyce E; Bishop, Shawn G; Aase, Lee A; Timimi, Farris K; Montori, Victor M; Patten, Christi A

    2016-09-09

    Community-engaged research is defined by the Institute of Medicine as the process of working collaboratively with groups of people affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being. Traditional face-to-face community-engaged research is limited by geographic location, limited in resources, and/or uses one-way communications. Web 2.0 technologies including social media are novel communication channels for community-engaged research because these tools can reach a broader audience while promoting bidirectional dialogs. This paper reports on a preliminary program evaluation of the use of social media platforms for promoting engagement of researchers and community representatives in dialogs about community-engaged research. For this pilot program evaluation, the Clinical and Translational Science Office for Community Engagement in Research partnered with the Social Media Network at our institution to create a WordPress blog and Twitter account. Both social media platforms were facilitated by a social media manager. We used descriptive analytics for measuring engagement with WordPress and Twitter over an 18-month implementation period during 2014-2016. For the blog, we examined type of user (researcher, community representative, other) and used content analysis to generate the major themes from blog postings. For use of Twitter, we examined selected demographics and impressions among followers. There were 76 blog postings observed from researchers (48/76, 64%), community representatives (23/76, 32%) and funders (5/76, 8%). The predominant themes of the blog content were research awareness and dissemination of community-engaged research (35/76, 46%) and best practices (23/76, 30%). For Twitter, we obtained 411 followers at the end of the 18-month evaluation period, with an increase of 42% (from 280 to 411) over the final 6 months. Followers reported varied geographic location (321/411, 78

  8. Use of Web 2.0 Social Media Platforms to Promote Community-Engaged Research Dialogs: A Preliminary Program Evaluation

    Science.gov (United States)

    Valdez Soto, Miguel; Bishop, Shawn G; Aase, Lee A; Timimi, Farris K; Montori, Victor M; Patten, Christi A

    2016-01-01

    Background Community-engaged research is defined by the Institute of Medicine as the process of working collaboratively with groups of people affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being. Traditional face-to-face community-engaged research is limited by geographic location, limited in resources, and/or uses one-way communications. Web 2.0 technologies including social media are novel communication channels for community-engaged research because these tools can reach a broader audience while promoting bidirectional dialogs. Objective This paper reports on a preliminary program evaluation of the use of social media platforms for promoting engagement of researchers and community representatives in dialogs about community-engaged research. Methods For this pilot program evaluation, the Clinical and Translational Science Office for Community Engagement in Research partnered with the Social Media Network at our institution to create a WordPress blog and Twitter account. Both social media platforms were facilitated by a social media manager. We used descriptive analytics for measuring engagement with WordPress and Twitter over an 18-month implementation period during 2014-2016. For the blog, we examined type of user (researcher, community representative, other) and used content analysis to generate the major themes from blog postings. For use of Twitter, we examined selected demographics and impressions among followers. Results There were 76 blog postings observed from researchers (48/76, 64%), community representatives (23/76, 32%) and funders (5/76, 8%). The predominant themes of the blog content were research awareness and dissemination of community-engaged research (35/76, 46%) and best practices (23/76, 30%). For Twitter, we obtained 411 followers at the end of the 18-month evaluation period, with an increase of 42% (from 280 to 411) over the final 6 months. Followers reported varied

  9. Integrating multimodal information for intraoperative assistance in neurosurgery

    Directory of Open Access Journals (Sweden)

    Eisenmann U.

    2015-09-01

    Full Text Available Computer-assisted planning of complex neurosurgical interventions benefits from a variety of specific functions and tools. However, commercial planning- and neuronavigation systems are rather restrictive concerning the availability of innovative methods such as novel imaging modalities, fiber tracking algorithms or electrical dipole mapping. In this respect there is a demand for modular neurosurgical planning systems offering flexible interfaces for easy enhancement. Furthermore all relevant planning information should be available within neuron-avigation. In this work we present a planning system providing these capabilities and its suitability and application in a clinical setting. Our Multimodal Planning System (MOPS 3D offers a variety of tools such as definition of trajectories for minimally invasive surgery, segmentation of ROIs, integration of functional information from atlas maps or magnetoencephalography. It also supplies plugin interfaces for future extensions. For intraoperative application MOPS is coupled with the neuronavigation system Brainlab Vector Vision Cranial/ENT (VVC. We evaluated MOPS in the Department of Neurosurgery at the University Hospital Heidelberg. Surgical planning and navigation was performed in 5 frequently occurring clinical cases. The time necessary for planning was between 5 and 15 minutes including data import, segmentation and planning tasks. The additional information intraoperatively provided by MOPS 3D was highly appreciated by the neurosurgeons and the performance was satisfactory.

  10. Shining light on neurosurgery diagnostics using Raman spectroscopy.

    Science.gov (United States)

    Broadbent, Brandy; Tseng, James; Kast, Rachel; Noh, Thomas; Brusatori, Michelle; Kalkanis, Steven N; Auner, Gregory W

    2016-10-01

    Surgical excision of brain tumors provides a means of cytoreduction and diagnosis while minimizing neurologic deficit and improving overall survival. Despite advances in functional and three-dimensional stereotactic navigation and intraoperative magnetic resonance imaging, delineating tissue in real time with physiological confirmation is challenging. Raman spectroscopy is a promising investigative and diagnostic tool for neurosurgery, which provides rapid, non-destructive molecular characterization in vivo or in vitro for biopsy, margin assessment, or laboratory uses. The Raman Effect occurs when light temporarily changes a bond's polarizability, causing change in the vibrational frequency, with a corresponding change in energy/wavelength of the scattered photon. The recorded inelastic scattering results in a "fingerprint" or Raman spectrum of the constituent under investigation. The amount, location, and intensity of peaks in the fingerprint vary based on the amount of vibrational bonds in a molecule and their ensemble interactions with each other. Distinct differences between various pathologic conditions are shown as different intensities of the same peak, or shifting of a peak based on the binding conformation. Raman spectroscopy has potential for integration into clinical practice, particularly in distinguishing normal and diseased tissue as an adjunct to standard pathologic diagnosis. Further, development of fiber-optic Raman probes that fit through the instrument port of a standard endoscope now allows researchers and clinicians to utilize spectroscopic information for evaluation of in vivo tissue. This review highlights the need for such an instrument, summarizes neurosurgical Raman work performed to date, and discusses the future applications of neurosurgical Raman spectroscopy.

  11. [Antiphospholipid antibody syndrome in pediatric neurosurgery: a hemostasis problem].

    Science.gov (United States)

    Bocquet, R; Blanot, S; Dautzenberg, M D; Pierre-Kahn, A; Carli, P

    1999-11-01

    The case of a 11-year-old boy under anticoagulant therapy for a familial antiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cerebrovascular malformation responsible for an intracerebral haematoma, is reported. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), three days before. Heparin was discontinued two hours prior to surgery to obtain a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned to normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danaparoid (Orgaran), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurrence due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the value but also the risks of anticoagulant therapy in neurosurgery, when patients are at high risk for thrombosis.

  12. Operative Duration and Risk of Surgical Site Infection in Neurosurgery.

    Science.gov (United States)

    Bekelis, Kimon; Coy, Shannon; Simmons, Nathan

    2016-10-01

    The association of surgical duration with the risk of surgical site infection (SSI) has not been quantified in neurosurgery. We investigated the association of operative duration in neurosurgical procedures with the incidence of SSI. 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. To control for confounding, we used multivariable regression models and propensity score conditioning. During the study period there were 94,744 patients who underwent a neurosurgical procedure and met the inclusion criteria. Of these patients, 4.1% developed a postoperative SSI within 30 days. Multivariable logistic regression showed an association between longer operative duration with higher incidence of SSI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16-1.20). Compared with procedures of moderate duration (third quintile, 40th-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 2.07; 95% CI, 1.86-2.31) of developing SSI. The shortest procedures (surgical registry, longer operative duration was associated with increased incidence of SSI for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management and to stratify patients with regard to SSI risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Simulation training in neurosurgery: advances in education and practice

    Science.gov (United States)

    Konakondla, Sanjay; Fong, Reginald; Schirmer, Clemens M

    2017-01-01

    The current simulation technology used for neurosurgical training leaves much to be desired. Significant efforts are thoroughly exhausted in hopes of developing simulations that translate to give learners the “real-life” feel. Though a respectable goal, this may not be necessary as the application for simulation in neurosurgical training may be most useful in early learners. The ultimate uniformly agreeable endpoint of improved outcome and patient safety drives these investments. We explore the development, availability, educational taskforces, cost burdens and the simulation advancements in neurosurgical training. The technologies can be directed at achieving early resident milestones placed by the Accreditation Council for Graduate Medical Education. We discuss various aspects of neurosurgery disciplines with specific technologic advances of simulation software. An overview of the scholarly landscape of the recent publications in the realm of medical simulation and virtual reality pertaining to neurologic surgery is provided. We analyze concurrent concept overlap between PubMed headings and provide a graphical overview of the associations between these terms. PMID:28765716

  14. Preliminary testing of an asthma distance education program (ADEP) for school nurses in Appalachia.

    Science.gov (United States)

    Putman-Casdorph, Heidi; Pinto, Susan

    2011-12-01

    Asthma remains one of the most challenging chronic illnesses faced by school nurses both nationally and in the State of West Virginia. There is a clear need to provide ongoing continuing asthma education to school nurses. However, nurses face many barriers to receiving this education. The purpose of this pilot project was to develop and evaluate distance learning technology as a method to deliver continuing asthma education to school nurses in West Virginia. A sample of 20 school nurses from 2 counties in West Virginia participated in the study using the Wimba live classroom distance learning program. Significant modest improvements were found in both the intervention groups compared to a control group postintervention. The results of this pilot study are promising and show that distance learning technology could be a viable solution for school nurses to receive asthma continuing education.

  15. The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program.

    Science.gov (United States)

    Badsha, Humeira; Chhabra, Vishwas; Leibman, Cathy; Mofti, Ayman; Kong, Kok Ooi

    2009-10-01

    The aim of this study was to measure the effects of a bi-weekly Raj yoga program on rheumatoid arthritis (RA) disease activity. Subjects were recruited from among RA patients in Dubai, United Arab Emirates by email invitations of the RA database. Demographic data, disease activity indices, health assessment questionnaire (HAQ), and quality of life (QOL) by SF-36 were documented at enrollment and after completion of 12 sessions of Raj yoga. A total of 47 patients were enrolled: 26 yoga and 21 controls. Baseline demographics were similar in both groups. Patients who underwent yoga had statistically significant improvements in DAS28 and HAQ, but not QOL. Our pilot study of 12 sessions of yoga for RA was able to demonstrate statistically significant improvements in RA disease parameters. We believe that a longer duration of treatment could result in more significant improvements.

  16. [Preliminary results of a therapeutic program for childhood obesity in primary health care].

    Science.gov (United States)

    Temboury Molina, M C; Sacristán Martín, A; San Frutos Fernández, M A; Rodríguez Alfaro, F; Llorente González, R

    1993-05-01

    The high prevalence of childhood obesity in our society, its adverse consequences in the psychosocial development of the child, together with its risk of persistence into adulthood, prompted us to carry out this treatment program in our Primary Care Unit. It is based fundamentally on four aspects: diet, physical exercise, psychological and family support. Thirty children, between 4 and 14 years of age, were controlled for 11 months. These children's personal and family characteristics, their habits and psychological aspects were described. An average reduction of the IMC of 2.50 was obtained. The best results were obtained in children with two or more siblings, with a good adherence to the diet and with adequate family support. Sex, obesity of other family members, initial age, previous habits, etc., were not found to be influential. The importance of prevention and family collaboration is emphasized.

  17. Preliminary Data on a Care Coordination Program for Home Care Recipients.

    Science.gov (United States)

    Dean, Katie M; Hatfield, Laura A; Jena, Anupam B; Cristman, David; Flair, Michael; Kator, Kylie; Nudd, Geoffrey; Grabowski, David C

    2016-09-01

    Home care recipients are often hospitalized for potentially avoidable reasons. A pilot program (Intervention in Home Care to Improve Health Outcomes (In-Home)) was designed to help home care providers identify acute clinical changes in condition and then manage the condition in the home and thereby avoid a costly hospitalization. Caregivers answer simple questions about the care recipient's condition during a telephone-based "clock-out" at the end of each shift. Responses are electronically captured in the agency management software that caregivers use to "clock-in," manage care, and "clock-out" on every shift. These are transmitted to the agency's care manager, who follows up on the change in condition and escalates appropriately. A description of the In-Home model is presented, and pilot data from 22 home care offices are reported. In the pilot, caregivers reported a change in condition after 2% of all shifts, representing an average of 1.9 changes per care recipient in a 6-month period. Changes in behavior and skin condition were the most frequently recorded domains. Interviews with participating caregivers and care managers suggested positive attitudes regarding the intervention; challenges included resistance to change on the part of home care staff and difficulties in applying a uniform intervention to individuals with varying needs in home care offices with varying capacities. In an ongoing randomized trial, the success of the overall program will be measured primarily according to the potential reduction in avoidable hospitalizations of home care recipients and the effect this potential reduction has on spending and healthcare outcomes. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  18. Master's Degree Program in Scientific and Cultural Communication: Preliminary reports on an innovative experience in Brazil

    Directory of Open Access Journals (Sweden)

    Carlos A. Vogt

    2009-03-01

    Full Text Available The multidisiciplinary Master’s Degree Program in Scientific and Cultural Communication (MDCC began in the first semester of 2007. It is offered by the Laboratory of Advanced Studies in Journalism (Labjor of the Creativity Development Nucleus (NUDECRI and by the Institute of Language Studies (IEL, both of which are entities the State University of Campinas (UNICAMP. The program is also supported by the Department of Scientific and Technological Policy (DPCT of the Geosciences Institute (IG and by MediaTec – Media and Communication Technologies Laboratory of the Multimedia Department (DMM of the Art Institute (IA. The objective of the MDCC is to train and enable researchers with in-depth theoretical knowledge about current questions related to science communication. A global vision of the systems of science and technology are joined together with an understanding of a solid, contemporary literary and cultural repertoire. The interaction among subjects offered in the MDCC seeks to provide an education that allows critical reflection about the main accomplishments of science, technology and culture in our current society and the way in which the mass or specialized media have worked in order to communicate these accomplishments. The areas of research focus on the analysis of cultural production and science communication within the most diverse means of information, such as print, radio, television and electronic media. There is a special emphasis on areas such as science and technical history and the sociology of science, as well as other spaces of science and cultural communication, such as museums, forums and events.

  19. Preliminary PINC(Program for the Inspection of Nickel Alloy Components) RRT(Round Robin Test) - Pressurizer Dissimilar Metal Weld

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Cho; Kang, Sung Sik; Shin, Ho Sang; Chung, Ku Kab; Song, Myung Ho; Chung, Hae Dong [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2009-06-15

    After several damages by PWSCC were found in the world, USNRC and PNNL(Pacific Northwest National Laboratory) started the research on PWSCC under the project name of PINC. The aim of the project was 1) to fabricate representative NDE mock-ups with flaws to simulate PWSCCs, 2) to identify and quantitatively assess NDE methods for accurately detecting, sizing and characterizing PWSCCs, 3) to document the range of locations and morphologies of PWSCCs and 4) to incorporate results with other results of ongoing PWSCC research programs, as appropriate. Korea nuclear industries have also been participating in the project. Thermally and mechanically cracked-four mockups were prepared and phased array and manual ultrasonic testing(UT) techniques were applied. The results and lessons learned from the preliminary RRT are summarized as follows: 1) Korea RRT teams performed the RRT successfully. 2) Crack detection probability of the participating organizations was an average 87%, 80% and 80% respectively. 3) RMS error of the crack sizing showed comparatively good results. 4) The lessons learned may be helpful to perform the PINC RRT and PSI /ISI in Korea in the future.

  20. Hurricanes and anchors: preliminary results from the National Park Service regional reef assessment program

    Science.gov (United States)

    Rogers, Caroline S.

    1994-01-01

    The U .S . National Park Service NPS began a Regional Assessment Program for coral reefs in the U.S. Virgin Islands and Florida in 1988. Scientists from NPS and six other institutions have now established longterm monitoring sites at Virgin Islands National Park St. John, USVI, Buck Island Reef National Monument St. Croix, USVI, Biscayne National Park Florida and Fort Jefferson National Monument Florida. Hurricane Hugo passed through the USVI in 1989, causing severe destruction in some reef areas while leaving others untouched. Patchy damage to reefs in Florida was also noted after Hurricane Andrew; damage from this August 1992 storm is still being assessed. Fort Jefferson National Monument escaped the onslaught of Andrew. No significant recovery in live coral cover has been evident at the Buck Island or Virgin Islands National Park VINP study sites 3.5 years after Hurricane Hugo. Similarly, no recovery was evident at another site in St. John which was destroyed by a large anchor 4.5 years ago.

  1. Preliminary Multirod Burst Test Program results and implications of interest to reactor safety evaluations

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, R.H. (comp.)

    1978-01-01

    The Multirod Burst Test (MRBT) Program, in progress at Oak Ridge National Laboratory, is investigating LWR cladding deformation in single- and multirod test arrays under conditions representative of reflood and refill phases of a LOCA. In these tests internally pressurized, unirradiated Zircaloy-4 tubes containing electrically heated fuel simulators are tested to failure in a low-pressure, superheated-steam environment. The tubes are ''uniformly'' heated over a 915-mm length; the simulator pressure, due to the small enclosed gas volume, also varies with temperature (and deformation) during the test. Two 4 x 4 multirod tests (B-1 and B-2), one with and one without the shroud being heated, have been conducted with a bundle heating rate of approx. 29/sup 0/C/sec; initial pressure conditions for these tests were selected to cause failure at about 860/sup 0/C. An additional 4 x 4 array (B-3) was tested using a bundle heating rate of approx. 10/sup 0/C/sec; the shroud was also heated in this test. Initial conditions were adjusted to cause failure at approx. 760/sup 0/C. Posttest examination (including flow tests) of the B-1 and B-2 test arrays, is essentially complete, and pertinent data are included in this summary.

  2. Preliminary Mark-18A (Mk-18A) Target Material Recovery Program Product Acceptance Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, Sharon M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Patton, Bradley D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-09-01

    The U.S. Department of Energy (DOE) manages an inventory of materials that contains a range of long-lived radioactive isotopes that were produced from the 1960s through the 1980s by irradiating targets in production nuclear reactors at the Savannah River Site (SRS). One reactor was operated in a high-flux mode to produce heavy isotopes for defense purposes, DOE programmatic use, scientific research, and industrial and medical applications. In this reactor, eighty-six Mk-18A (Mk-18A) targets were subjected to long-term high neutron fluxes 47 years ago. Twentyone targets of these were processed to recover 244Pu, heavy curium (i.e., curium rich in 246-248Cm), and 252Cf. The plutonium fraction, which was rich in 244Pu, was electromagnetically enriched in the Oak Ridge National Laboratory (ORNL) calutrons to produce gram quantities of 244Pu. This high-purity 244Pu was portioned out to scientists for basic research and for nuclear nonproliferation safeguards programs. The recovered tails (designated as FP-33) contain 244Pu isotopic purities below 20% and are stored at ORNL. The processing of these 21 Mk-18A targets provided the supply of 244Pu and heavy curium in use today. The remaining 65 unprocessed targets are currently in a storage pool at SRS; they contain the world’s remaining supply of unseparated 244Pu and heavy curium.

  3. Robotics in neurosurgery: state of the art and future technological challenges.

    Science.gov (United States)

    Zamorano, L; Li, Q; Jain, S; Kaur, G

    2004-06-01

    The use of robotic technologies to assist surgeons was conceptually described almost thirty years ago but has only recently become feasible. In Neurosurgery, medical robots have been applied to neurosurgery for over 19 years. Nevertheless this field remains unknown to most neurosurgeons. The intrinsic characteristics of robots, such as high precision, repeatability and endurance make them ideal surgeon's assistants. Unfortunately, limitations in the current available systems make its use limited to very few centers in the world. During the last decade, important efforts have been made between academic and industry partnerships to develop robots suitable for use in the operating room environment. Although some applications have been successful in areas of laparoscopic surgery and orthopaedics, Neurosurgery has presented a major challenge due to the eloquence of the surrounding anatomy. This review focuses on the application of medical robotics in neurosurgery. The paper begins with an overview of the development of the medical robotics, followed by the current clinical applications in neurosurgery and an analysis of current limitations. We discuss robotic applications based in our own experience in the field. Next, we discuss the technological challenges and research areas to overcome those limitations, including some of our current research approaches for future progress in the field.

  4. History of the Neurosurgery Department of Pontificia Universidad Catolica, Santiago, Chile.

    Science.gov (United States)

    Sfeir, Felipe; Villanueva, Pablo; Tagle, Patricio

    2017-01-01

    Pontificia Universidad Católica de Chile's medical school was founded in 1929. An interest in neurosurgical development arose in the minds of the Dean, Dr. Cristobal Espíldora, and the Chief of Surgery, Dr. Rodolfo Rencoret, in 1946. They encouraged and supported Dr. J. Ricardo Olivares to specialize in Neurosurgery with Professor H. Olivecrona in Stockholm, Sweden. The first neurosurgical procedure in the Hospital Clínico de la Universidad Católica was performed in 1950. Since then, intensive efforts have been made to develop neurosurgery and its science. As a result, it is now a center capable of achieving high-quality standards in vascular, oncologic, and endoscopic neurosurgery; stereotactic and radiosurgery; complex spine surgery; pediatric neurosurgery; and epilepsy surgery. This article tells the story of a university hospital neurosurgery service in a country at the southern end of the world and how it became one of the most important neurosurgical centers in Chile and South America.

  5. Functional neurosurgery for movement disorders: a historical perspective.

    Science.gov (United States)

    Benabid, Alim Louis; Chabardes, Stephan; Torres, Napoleon; Piallat, Brigitte; Krack, Paul; Fraix, Valerie; Pollak, Pierre

    2009-01-01

    Since the 1960s, deep brain stimulation and spinal cord stimulation at low frequency (30 Hz) have been used to treat intractable pain of various origins. For this purpose, specific hardware have been designed, including deep brain electrodes, extensions, and implantable programmable generators (IPGs). In the meantime, movement disorders, and particularly parkinsonian and essential tremors, were treated by electrolytic or mechanic lesions in various targets of the basal ganglia, particularly in the thalamus and in the internal pallidum. The advent in the 1960s of levodopa, as well as the side effects and complications of ablative surgery (e.g., thalamotomy and pallidotomy), has sent functional neurosurgery of movement disorders to oblivion. In 1987, the serendipitous discovery of the effect of high-frequency stimulation (HFS), mimicking lesions, allowed the revival of the surgery of movement disorders by stimulation of the thalamus, which treated tremors with limited morbidity, and adaptable and reversible results. The stability along time of these effects allowed extending it to new targets suggested by basic research in monkeys. The HFS of the subthalamic nucleus (STN) has profoundly challenged the practice of functional surgery as the effect on the triad of dopaminergic symptoms was very significant, allowing to decrease the drug dosage and therefore a decrease of their complications, the levodopa-induced dyskinesias. In the meantime, based on the results of previous basic research in various fields, HFS has been progressively extended to potentially treat epilepsy and, more recently, psychiatric disorders, such as obsessive-compulsive disorders, Gilles de la Tourette tics, and severe depression. Similarly, suggested by the observation of changes in PET scan, applications have been extended to cluster headaches by stimulation of the posterior hypothalamus and even more recently, to obesity and drug addiction. In the field of movement disorders, it has become

  6. National survey on postoperative care and treatment circuits in neurosurgery.

    Science.gov (United States)

    Valero, R; Carrero, E; Fàbregas, N; Iturri, F; Saiz-Sapena, N; Valencia, L

    2017-10-01

    The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Sensors management in robotic neurosurgery: the ROBOCAST project.

    Science.gov (United States)

    Vaccarella, Alberto; Comparetti, Mirko Daniele; Enquobahrie, Andinet; Ferrigno, Giancarlo; De Momi, Elena

    2011-01-01

    Robot and computer-aided surgery platforms bring a variety of sensors into the operating room. These sensors generate information to be synchronized and merged for improving the accuracy and the safety of the surgical procedure for both patients and operators. In this paper, we present our work on the development of a sensor management architecture that is used is to gather and fuse data from localization systems, such as optical and electromagnetic trackers and ultrasound imaging devices. The architecture follows a modular client-server approach and was implemented within the EU-funded project ROBOCAST (FP7 ICT 215190). Furthermore it is based on very well-maintained open-source libraries such as OpenCV and Image-Guided Surgery Toolkit (IGSTK), which are supported from a worldwide community of developers and allow a significant reduction of software costs. We conducted experiments to evaluate the performance of the sensor manager module. We computed the response time needed for a client to receive tracking data or video images, and the time lag between synchronous acquisition with an optical tracker and ultrasound machine. Results showed a median delay of 1.9 ms for a client request of tracking data and about 40 ms for US images; these values are compatible with the data generation rate (20-30 Hz for tracking system and 25 fps for PAL video). Simultaneous acquisitions have been performed with an optical tracking system and US imaging device: data was aligned according to the timestamp associated with each sample and the delay was estimated with a cross-correlation study. A median value of 230 ms delay was calculated showing that realtime 3D reconstruction is not feasible (an offline temporal calibration is needed), although a slow exploration is possible. In conclusion, as far as asleep patient neurosurgery is concerned, the proposed setup is indeed useful for registration error correction because the brain shift occurs with a time constant of few tens of minutes.

  8. MINOP: development of a miniaturized endoscopic operation system for neurosurgery

    Science.gov (United States)

    Guber, Andreas E.; Wieneke, Paul

    1996-04-01

    Within the framework of R&D activities in the field of microsystems technology, the Institute for Microstructure Technology of Karlsruhe Research Center among others has started to improve the functionality of existing medicotechnical instruments by increased integration of microtechnical components. On the basis of microsystems fabrication techniques, completely novel medical endoscope systems have become feasible. In cooperation with clinical, technical and industrial partners, a novel endoscopic operation system based on microsystems technology is being developed by the Institute for Microstructure Technology and the Aesculap AG company, Tuttlingen within the framework of the MINOP joint project. This new system shall be applied above all in the field of neurosurgery. This newly conceived endosystem is characterized by a multitude of novelties. It can perform a number of both sensor and actor functions. Due to its extremely small outer diameter, it can be applied through minute openings. As a result of the integrated microfluidic control system, the flexible endoscope can be moved to the actual site of operation on a previously specified path. This will allow future bi- and triportal neuro-endoscopic interventions for critical operations in the brain area. The different lumina of the flexible endoscope fulfill various functions. Via the optical fibers, laser radiation may be led to the distal end of the endoscope. Using microtechnical fabrication methods, special plastic microlenses have been produced. The working channel can be applied for rinsing and removal. Furthermore, the cleaning of the optics or the taking of tissue samples are possible. If required, another laser fiber can be driven forward through the working channel for selective therapy. For the first time, high-performance microinstruments have been developed on the basis of novel materials. These instruments can be applied either through the working channel or through an additional trocar.

  9. Innovation in neurosurgery: less than IDEAL? A systematic review.

    Science.gov (United States)

    Muskens, I S; Diederen, S J H; Senders, J T; Zamanipoor Najafabadi, A H; van Furth, W R; May, A M; Smith, T R; Bredenoord, A L; Broekman, M L D

    2017-08-06

    Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms. The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework. Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b. The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.

  10. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

    Science.gov (United States)

    Nuttin, Bart; Wu, Hemmings; Mayberg, Helen; Hariz, Marwan; Gabriëls, Loes; Galert, Thorsten; Merkel, Reinhard; Kubu, Cynthia; Vilela-Filho, Osvaldo; Matthews, Keith; Taira, Takaomi; Lozano, Andres M; Schechtmann, Gastón; Doshi, Paresh; Broggi, Giovanni; Régis, Jean; Alkhani, Ahmed; Sun, Bomin; Eljamel, Sam; Schulder, Michael; Kaplitt, Michael; Eskandar, Emad; Rezai, Ali; Krauss, Joachim K; Hilven, Paulien; Schuurman, Rick; Ruiz, Pedro; Chang, Jin Woo; Cosyns, Paul; Lipsman, Nir; Voges, Juergen; Cosgrove, Rees; Li, Yongjie; Schlaepfer, Thomas

    2014-01-01

    Background For patients with psychiatric illnesses remaining refractory to ‘standard’ therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered ‘established’ in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety. PMID:24444853

  11. Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma.

    Science.gov (United States)

    Gephart, Melanie G Hayden; Taft, Bonnie P; Giese, Anne-Katrin; Guzman, Raphael; Edwards, Michael S B

    2011-03-01

    Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.

  12. Neurosurgery in Turkish poetry: three poets, two poems and two neurosurgeons.

    Science.gov (United States)

    Kahilogullari, Gokmen

    2015-01-01

    Poems are essential in art and vital organs in literature. Similarly, surgery (and neurosurgery) is also regarded to be an art in medicine. From Hippocrates to nowadays, there is a debate on whether medicine -especially surgery- is a kind of an art or a field of science or a combination of both. This close relation becomes clearer during the practice of surgery, especially in neurosurgery. Herein, the relation between Turkish poetry and Turkish neurosurgery is being presented by researching the interesting and exciting stories about three poets (Can Yücel, Hasan Hüseyin Korkmazgil, Nazım Hikmet), their poems; and two Turkish neurosurgeons (Gazi Yaşargil, Yücel Kanpolat).

  13. Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India

    Directory of Open Access Journals (Sweden)

    Ashish Suri

    2014-01-01

    Full Text Available Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

  14. Constantin N. Arseni (1912-1994) centenary: the birth of modern neurosurgery in Romania.

    Science.gov (United States)

    Dinca, Eduard B; Banu, Matei; Ciurea, Alexandru V

    2014-01-01

    Prof. Dr. Constantin N. Arseni and his mentor, Prof. Dr. D. Bagdasar, are revered by later generations of doctors as the forefathers of Romanian neurosurgery. In 2012, we have celebrated 100 years since Prof. Arseni's birth in a small village within a deprived area of the country. Through his talents and perseveration, he rose to be a neurosurgical school creator and one of the most prominent figures in 20th-century Eastern European neurosurgery. This historical vignette is a modest tribute to his legacy and tells the story of his titanic endeavor.

  15. 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.

  16. A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study.

    Directory of Open Access Journals (Sweden)

    Michèle Bisson

    Full Text Available To evaluate whether a 12-week supervised exercise program promotes an active lifestyle throughout pregnancy in pregnant women with obesity.In this preliminary randomised trial, pregnant women (body mass index ≥ 30 kg/m2 were allocated to either standard care or supervised training, from 15 to 27 weeks of gestation. Physical activity was measured by accelerometry at 14, 28 and 36 weeks, while fitness (oxygen consumption (VO2 at the anaerobic threshold, nutrition (caloric intake and macronutrients percentage and anthropometry were assessed at 14 and 28 weeks of gestation. Analyses were performed using repeated measures ANOVA.A total of fifty (50 women were randomised, 25 in each group. There was no time-group interaction for time spent at moderate and vigorous activity (pinteraction = 0.064, but the exercise group's levels were higher than controls' at all times (pgroup effect = 0.014. A significant time-group interaction was found for daily physical activity (p = 0.023; similar at baseline ((22.0 ± 6.7 vs 21.8 ± 7.3 x 10(4 counts/day the exercise group had higher levels than the control group following the intervention ((22.8 ± 8.3 vs 19.2 ± 4.5 x 10(4 counts/day, p = 0.020 and at 36 weeks of gestation ((19.2 ± 1.5 vs 14.9 ± 1.5 x 10(4 counts/day, p = 0.034. Exercisers also gained less weight than controls during the intervention period despite similar nutritional intakes (difference in weight change = -0.1 kg/week, 95% CI -0.2; -0.02, p = 0.016 and improved cardiorespiratory fitness (difference in fitness change = 8.1%, 95% CI 0.7; 9.5, p = 0.041.Compared with standard care, a supervised exercise program allows pregnant women with obesity to maintain fitness, limit weight gain and attenuate the decrease in physical activity levels observed in late pregnancy.ClinicalTrials.gov NCT01610323.

  17. BioXTAS RAW, a software program for high-throughput automated small-angle X-ray scattering data reduction and preliminary analysis

    DEFF Research Database (Denmark)

    Nielsen, S.S.; Toft, K.N.; Snakenborg, Detlef

    2009-01-01

    -dimensional data in terms of the indirect Fourier transform using the objective Bayesian approach to obtain the pair-distance distribution function, PDDF, and is thereby a free and open-source alternative to existing PDDF estimation software. Apart from the TIFF input format, the program also accepts ASCII......A fully open source software program for automated two-dimensional and one-dimensional data reduction and preliminary analysis of isotropic small-angle X-ray scattering (SAXS) data is presented. The program is freely distributed, following the open-source philosophy, and does not rely on any...... commercial software packages. BioXTAS RAW is a fully automated program that, via an online feature, reads raw two-dimensional SAXS detector output files and processes and plots data as the data files are created during measurement sessions. The software handles all steps in the data reduction. This includes...

  18. Defensive Medicine in U.S. Spine Neurosurgery.

    Science.gov (United States)

    Din, Ryan S; Yan, Sandra C; Cote, David J; Acosta, Michael A; Smith, Timothy R

    2017-02-01

    Observational cross-sectional survey. To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0

  19. Preliminary assessment report for Grubbs/Kyle Training Center, Smyrna/Rutherford County Regional Airport, Installation 47340, Smyrna, Tennessee. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Dennis, C.; Stefano, J.

    1993-07-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Tennessee Army National Guard (TNARNG) property near Smyrna, Tennessee. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the Grubbs/Kyle Training Center property, the requirement of the Department of Defense Installation Restoration Program.

  20. Roots of neuroanatomy, neurology, and neurosurgery as found in the Bible and Talmud.

    Science.gov (United States)

    Tubbs, R Shane; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A; Wellons, John C; Oakes, W Jerry

    2008-07-01

    Historical observations and interpretations regarding the treatment of components of the nervous system can be found in the writings of the Bible and Talmud. A review of topics germane to modern neuroanatomy, neurology, and neurosurgery from these early, rich writings is presented herein. These historic writings provide a glimpse into the early understanding, description, and treatment of pathologies of the nervous system.

  1. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

    Science.gov (United States)

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D

    2014-01-01

    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  2. Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

    Science.gov (United States)

    Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela

    2016-01-01

    Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

  3. Effectiveness of the Tier 1 Program of the Project P.A.T.H.S.: Preliminary Objective and Subjective Outcome Evaluation Findings

    Directory of Open Access Journals (Sweden)

    Daniel T.L. Shek

    2006-01-01

    Full Text Available There are two tiers of programs in the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes. In the Tier 1 Program, teaching units based on different positive youth development constructs are covered. Pre- and post-test data utilizing the Chinese Positive Youth Development Scale (CPYDS and post-test subjective outcome evaluation data were collected from 546 students who participated in the 20h Tier 1 Program of the P.A.T.H.S. Project. Results showed that high proportions of the respondents had positive perceptions of the program and the instructors, with 85.3% of the respondents regarding the program as helpful to them. Positive changes in the program participants in many measures of positive youth development were also observed. Although there were some increases in problem behavior in some areas, adolescent problem behavior was generally stable. The present study provides preliminary support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

  4. Effectiveness of the Tier 1 Program of the Project P.A.T.H.S.: preliminary objective and subjective outcome evaluation findings.

    Science.gov (United States)

    Shek, Daniel T L

    2006-11-16

    There are two tiers of programs in the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes). In the Tier 1 Program, teaching units based on different positive youth development constructs are covered. Pre- and post-test data utilizing the Chinese Positive Youth Development Scale (CPYDS) and post-test subjective outcome evaluation data were collected from 546 students who participated in the 20 h Tier 1 Program of the P.A.T.H.S. Project. Results showed that high proportions of the respondents had positive perceptions of the program and the instructors, with 85.3% of the respondents regarding the program as helpful to them. Positive changes in the program participants in many measures of positive youth development were also observed. Although there were some increases in problem behavior in some areas, adolescent problem behavior was generally stable. The present study provides preliminary support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

  5. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery

    Science.gov (United States)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2006-03-01

    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  6. Evaluation of the impact of collaborative work by teams from the National Medical Residency Committee and the Brazilian Society of Neurosurgery. Retrospective and prospective study

    Directory of Open Access Journals (Sweden)

    Renato Antunes dos Santos

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Training for specialist physicians in Brazil can take place in different ways. Closer liaison between institutions providing this training and assessment and health care services may improve qualifications. This article analyzes the impact of closer links and joint work by teams from the National Medical Residency Committee (Comissão Nacional de Residência Médica, CNRM and the Brazilian Society of Neurosurgery (Sociedade Brasileira de Neurocirurgia, SBN towards evaluating these programs. DESIGN AND SETTING: Retrospective and prospective study, conducted in a public university on a pilot project developed between CNRM and SBN for joint assessment of training programs across Brazil. METHODS: The literature in the most relevant databases was reviewed. Documents and legislation produced by official government bodies were evaluated. Training locations were visited. Reports produced about residency programs were analyzed. RESULTS: Only 26% of the programs were immediately approved. The joint assessments found problems relating to teaching and to functioning of clinical service in 35% of the programs. The distribution of programs in this country has a strong relationship with the Human Development Index (HDI of the regions and is very similar to the distribution of specialists. CONCLUSION: Closer collaboration between the SBN and CNRM had a positive impact on assessment of neurosurgery medical residency across the country. The low rates of direct approval have produced modifications and improvements to the quality of teaching and care (services. Closer links between the CNRM and other medical specialties have the capability to positively change the structure and function of specialty training in Brazil.

  7. Military Personnel. Preliminary Observations on DOD’s and the Coast Guard’s Sexual Assault Prevention and Response Programs

    Science.gov (United States)

    2008-07-31

    sexual assault; and (3) exercise oversight over reports of sexual assault. This statement draws on GAO’s preliminary observations from an ongoing...would enable servicemembers to confidentially disclose an incident of sexual assault. Since 2005, active duty servicemembers have had two options...incidents involving servicemembers; • have visibility over reports of sexual assault involving servicemembers; and • exercise oversight over

  8. Computer-Based Reading Programs: A Preliminary Investigation of Two Parent Implemented Programs with Students At-Risk for Reading Failure

    Science.gov (United States)

    Pindiprolu, Sekhar S.; Forbush, David

    2009-01-01

    In 2000, National Reading Panelists (NRP) reported that computer delivered reading instruction has potential for promoting the reading skills of students at-risk for reading failure. However, panelists also noted a scarcity of data present in the literature on the effects of computer-based reading instruction. This preliminary investigation…

  9. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery : an animal model

    NARCIS (Netherlands)

    Kalmar, A. F.; De Ley, G.; Van Den Broecke, C.; Van Aken, J.; Struys, M. M. R. F.; Praet, M. M.; Mortier, E. P.

    2009-01-01

    During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption. In a newly presented rat model

  10. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery : an animal model

    NARCIS (Netherlands)

    Kalmar, A. F.; De Ley, G.; Van Den Broecke, C.; Van Aken, J.; Struys, M. M. R. F.; Praet, M. M.; Mortier, E. P.

    2009-01-01

    During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption. In a newly presented rat model

  11. A Preliminary Study of the Effects of an Arts Education Program on Executive Function, Behavior, and Brain Structure in a Sample of Nonclinical School-Aged Children.

    Science.gov (United States)

    Park, Subin; Lee, Jong-Min; Baik, Young; Kim, Kihyun; Yun, Hyuk Jin; Kwon, Hunki; Jung, Yeon-Kyung; Kim, Bung-Nyun

    2015-11-01

    The authors examined the effects of arts education on cognition, behavior, and brain of children. Twenty-nine nonclinical children participated in a 15-week arts education program that was composed of either creative movement or musical arts. Children completed the Wisconsin Card Sorting Test, clinical scales, and brain magnetic resonance imaging before and after the intervention. Following program completion, performances on the Wisconsin Card Sorting Test, the Children's Depression Inventory scores, and conduct disorder scores were significantly improved. Furthermore, cortical thickness in the left postcentral gyrus and superior parietal lobule were increased, and the mean diffusivity values in the right posterior corona radiate and superior longitudinal fasciculus were decreased. Positive correlations between changes in cognitive measurements and changes in cortical thickness were observed. This preliminary study suggests a positive effect of arts education on executive functions in association with brain changes. However, these findings must be interpreted with caution due to the noncomparative study design.

  12. Near Term Hybrid Passenger Vehicle Development Program. Phase I, Final report. Appendix C: preliminary design data package. Volume I

    Energy Technology Data Exchange (ETDEWEB)

    Piccolo, R.

    1979-07-31

    The assumptions made, analysis methods used, and preliminary results of research to determine the design specifications for a hybrid electric-powered and internal combustion engine-powered vehicle that would optimize the fuel economy of passenger automobiles are described. Information is included on body and component design, selection of spark-ignition engine and Ni-Zn batteries, life-cycle costs and life-cycle fuel consumption. (LCL)

  13. Phase 1 of the near team hybrid passenger vehicle development program. Appendix C: Preliminary design data package, volume 1

    Science.gov (United States)

    Piccolo, R.

    1979-01-01

    The methodology used for vehicle layout and component definition is described as well as techniques for system optimization and energy evaluation. The preliminary design is examined with particular attention given to body and structure; propulsion system; crash analysis and handling; internal combustion engine; DC motor separately excited; Ni-Zn battery; transmission; control system; vehicle auxiliarries; weight breakdown, and life cycle costs. Formulas are given for the quantification of energy consumption and results are compared with the reference vehicle.

  14. Preliminary Evaluations of Polymer-based Lithium Battery Electrolytes Under Development for the Polymer Electrolyte Rechargeable Systems Program

    Science.gov (United States)

    Manzo, Michelle A.; Bennett, William R.

    2003-01-01

    A component screening facility has been established at The NASA Glenn Research Center (GRC) to evaluate candidate materials for next generation, lithium-based, polymer electrolyte batteries for aerospace applications. Procedures have been implemented to provide standardized measurements of critical electrolyte properties. These include ionic conductivity, electronic resistivity, electrochemical stability window, cation transference number, salt diffusion coefficient and lithium plating efficiency. Preliminary results for poly(ethy1ene oxide)-based polymer electrolyte and commercial liquid electrolyte are presented.

  15. A Preliminary Evaluation of a Massage Program for Children Who Have Been Sexually Abused and Their Nonabusing Mothers

    Science.gov (United States)

    Powell, Lesley; Cheshire, Anna

    2010-01-01

    The aim of this study was to conduct a pilot evaluation of the Mosac Massage Program, a novel program that uses massage to address some of the difficulties faced by children who have been sexually abused and their nonabusing parents. Interviews were conducted with four participating mothers immediately before and after the program. Benefits…

  16. A Preliminary Controlled Comparison of Programs Designed to Reduce Risk of Eating Disorders Targeting Perfectionism and Media Literacy

    Science.gov (United States)

    Wilksch, Simon M.; Durbridge, Mitchell R.; Wade, Tracey D.

    2008-01-01

    The study aims to find out whether programs targeting perfectionism and media literacy are more effective than control classes in reducing eating disorder risk factors. Finding reveals that perfectionism programs are well suited to individuals of mid- to late adolescent age and shows the importune of making prevention programs developmentally…

  17. A Preliminary Evaluation of a Massage Program for Children Who Have Been Sexually Abused and Their Nonabusing Mothers

    Science.gov (United States)

    Powell, Lesley; Cheshire, Anna

    2010-01-01

    The aim of this study was to conduct a pilot evaluation of the Mosac Massage Program, a novel program that uses massage to address some of the difficulties faced by children who have been sexually abused and their nonabusing parents. Interviews were conducted with four participating mothers immediately before and after the program. Benefits…

  18. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

    Science.gov (United States)

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

    2017-05-01

    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  19. Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery.

    Science.gov (United States)

    Hart, Michael G; Ypma, Rolf J F; Romero-Garcia, Rafael; Price, Stephen J; Suckling, John

    2016-06-01

    Neuroanatomy has entered a new era, culminating in the search for the connectome, otherwise known as the brain's wiring diagram. While this approach has led to landmark discoveries in neuroscience, potential neurosurgical applications and collaborations have been lagging. In this article, the authors describe the ideas and concepts behind the connectome and its analysis with graph theory. Following this they then describe how to form a connectome using resting state functional MRI data as an example. Next they highlight selected insights into healthy brain function that have been derived from connectome analysis and illustrate how studies into normal development, cognitive function, and the effects of synthetic lesioning can be relevant to neurosurgery. Finally, they provide a précis of early applications of the connectome and related techniques to traumatic brain injury, functional neurosurgery, and neurooncology.

  20. Parenteral Admixture Compatibility in Neurosurgery Ward in Prof. Dr. Margono Soekarjo Regional Public Hospital

    Directory of Open Access Journals (Sweden)

    Laksmi Maharani

    2014-03-01

    Full Text Available Parenteral admixtures (intravenous admixtures have been done commonly in hospitals. However, it has a possibility of failures, like incompatibilities and changes in drug stabilities. The aim of this study was to determine the rate of drug incompatibilities in mixing parenteral preparations in neurosurgery ward in Prof. Dr. Margono Soekarjo Regional Public Hospital which undergo physical incompatibility observed in organoleptic. This study was a prospective descriptive research for one month period. Data were collected and analyzed descriptively. The results showed that from 667 parenteral admixtures in neurosurgery ward in Prof Dr Margono Soekarjo Hospital in February 2010, there were 0.45% potential incompatibility and 2.55% actual incompatibility happened. Actual incompatibility shown as crystal 0.17%, sediment 0.17%, and 2.04% was non-permanent haze in phenytoin and sodium chloride or ringer lactate admixtures.

  1. History of neurosurgery in Sher-I-Kashmir Institute of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2015-01-01

    Full Text Available Sher-i-Kashmir Institute of Medical Sciences (SKIMS is the only tertiary care institute in the state of Jammu and Kashmir. The department of neurosurgery was established nearly three decades ago and continues to be the leader in providing high quality neurosurgical services in the region. The article provides an insight into the genesis of the department and its sustained growth over these years. It also describes the plans for its future development.

  2. The Opioid-sparing Effect of Perioperative Dexmedetomidine plus Sufentanil Infusion during Neurosurgery: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Shiyu Su

    2016-10-01

    Full Text Available Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and postoperative infusions of dexmedetomidine (DEX plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg–1 for 10 min, then adjusted to 0.3 μg·kg–1·h–1 until incision suturing and Group ND (no DEX infusion during surgery. Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg–1·h–1 plus DEX 0.02 μg·kg–1·h–1, Group ND: sufentanil 0.02 μg·kg–1·h–1 in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity (Visual Analogue Scale [VAS], Ramsay sedation scale (RSS and Bruggemann comfort scale (BCS were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P0.05.Conclusions: DEX (0.02 μg·kg–1·h–1 plus sufentanil (0.02 μg·kg–1·h–1 could reduce postoperative opioid consumption and concerning

  3. Influence of intraoperative magnetic resonance imaging used in neurosurgery on anesthesia

    Directory of Open Access Journals (Sweden)

    Mao-wei GONG

    2011-09-01

    Full Text Available Objective To observe the influcences of intraoperative magnetic resonance imaging(iMRI used in neurosurgery on anesthesia.Methods Sixty patients with glioma were randomly divided into two groups(30 each,the patients in iMRI group underwent craniotomy and glioma ablation under the guidance of iMRI and functional neuro-navigation,and in N group with the functional neuro-navigation only.The patients’ general status and concerning parameters were observed and recorded,including anesthesia duration,preparation time for surgery,duration of surgery,blood loss,volume of fluid administration,number of patients who needed blood transfusion,preoperative and postoperative hemoglobin,postoperative body temperature,dosage of muscle relaxant,and the unforeseen incidents related to iMRI and anesthesia.Results No significant differences existed between the two groups(P > 0.05 in patients’ general status,anesthesia duration,blood loss,volume of fluid administration,numbers of patients who needed blood transfusion,preoperative and postoperative hemoglobin,and body temperature.However,the preparation time for and duration of surgery were longer,the dosage of muscle relaxant was larger in iMRI group than in N group(P < 0.05.No inadvertent incident related to iMRI and anesthesia occurred in both groups.Conclusions The application of iMRI in neurosurgery may improve the accuracy in operative manipulation and make the tumor resection more thorough,but it may prolong duration of surgery.Other perimoperative care related to iMRI surgery is similar to that of traditional functional neuro-navigation surgery.Besides the basic rules of neurosurgery anesthetic management for neurosurgery,anesthetist should focus on anesthetic adjustment for a long operation.

  4. Neurosurgery in Egypt: past, present, and future-from pyramids to radiosurgery.

    Science.gov (United States)

    El Gindi, Sayed

    2002-09-01

    THE CONTEMPORARY DEVELOPMENT of neurosurgery in Egypt is described, with reference to the ancient past and recent American and European influences. This article traces the steps taken by several leading Egyptian pioneers. Egypt, one of the key countries in the Middle East, has led the development of the specialty in the region and has maintained close ties with the international body of neurological surgeons and surgical societies.

  5. Neurosurgery in the realm of 10(-9), part 1: stardust and nanotechnology in neuroscience.

    Science.gov (United States)

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J

    2008-01-01

    Nanotechnology as a science has evolved from notions and speculation to emerge as a prominent combination of science and engineering that stands to impact innumerable aspects of technology. Medicine in general and neurosurgery in particular will benefit greatly in terms of improved diagnostic and therapeutic capabilities. The recent explosion in nanotechnology products, including diverse applications such as beauty products and medical contrast agents, has been accompanied by an ever increasing volume of literature. Recent articles from our institution provided an historical and scientific background of nanotechnology, with a purposeful focus on nanomedicine. Future applications of nanotechnology to neuroscience and neurosurgery were briefly addressed. The present article is the first of two that will further this discussion by providing specific details of current nanotechnology applications and research related to neuroscience and clinical neurosurgery. This article also provides relevant perspective in scale, history, economics, and toxicology. Topics of specific importance to developments or advances of technologies used by neuroscientists and neurosurgeons are presented. In addition, advances in the field of microelectromechanical systems technology are discussed. Although larger than nanoscale, microelectromechanical systems technologies will play an important role in the future of medicine and neurosurgery. The second article will discuss current nanotechnologies that are being, or will be in the near future, incorporated into the armamentarium of the neurosurgeon. The goal of these articles is to keep the neuroscience community abreast of current developments in nanotechnology, nanomedicine, and, in particular, nanoneurosurgery, and to present possibilities for future applications of nanotechnology. As applications of nanotechnology permeate all forms of scientific and medical research, clinical applications will continue to emerge. Physicians of the

  6. Free-access open-source e-learning in comprehensive neurosurgery skills training

    Directory of Open Access Journals (Sweden)

    Payal Jotwani

    2014-01-01

    Full Text Available Background: Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. Materials and Methods: This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. ′Neurosurgery Education and Training School (NETS, e-learning platform′ has integration of web-based technologies like ′Content Management System′ for organizing the education material and ′Learning Management System′ for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Results: Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2; 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3; average 402 views per post. Conclusion: The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and

  7. The Establishment and Development of Neurosurgery Services in Papua New Guinea.

    Science.gov (United States)

    Kaptigau, W Matui; Rosenfeld, Jeffrey V; Kevau, Ikau; Watters, David A

    2016-02-01

    Papua New Guinea (PNG) is a developing Pacific Nation of 7.3 million people. Although neurosurgery training was introduced to PNG in the year 2000, it was in 2003 that a neurosurgery service was established. Prior to this time, neurosurgery in PNG was performed by general surgeons, with some assistance from visiting Australian neurosurgeons. Neurosurgical training was introduced to PNG in 2000. The model involved a further 3 years of training for a surgeon who had already completed 4 years of general surgical training. We aim to review the output, outcomes and impact achieved by training the first national neurosurgeon. The data on activity (output) and outcomes were collected prospectively from 2003–2012. Ongoing mentoring and continuing professional development were provided through annual neurosurgical visits from Australia. There were serious limitations in the provision of equipment, with a lack of computerized tomographic or MR imaging, and adjuvant oncological services. There were 1618 neurosurgery admissions, 1020 neurosurgical procedures with a 5.74 % overall mortality. Seventy percent of cases presented as emergencies. There were improved outcomes, particularly for head injuries, whilst hydrocephalus was managed with an acceptable morbidity and revision rate. The training of a neurosurgeon resulted in PNG patients receiving a better range of surgical services, with a lower mortality. The outcomes able to be delivered were limited by late presentations of patients and lack of resources including imaging. These themes are familiar to all low- and middle-income countries (LMICs) and this may serve as a model for other LMIC neurosurgical services to adopt as they consider whether to establish and develop neurosurgical and other sub-specialist surgical services.

  8. Virtual reality training in neurosurgery: Review of current status and future applications

    Science.gov (United States)

    Alaraj, Ali; Lemole, Michael G.; Finkle, Joshua H.; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P. Pat; Rizzi, Silvio H.; Charbel, Fady T.

    2011-01-01

    Background: Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. Methods: A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Results: Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Conclusion: Fully immersive technology is starting to be applied to the practice of

  9. Intra-operative micro-electrode recording in functional neurosurgery: Past, present, future.

    Science.gov (United States)

    Maiti, Tanmoy K; Konar, Subhas; Bir, Shyamal; Kalakoti, Piyush; Nanda, Anil

    2016-10-01

    The field of functional neurosurgery has experienced a rise, fall and lastly a renaissance over the past 75years. Micro-electrode recording (MER) played a key role during this eventful journey. However, as the intra-operative MRI continues to evolve, a pertinent question about the utility of MER has been raised in recent years. In this article, we critically review these current controversies. The English literature is reviewed and the complex technique of MER is discussed in a simplified manner. The improvement of neuroimaging and its application in functional neurosurgery, especially in deep brain stimulation, is discussed. Finally, the current controversies and technical advances which can direct the future are reviewed. The results of existing meta-analyses addressing the controversies are summarized. Wide variations of pre-operative and intra-operative targeting methods have been described in the literature. Though functional neurosurgery is generally safe, complications do occur and multiple passes during MER can certainly add to the risk of inadvertent hemorrhage and infection. Additionally, the recent introduction of newer MRI modalities has ensured better delineation of the target. However, MER is still useful to address brain shift, for mapping of newer targets, for ablative surgeries and in centers without an intra-operative imaging facility. In the current scenario, it is nearly impossible to conduct a prospective study to decide the utility of MER. The importance of MER may further diminish in the future as a routine procedure, but its role as a gold standard procedure may still persist.

  10. Aura of technology and the cutting edge: a history of lasers in neurosurgery.

    Science.gov (United States)

    Ryan, Robert W; Spetzler, Robert F; Preul, Mark C

    2009-09-01

    In this historical review the authors examine the important developments that have led to the availability of laser energy to neurosurgeons as a unique and sometimes invaluable tool. They review the physical science behind the function of lasers, as well as how and when various lasers based on different lasing mediums were discovered. They also follow the close association between advances in laser technology and their application in biomedicine, from early laboratory experiments to the first clinical experiences. Because opinions on the appropriate role of lasers in neurosurgery vary widely, the historical basis for some of these views is explored. Initial enthusiasm for a technology that appears to have innate advantages for safe resections has often given way to the strict limitations and demands of the neurosurgical operating theater. However, numerous creative solutions to improve laser delivery, power, safety, and ergonomics demonstrate the important role that technological advances in related scientific fields continue to offer neurosurgery. Benefiting from the most recent developments in materials science, current CO(2) laser delivery systems provide a useful addition to the neurosurgical armamentarium when applied in the correct circumstances and reflect the important historical advances that come about from the interplay between neurosurgery and technology.

  11. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre

    2012-02-01

    BACKGROUND: Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome. METHODS: All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review. RESULTS: Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%. CONCLUSIONS: Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure.

  12. Laser neurosurgery: A systematic analysis of magnetic resonance-guided laser interstitial thermal therapies.

    Science.gov (United States)

    Lagman, Carlito; Chung, Lawrance K; Pelargos, Panayiotis E; Ung, Nolan; Bui, Timothy T; Lee, Seung J; Voth, Brittany L; Yang, Isaac

    2017-02-01

    Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel minimally invasive modality that uses heat from laser probes to destroy tissue. Advances in probe design, cooling mechanisms, and real-time MR thermography have increased laser utilization in neurosurgery. The authors perform a systematic analysis of two commercially available MRgLITT systems used in neurosurgery: the Visualase® thermal therapy and NeuroBlate® Systems. Data extraction was performed in a blinded fashion. Twenty-two articles were included in the quantitative synthesis. A total of 223 patients were identified with the majority having undergone treatment with Visualase (n=154, 69%). Epilepsy was the most common indication for Visualase therapy (n=8 studies, 47%). Brain mass was the most common indication for NeuroBlate therapy (n=3 studies, 60%). There were no significant differences, except in age, wherein the NeuroBlate group was nearly twice as old as the Visualase group (p<0.001). Frame, total complications, and length-of-stay (LOS) were non-significant when adjusted for age and number of patients. Laser neurosurgery has evolved over recent decades. Clinical indications are currently being defined and will continue to emerge as laser technologies become more sophisticated. Head-to-head comparison of these systems was difficult given the variance in indications (and therefore patient population) and disparate literature.

  13. Atrial natriuretic factor: is it responsible for hyponatremia and natriuresis in neurosurgery?

    Science.gov (United States)

    Gasparotto, Ana Paula Devite Cardoso; Falcão, Antonio Luis Eiras; Kosour, Carolina; Araújo, Sebastião; Cintra, Eliane Araújo; de Oliveira, Rosmari Aparecida Rosa Almeida; Martins, Luiz Claudio; Dragosavac, Desanka

    2016-01-01

    Objective To evaluate the presence of hyponatremia and natriuresis and their association with atrial natriuretic factor in neurosurgery patients. Methods The study included 30 patients who had been submitted to intracranial tumor resection and cerebral aneurism clipping. Both plasma and urinary sodium and plasma atrial natriuretic factor were measured during the preoperative and postoperative time periods. Results Hyponatremia was present in 63.33% of the patients, particularly on the first postoperative day. Natriuresis was present in 93.33% of the patients, particularly on the second postoperative day. Plasma atrial natriuretic factor was increased in 92.60% of the patients in at least one of the postoperative days; however, there was no statistically significant association between the atrial natriuretic factor and plasma sodium and between the atrial natriuretic factor and urinary sodium. Conclusion Hyponatremia and natriuresis were present in most patients after neurosurgery; however, the atrial natriuretic factor cannot be considered to be directly responsible for these alterations in neurosurgery patients. Other natriuretic factors are likely to be involved. PMID:27410411

  14. Evolution in Practice: How has British Neurosurgery Changed in the Last 10 Years?

    Science.gov (United States)

    Tarnaris, A; Arvin, B; Ashkan, K

    2008-01-01

    INTRODUCTION Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. PATIENTS AND METHODS A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. RESULTS Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. CONCLUSIONS Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes. PMID:18765031

  15. Preliminary clinical prediction rule for identifying patients with ankylosing spondylitis who are likely to respond to an exercise program: a pilot study.

    Science.gov (United States)

    Alonso-Blanco, Cristina; Fernández-de-las-Peñas, César; Cleland, Joshua A

    2009-06-01

    The aim of this study was to develop a preliminary clinical prediction rule to identify the potential predictors for identifying patients presenting with ankylosing spondylitis who are likely to respond to a specific exercise program. Consecutive patients with ankylosing spondylitis underwent a standardized examination and then received eight physical therapy sessions during a 2-mo period, which included an exercise program based on the treatment of the shortened muscle chains, following the guideline described by the global posture re-education method. Patients were classified as having experienced a successful outcome at 1 mo after discharge based on a 20% reduction on Bath Ankylosing Spondylitis Functional Index and self-report perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for identifying treatment success. Data from 35 patients were included, of which 16 (46%) experienced a successful outcome. A clinical prediction rule with three variables (physical role >37, bodily pain >27, and Bath Ankylosing Spondylitis Disease Activity Index >31) was identified. The most accurate predictor of success was if the patient exhibited two of the three variables, and the positive likelihood ratio was 11.2 (95% confidence interval, 1.7-76.0) and the posttest probability of success increased to 91%. The accuracy of prediction declined if either 1/3 (+likelihood ratio = 7.7; 95% confidence interval, 0.52-113.5) or 3/3 (+likelihood ratio = 2.6, 95% confidence interval, 1.6-4.0) variables were present. The present preliminary clinical prediction rule provides the potential to identify patients with ankylosing spondylitis who are likely to experience short-term follow-up success with a specific exercise program. Future studies are necessary to validate the clinical prediction rule.

  16. Synthesis of feedback control law for stabilization of chaotic system oscillations by means of analytic programming - Preliminary study

    Science.gov (United States)

    Senkerik, Roman; Oplatkova, Zuzana; Zelinka, Ivan; Davendra, Donald; Jasek, Roman

    2012-11-01

    This research deals with a synthesis of control law for selected discrete chaotic system - logistic equation by means of analytic programming. The novelty of the approach is that a tool for symbolic regression - analytic programming - is used for the purpose of stabilization of higher periodic orbits - oscillations between several values of chaotic system. The paper consists of the descriptions of analytic programming as well as used chaotic system and detailed proposal of cost function used in optimization process. For experimentation, Self-Organizing Migrating Algorithm (SOMA) with analytic programming and Differential evolution (DE) as second algorithm for meta-evolution were used.

  17. Preliminary test results from a free-piston Stirling engine technology demonstration program to support advanced radioisotope space power applications

    Science.gov (United States)

    White, Maurice A.; Qiu, Songgang; Augenblick, Jack E.

    2000-01-01

    Free-piston Stirling engines offer a relatively mature, proven, long-life technology that is well-suited for advanced, high-efficiency radioisotope space power systems. Contracts from DOE and NASA are being conducted by Stirling Technology Company (STC) for the purpose of demonstrating the Stirling technology in a configuration and power level that is representative of an eventual space power system. The long-term objective is to develop a power system with an efficiency exceeding 20% that can function with a high degree of reliability for up to 15 years on deep space missions. The current technology demonstration convertors (TDC's) are completing shakedown testing and have recently demonstrated performance levels that are virtually identical to projections made during the preliminary design phase. This paper describes preliminary test results for power output, efficiency, and vibration levels. These early results demonstrate the ability of the free-piston Stirling technology to exceed objectives by approximately quadrupling the efficiency of conventional radioisotope thermoelectric generators (RTG's). .

  18. A Preliminary Evaluation of Federal Dental Manpower Subsidy Program. Health Manpower Policy Discussion Paper Series, No. A5.

    Science.gov (United States)

    Feldstein, Paul J.

    This paper suggests an approach and an analysis of the impact that federal manpower programs have had on dentistry. The main beneficiaries under health manpower subsidy programs are indicated and some policy alternatives suggested. Emphasis is placed on federal subsidies for increasing the supply of dentists including students' financial…

  19. Preliminary assessment report for Bee Caves Armory (former Nike BG-80 Fire Control Facility), Installation 48055, Austin, Texas. Installation Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Dennis, C.

    1993-08-01

    This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Texas Army National Guard (ARNG) property in Austin, Texas. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing, preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining, site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the Bee Caves Armory property, the requirements of the Department of Defense Installation Restoration Program. Of concern is the potential for hazardous waste to be present on the property as a result of the former Nike Missile Base operations or in the form of original construction materials. Environmentally sensitive operations associated with the property from that period include (1) underground fuel storage, (2) hazardous materials storage/use, (3) disposal of hazardous waste and (4) release of hazardous waste water.

  20. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    Science.gov (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  1. Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes.

    Science.gov (United States)

    Sadeh-Sharvit, Shiri; Zubery, Eynat; Mankovski, Esty; Steiner, Evelyne; Lock, James D

    2016-01-01

    The children of mothers with eating disorders are at high risk of feeding and eating problems and broader developmental difficulties. The Parent-Based Prevention (PBP) of eating disorders targets risk factors and facilitates behavioral change in parents to mitigate potentially negative outcomes of their children. This pre/post uncontrolled study evaluated the feasibility and preliminary outcomes of PBP. PBP was found to be a feasible intervention for mothers with eating disorders and their spouses, with satisfactory retention rates. A total of 16 intact families were assessed at three measurement points for parents' feeding practices, child outcomes, and maternal functioning. Both parents reported improved feeding practices as well as more positive perceptions of their children in comparison to baseline. These pilot findings suggest that PBP is linked with decreased risk of eating and mental problems among the offspring of mothers with eating disorders.

  2. Preliminary assessment of a water-quality monitoring program for total maximum daily loads in Johnson County, Kansas, January 2015 through June 2016

    Science.gov (United States)

    Rasmussen, Teresa J.; Paxson, Chelsea R.

    2017-08-25

    Municipalities in Johnson County in northeastern Kansas are required to implement stormwater management programs to reduce pollutant discharges, protect water quality, and comply with applicable water-quality regulations in accordance with National Pollutant Discharge Elimination System permits for stormwater discharge. To this end, municipalities collect grab samples at streams entering and leaving their jurisdiction to determine levels of excessive nutrients, sediment, and fecal bacteria to characterize pollutants and understand the factors affecting them.In 2014, the U.S. Geological Survey and the Johnson County Stormwater Management Program, with input from the Kansas Department of Health and Environment, initiated a 5-year monitoring program to satisfy minimum sampling requirements for each municipality as described by new stormwater permits issued to Johnson County municipalities. The purpose of this report is to provide a preliminary assessment of the monitoring program. The monitoring program is described, a preliminary assessment of the monitoring program design is provided using water-quality data collected during the first 2 years of the program, and the ability of the current monitoring network and sampling plan to provide data sufficient to quantify improvements in water quality resulting from implemented and planned best management practices is evaluated. The information in this initial report may be used to evaluate changes in data collection methods while data collection is still ongoing that may lead to improved data utility.Discrete water-quality samples were collected at 27 sites and analyzed for nutrients, Escherichia coli (E. coli) bacteria, total suspended solids, and suspended-sediment concentration. In addition, continuous water-quality data (water temperature, pH, dissolved oxygen, specific conductance, turbidity, and nitrate plus nitrite) were collected at one site to characterize variability and provide a basis for comparison to discrete

  3. The application of quality control circle in neurosurgery ICU nurses in raising compliance of the head of a bed

    Directory of Open Access Journals (Sweden)

    Na LI

    2014-11-01

    Full Text Available Objective: To explore the application of quality control circle in raising compliance of the head of a bed in neurosurgery ICU nurses. Methods: The quality control circle was made up of 4 ICU nurses, determine the subject in order to improve the neurosurgery ICU nurses in raising compliance of the head of a bed, according to the QCC activity steps to formulate plans, including grasp the current situation, goal setting, through analysis, circle members develop strategy and plan implementation and review, finally compared the situation before and after neurosurgery ICU nurses raised bed activities compliance. Results: After implementation of QCC, neurosurgery ICU nurses raised bed to 30 ~ 45 degrees. After activities, circle members in the team cooperation ability, cohesion, to accept new things ability, and innovative thinking ability and to raise the understanding of the relevant knowledge of the head of a bed has improved significantly. Conclusion: The application of quality management circle activity improves the neurosurgery ICU nurses effectively raise the compliance of the head of a bed, improve the comprehensive quality of the clinical nurses.

  4. Preliminary Analysis of the Jobs and Economic Impacts of Renewable Energy Projects Supported by the §1603 Treasury Grant Program

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, Daniel [National Renewable Energy Lab. (NREL), Golden, CO (United States); Porro, Gian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Goldberg, Marshall [MRG & Associates, Nevada City, CA (United States)

    2012-04-09

    This analysis responds to a request from the Department of Energy Office of Energy Efficiency and Renewable Energy to the National Renewable Energy Laboratory (NREL) to estimate the direct and indirect jobs and economic impacts of projects supported by the §1603 Treasury grant program. The analysis employs the Jobs and Economic Development Impacts (JEDI) models to estimate the gross jobs, earnings, and economic output supported by the construction and operation of the large wind (greater than 1 MW) and solar photovoltaic (PV) projects funded by the §1603 grant program.

  5. Preliminary Analysis of the Jobs and Economic Impacts of Renewable Energy Projects Supported by the §1603Treasury Grant Program

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, Daniel [National Renewable Energy Lab. (NREL), Golden, CO (United States); Porro, Gian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Goldberg, Marshall [MRG and Associates, New York, NY (United States)

    2012-04-01

    This analysis responds to a request from the Department of Energy Office of Energy Efficiency and Renewable Energy to the National Renewable Energy Laboratory (NREL) to estimate the direct and indirect jobs and economic impacts of projects supported by the §1603 Treasury grant program. The analysis employs the Jobs and Economic Development Impacts (JEDI) models to estimate the gross jobs, earnings, and economic output supported by the construction and operation of the large wind (greater than 1 MW) and solar photovoltaic (PV) projects funded by the §1603 grant program.

  6. Preliminary Analysis of the Jobs and Economic Impacts of Renewable Energy Projects Supported by the ..Section..1603 Treasury Grant Program

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, D.; Porro, G.; Goldberg, M.

    2012-04-01

    This analysis responds to a request from the Department of Energy Office of Energy Efficiency and Renewable Energy to the National Renewable Energy Laboratory (NREL) to estimate the direct and indirect jobs and economic impacts of projects supported by the Section 1603 Treasury grant program. The analysis employs the Jobs and Economic Development Impacts (JEDI) models to estimate the gross jobs, earnings, and economic output supported by the construction and operation of the large wind (greater than 1 MW) and solar photovoltaic (PV) projects funded by the Section 1603 grant program.

  7. Effects of palliative care training program on knowledge, attitudes, beliefs and experiences among student physiotherapists: A preliminary quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Background: Physiotherapists play an inherent role in the multidisciplinary palliative care team. Existing knowledge, attitudes, beliefs and experiences influence their team participation in palliative care. Aims: The objective of this study was to assess the changes in knowledge, attitudes, beliefs and experiences among student physiotherapists who attended a palliative care training program. Settings and Design: Preliminary quasi-experimental study design, conducted at an academic institution. Materials and Methods: Fifty-two student physiotherapists of either gender (12 male, 40 female of age (20.51±1.78 years who attended a palliative care training program which comprised lectures and case examples of six-hours duration participated in this study. The study was performed after getting institutional approval and obtaining participants′ written informed consent. The lecture content comprised WHO definition of palliative care, spiritual aspects of life, death and healing, principles, levels and models of palliative care, and role of physiotherapists in a palliative care team. The physical therapy in palliative care-knowledge, attitudes, beliefs and experiences scale (PTiPC-KABE Scale- modified from palliative care attitudes scale were used for assessing the participants before and after the program. Statistical Analysis: Paired t-test and Wilcoxon signed rank test at 95% confidence interval using SPSS 11.5 for Windows. Results: Statistically significant differences (P<0.05 were noted for all four subscales- knowledge (7.84±4.61 points, attitudes (9.46±8.06 points, beliefs (4.88±3.29 points and experiences (15.8±11.28 points out of a total score of 104 points. Conclusions: The focus-group training program produced a significant positive change about palliative care in knowledge, attitudes, beliefs and experiences among student physiotherapists.

  8. Neurosurgery Nursing Management Analysis%神经外科护理管理分析

    Institute of Scientific and Technical Information of China (English)

    李咏梅

    2016-01-01

    目的:探讨有效的神经外科护理管理方法及应用效果。方法该院神经外科于2015年7月开始实施分级质量控制护理管理,选择实施前(2015年1-6月)期间神经外科收治的35例患者作为对照组,另选择实施后(2015年7-12月)期间神经外科收治的35例患者作为观察组,比较两组患者护理满意度;同时,实施前,实施后分别行护理质量评估,评估实施前后护理质量情况。结果实施后,神经外科临床护理质量指标(基础护理、重点环节护理、急救药品器材管理、病房护理、护理文件书写、压疮护理)评分均显著高于实施前,组间差异有统计学意义,P<0.05。观察组护理满意度(97.05%)显著高于对照组(70.58%),组间差异有统计学意义,P<0.05。结论神经外科护理管理应用分级质量控制管理,有助于提高临床护理质量和患者满意度,应推广使用该护理管理模式。%Objective objective to explore the effective method and application effect of neurosurgery nursing management. methods Our hospital neurosurgery began in July 2015 to carry out the implementation of grading nursing quality control management, choose before carrying out (from January 2015 to June) neurosurgery admitted during the period of 35 patients as control group, another choice after implementation (July to December 2015) neurosurgery admitted during the period of 35 patients as observation group, compared two groups of patients nursing satisfaction;Line at the same time, before the im-plementation, after implementation, respectively, nursing quality evaluation, evaluation before and after the implementation of nursing quality. Results after implementation of neurosurgery clinical nursing quality indicators (basic nursing care, e-mergency medicine equipment management, key link, ward nursing, nursing documents writing, pressure sores) scores were significantly higher than that of before

  9. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

    Science.gov (United States)

    Lecky, Fiona; Russell, Wanda; Fuller, Gordon; McClelland, Graham; Pennington, Elspeth; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damien; Freeman, Jennifer; Chapman, Nathan; Stevenson, Matt; Byers, Sonia; Mason, Suzanne; Potter, Hugh; Coats, Tim; Mackway-Jones, Kevin; Peters, Mary; Shewan, Jane; Strong, Mark

    2016-01-01

    Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70

  10. A preliminary controlled comparison of programs designed to reduce risk of eating disorders targeting perfectionism and media literacy.

    Science.gov (United States)

    Wilksch, Simon M; Durbridge, Mitchell R; Wade, Tracey D

    2008-08-01

    The primary objective was to compare the efficacy of two eight-lesson programs, targeting perfectionism and media literacy compared to control classes in reducing eating disorder risk. Students from six classes (N = 127, mean age 15.0 years, SD 0.4) and two schools participated. Linear mixed-model analyses were conducted by group (3: perfectionism, media literacy, control), time (2: postprogram, 3-month follow-up) and eating disorder risk status (2: high, low), with baseline observations included as a covariate. An interaction effect favoring the perfectionism program at 3-month follow-up was found for concern over mistakes (effect size 0.45). A main effect for group, also favoring the perfectionism program, was found for personal standards (effect size 0.44). High-risk participants (i.e., those with high levels of shape and weight concern at baseline) benefited most from the perfectionism program with reliable change indices indicating favorable rates of improvement beyond chance on all of the variables, whereas the media literacy and control participants experienced a comparable rate of change during the course of the study. Targeting perfectionism represents a promising prevention option that requires further investigation in children of mid-adolescence age, and further investigation is required to determine the demographic most likely to benefit from media literacy.

  11. The implementation of a statewide bullying prevention program: preliminary findings from the field and the importance of coalitions.

    Science.gov (United States)

    Schroeder, Betsy A; Messina, Allison; Schroeder, Diana; Good, Karla; Barto, Shiryl; Saylor, Jennifer; Masiello, Matthew

    2012-07-01

    Bullying in schools has become recognized as a significant public health problem. The Olweus Bullying Prevention Program (OBPP) has been identified as an effective means to reduce bullying behavior in schools. The goal of this large population-based initiative was to reduce bullying by producing a quantifiable change in school climate using an established program and standardized measurement tool. Program participants over a 2-year period included 56,137 students and more than 2,400 teachers from 107 schools in 49 counties across Pennsylvania. An age cohorts design was used, and data from two equivalent age cohorts of students were compared at two or more points in time. After 1 to 2 years of program implementation, across cohorts, there were reductions in student self-reports of bullying others, and improvements in student perceptions of adults' responsiveness, and students' attitudes about bullying. This study is the largest bullying prevention initiative to date in the United States. This initiative reaffirms the efficacy of the OBPP, emphasizes the importance of an identified coalition, and highlights several positive outcomes. It is recommended that the OBPP be implemented through the establishment of community partnerships and coalitions as consistent with the public health model.

  12. A Preliminary Evaluation of the Parent-Child Mother Goose Program in Relation to Children's Language and Parenting Stress

    Science.gov (United States)

    Terrett, Gill; White, Roxanne; Spreckley, Michele

    2013-01-01

    The purpose of this study was to assess changes in children's language skills and parenting stress following participation in the Parent-Child Mother Goose Program (PCMGP). The intervention group consisted of 29 parents (age range 24 to 43 years, "M" = 33.5, SD = 4.1) and 30 children (18 females and 12 males) with ages ranging from 1 to 46 months…

  13. Aerobic exercise in adolescents with obesity: preliminary evaluation of a modular training program and the modified shuttle test

    Directory of Open Access Journals (Sweden)

    van der Baan-Slootweg Olga H

    2007-04-01

    Full Text Available Abstract Background Increasing activity levels in adolescents with obesity requires the development of exercise programs that are both attractive to adolescents and easily reproducible. The aim of this study was to develop a modular aerobic training program for adolescents with severe obesity, with a focus on variety, individual targets and acquiring physical skills. We report here the effects on aerobic fitness from a pilot study. Furthermore, we examined the feasibility of the modified shuttle test (MST as an outcome parameter for aerobic fitness in adolescents with severe obesity. Methods Fifteen adolescents from an inpatient body weight management program participated in the aerobic training study (age 14.7 ± 2.1 yrs, body mass index 37.4 ± 3.5. The subjects trained three days per week for 12 weeks, with each session lasting 30–60 minutes. The modular training program consisted of indoor, outdoor and swimming activities. Feasibility of the MST was studied by assessing construct validity, test-retest reliability and sensitivity to change. Results Comparing pretraining and end of training period showed large clinically relevant and significant improvements for all aerobic indices: e.g. VO2 peak 17.5%, effect size (ES 2.4; Wmax 8%, ES 0.8. In addition, a significant improvement was found for the efficiency of the cardiovascular system as assessed by the oxygen pulse (15.8%, ES 1.6. Construct validity, test-retest reliability and sensitivity to change of the MST were very good. MST was significantly correlated with VO2 peak (r = 0.79 and Wmax (r = 0.84 but not with anthropometric measures. The MST walking distance improved significantly by 32.5%, ES 2.5. The attendance rate at the exercise sessions was excellent. Conclusion This modular, varied aerobic training program has clinically relevant effects on aerobic performance in adolescents with severe obesity. The added value of our aerobic training program for body weight management programs

  14. Cost-benefit analysis for sheltered employment service programs for people with disabilities in Taiwan - a preliminary study.

    Science.gov (United States)

    Wang, Yun-Tung; Lin, Yi-Jiun; Shu, Ching-Hsien

    2012-01-01

    The aim of this study is to do a cost-benefit analysis with monetary and non-monetary benefits for sheltered employment service programs and try to provide more evidence-based information for policy makers and practitioners to understand the outcomes of sheltered employment services. This study analyzed 3 sheltered employment service programs for people with disabilities (2006-2007) implemented by Sunshine Social Welfare Foundation in Taiwan using cost-benefit analysis (including non-monetary benefits). Three groups were analyzed, including participants in the programs, taxpayers, and society (participants and taxpayers). This study found that the net social monetary benefit was $NT29,432.07 per participant per year and the benefit cost ratio was 1.43. (In 2006-2007, $US1 = $NT32.5 averagely around.) The net monetary benefit for the participants was between $NT7,890.86 and $NT91,890.86 per participant per year. On the non-monetary benefit side, the physical health (raised 7.49%), social relationship (raised 3.36%) domains, and general quality of life (raised 2.53%) improved. However, the psychological (decreased 1.51%) and working/environment (decreased 3.85%) domains backslided. In addition, the differences between pre-test and post-test average scores of all domains were not statistically significant. This study is the first to use monetary and non-monetary cost-benefit analysis methods to analyze sheltered employment service programs for people with disabilities in Taiwan. The findings indicated that sheltered employment service programs for people with disabilities could be efficient and beneficial for the whole society and sheltered employees/clients, and also helpful for raising their quality of lives.

  15. A novel augmented reality system of image projection for image-guided neurosurgery.

    Science.gov (United States)

    Mahvash, Mehran; Besharati Tabrizi, Leila

    2013-05-01

    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  16. German Emergency Care in Neurosurgery and Military Neurology during World War II, 1939-1945.

    Science.gov (United States)

    Stahnisch, Frank W

    2016-01-01

    A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine

  17. Hand-tool-tissue interaction forces in neurosurgery for haptic rendering.

    Science.gov (United States)

    Aggravi, Marco; De Momi, Elena; DiMeco, Francesco; Cardinale, Francesco; Casaceli, Giuseppe; Riva, Marco; Ferrigno, Giancarlo; Prattichizzo, Domenico

    2016-08-01

    Haptics provides sensory stimuli that represent the interaction with a virtual or tele-manipulated object, and it is considered a valuable navigation and manipulation tool during tele-operated surgical procedures. Haptic feedback can be provided to the user via cutaneous information and kinesthetic feedback. Sensory subtraction removes the kinesthetic component of the haptic feedback, having only the cutaneous component provided to the user. Such a technique guarantees a stable haptic feedback loop, while it keeps the transparency of the tele-operation system high, which means that the system faithfully replicates and render back the user's directives. This work focuses on checking whether the interaction forces during a bench model neurosurgery operation can lie in the solely cutaneous perception of the human finger pads. If this assumption is found true, it would be possible to exploit sensory subtraction techniques for providing surgeons with feedback from neurosurgery. We measured the forces exerted to surgical tools by three neurosurgeons performing typical actions on a brain phantom, using contact force sensors, while the forces exerted by the tools to the phantom tissue were recorded using a load cell placed under the brain phantom box. The measured surgeon-tool contact forces were 0.01-3.49 N for the thumb and 0.01-6.6 N for index and middle finger, whereas the measured tool-tissue interaction forces were from six to 11 times smaller than the contact forces, i.e., 0.01-0.59 N. The measurements for the contact forces fit the range of the cutaneous sensitivity for the human finger pad; thus, we can say that, in a tele-operated robotic neurosurgery scenario, it would possible to render forces at the fingertip level by conveying haptic cues solely through the cutaneous channel of the surgeon's finger pads. This approach would allow high transparency and high stability of the haptic feedback loop in a tele-operation system.

  18. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    Science.gov (United States)

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan

    2017-01-01

    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  19. The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

    Science.gov (United States)

    Wong, Kendrew; MacKenzie, Todd A.

    2015-01-01

    Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

  20. IBIS: an OR ready open-source platform for image-guided neurosurgery.

    Science.gov (United States)

    Drouin, Simon; Kochanowska, Anna; Kersten-Oertel, Marta; Gerard, Ian J; Zelmann, Rina; De Nigris, Dante; Bériault, Silvain; Arbel, Tal; Sirhan, Denis; Sadikot, Abbas F; Hall, Jeffery A; Sinclair, David S; Petrecca, Kevin; DelMaestro, Rolando F; Collins, D Louis

    2017-03-01

    Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.

  1. The Effects of a Gentle Yoga Program on Sleep, Mood, and Blood Pressure in Older Women with Restless Legs Syndrome (RLS): A Preliminary Randomized Controlled Trial.

    Science.gov (United States)

    Innes, Kim E; Selfe, Terry Kit

    2012-01-01

    Objective. To examine the effects of yoga versus an educational film program on sleep, mood, perceived stress, and sympathetic activation in older women with RLS. Methods. Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight, sedentary postmenopausal women. Seventy-five women were randomized to receive either an 8-week yoga (n = 38) or educational film (n = 37) program. All 75 participants completed an RLS screening questionnaire. The 20 women who met all four diagnostic criteria for RLS (n = 10 yoga, 10 film group) comprised the population for this nested study. Main outcomes assessed pre- and post-treatment included: sleep (Pittsburgh Sleep Quality Index), stress (Perceived Stress Scale), mood (Profile of Mood States, State-Trait Anxiety Inventory), blood pressure, and heart rate. Results. The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood, and significantly greater reductions in insomnia prevalence, anxiety, perceived stress, and blood pressure (all P's≤0.05). Adjusted intergroup effect sizes for psychosocial variables were large, ranging from 1.9 for state anxiety to 2.6 for sleep quality. Conclusions. These preliminary findings suggest yoga may offer an effective intervention for improving sleep, mood, perceived stress, and blood pressure in older women with RLS.

  2. The Effects of a Gentle Yoga Program on Sleep, Mood, and Blood Pressure in Older Women with Restless Legs Syndrome (RLS: A Preliminary Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Kim E. Innes

    2012-01-01

    Full Text Available Objective. To examine the effects of yoga versus an educational film program on sleep, mood, perceived stress, and sympathetic activation in older women with RLS. Methods. Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight, sedentary postmenopausal women. Seventy-five women were randomized to receive either an 8-week yoga (=38 or educational film (=37 program. All 75 participants completed an RLS screening questionnaire. The 20 women who met all four diagnostic criteria for RLS (=10 yoga, 10 film group comprised the population for this nested study. Main outcomes assessed pre- and post-treatment included: sleep (Pittsburgh Sleep Quality Index, stress (Perceived Stress Scale, mood (Profile of Mood States, State-Trait Anxiety Inventory, blood pressure, and heart rate. Results. The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood, and significantly greater reductions in insomnia prevalence, anxiety, perceived stress, and blood pressure (all 's≤0.05. Adjusted intergroup effect sizes for psychosocial variables were large, ranging from 1.9 for state anxiety to 2.6 for sleep quality. Conclusions. These preliminary findings suggest yoga may offer an effective intervention for improving sleep, mood, perceived stress, and blood pressure in older women with RLS.

  3. Autostereoscopic 3D visualization and image processing system for neurosurgery.

    Science.gov (United States)

    Meyer, Tobias; Kuß, Julia; Uhlemann, Falk; Wagner, Stefan; Kirsch, Matthias; Sobottka, Stephan B; Steinmeier, Ralf; Schackert, Gabriele; Morgenstern, Ute

    2013-06-01

    A demonstrator system for planning neurosurgical procedures was developed based on commercial hardware and software. The system combines an easy-to-use environment for surgical planning with high-end visualization and the opportunity to analyze data sets for research purposes. The demonstrator system is based on the software AMIRA. Specific algorithms for segmentation, elastic registration, and visualization have been implemented and adapted to the clinical workflow. Modules from AMIRA and the image processing library Insight Segmentation and Registration Toolkit (ITK) can be combined to solve various image processing tasks. Customized modules tailored to specific clinical problems can easily be implemented using the AMIRA application programming interface and a self-developed framework for ITK filters. Visualization is done via autostereoscopic displays, which provide a 3D impression without viewing aids. A Spaceball device allows a comfortable, intuitive way of navigation in the data sets. Via an interface to a neurosurgical navigation system, the demonstrator system can be used intraoperatively. The precision, applicability, and benefit of the demonstrator system for planning of neurosurgical interventions and for neurosurgical research were successfully evaluated by neurosurgeons using phantom and patient data sets.

  4. A universal system for interactive image-directed neurosurgery.

    Science.gov (United States)

    Maciunas, R J; Galloway, R L; Fitzpatrick, J M; Mandava, V R; Edwards, C A; Allen, G S

    1992-01-01

    Stereotactic methods confer great accuracy to intracranial target localization, but require strict adherence to a complex program of mechanical and computational maneuvers. A computerized, articulated, localizing 'arm' has been developed that frees the neurosurgeon of these constraints and provides a completely intuitive, 'user-friendly' interface. This universal system is independent of whatever localizing fiducial system is selected. The arm may be sterilized for intracranial use. A variety of intraoperative end effectors may be selected. The patient's CT/MR/PET scans are loaded into computer memory and a three-dimensional shaded surface wireframe diagram of the patient's head is displayed simultaneously with up to 3 independent sets of cross-referenced CT/MR/PET scan images on the intraoperative video screen. The arm's endpoint location and the directional vector are shown as cursors on the relevant scan slices, and change continuously as the surgeon moves the arm. Because the information is continuously updated, an unlimited number of targets and trajectories may be displayed throughout the operation. The arm has an ultimate design accuracy for end-point localization to within 0.1 mm throughout a target volume of 40 x 40 x 40 cm. The tested application accuracy of the first prototype model is 0.31 mm. In clinical use during 30 surgeries, its real-world application accuracy is 0.9 mm. This system provides stereotactic accuracy and universally compatible, intuitive, interactive operation.

  5. Natural and Artificial Intelligence in Neurosurgery: A Systematic Review.

    Science.gov (United States)

    Senders, Joeky T; Arnaout, Omar; Karhade, Aditya V; Dasenbrock, Hormuzdiyar H; Gormley, William B; Broekman, Marike L; Smith, Timothy R

    2017-09-07

    Machine learning (ML) is a domain of artificial intelligence that allows computer algorithms to learn from experience without being explicitly programmed. To summarize neurosurgical applications of ML where it has been compared to clinical expertise, here referred to as "natural intelligence." A systematic search was performed in the PubMed and Embase databases as of August 2016 to review all studies comparing the performance of various ML approaches with that of clinical experts in neurosurgical literature. Twenty-three studies were identified that used ML algorithms for diagnosis, presurgical planning, or outcome prediction in neurosurgical patients. Compared to clinical experts, ML models demonstrated a median absolute improvement in accuracy and area under the receiver operating curve of 13% (interquartile range 4-21%) and 0.14 (interquartile range 0.07-0.21), respectively. In 29 (58%) of the 50 outcome measures for which a P -value was provided or calculated, ML models outperformed clinical experts ( P .05), while in 3 of 50 (6%) clinical experts outperformed ML models ( P < .05). All 4 studies that compared clinicians assisted by ML models vs clinicians alone demonstrated a better performance in the first group. We conclude that ML models have the potential to augment the decision-making capacity of clinicians in neurosurgical applications; however, significant hurdles remain associated with creating, validating, and deploying ML models in the clinical setting. Shifting from the preconceptions of a human-vs-machine to a human-and-machine paradigm could be essential to overcome these hurdles.

  6. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery

    Science.gov (United States)

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises. PMID:27445707

  7. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery.

    Science.gov (United States)

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises.

  8. Anaesthesia and analgesia in Göttingen minipigs - examples of protocols used for neurosurgery and scanning procedures

    DEFF Research Database (Denmark)

    Alstrup, Aage Kristian Olsen

    Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections with bupr......Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections......, especially ensuring sufficient analgesia and water/food intake during the first hours and days. Compared to neurosurgery, scanning procedures are normally unproblematic from a welfare point of view. However, anaesthesia may influence the results of brain scans, particularly functional scans, such as positron...

  9. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration

    Science.gov (United States)

    MURAYAMA, Yuichi

    2016-01-01

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe’s growth strategy of Japanese economy. Innovative “Made in Japan” medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation. PMID:27298262

  10. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration.

    Science.gov (United States)

    Murayama, Yuichi

    2016-09-15

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe's growth strategy of Japanese economy. Innovative "Made in Japan" medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.

  11. [The processing of point clouds for brain deformation existing in image guided neurosurgery system].

    Science.gov (United States)

    Yao, Xufeng; Lin, Yixun; Song, Zhijian

    2008-08-01

    The finite element method (FEM) plays an important role in solving the brain deformation problem in the image guided neurosurgery system. The position of the brain cortex during the surgery provides the boundary condition for the FEM model. In this paper, the information of brain cortex is represented by the unstructured points and the boundary condition is achieved by the processing of unstructured points. The processing includes the mapping of texture, segmentation, simplification and denoising. The method of k-nearest clustering based on local surface properties is used to simplify and denoise the unstructured point clouds. The results of experiment prove the efficiency of point clouds processing.

  12. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    Science.gov (United States)

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

  13. Automated location detection of injection site for preclinical stereotactic neurosurgery procedure

    Science.gov (United States)

    Abbaszadeh, Shiva; Wu, Hemmings C. H.

    2017-03-01

    Currently, during stereotactic neurosurgery procedures, the manual task of locating the proper area for needle insertion or implantation of electrode/cannula/optic fiber can be time consuming. The requirement of the task is to quickly and accurately find the location for insertion. In this study we investigate an automated method to locate the entry point of region of interest. This method leverages a digital image capture system, pattern recognition, and motorized stages. Template matching of known anatomical identifiable regions is used to find regions of interest (e.g. Bregma) in rodents. For our initial study, we tackle the problem of automatically detecting the entry point.

  14. Preliminary on the isotope hydrology investigations at the Nevada test site: Hydrologic resources management program; FY 1992--1993

    Energy Technology Data Exchange (ETDEWEB)

    Davisson, M.L.; Kenneally, J.M.; Smith, D.K.; Hudson, G.B.; Nimz, G.J.; Rego, J.H.

    1994-01-01

    A comprehensive isotope data base of the NTS groundwaters collected during FY 92-93 is presented with preliminary interpretations. Multiple samples were collected from over 30 sites on pumped wells and open-holes by wireline bailing. Field water level measurements indicate essentially a bimodal distribution separated by water levels at higher elevations (e.g. Pahute Mesa) from water levels of lower elevations (e.g. Yucca and Frenchman Flats). Down hole temperature measurements have confirmed anomalous temperature gradients in the eastern Yucca Flat area and on Pahute Mesa, where horizontal temperature gradients up to 0.33{degrees}F/100ft are found. Consistent with previous reports by others, the major ion geochemistry of the NTS groundwater are dominated by Na-K-HCO{sub 3} and Ca-Mg-HCO{sub 3} water types, where the Na-rich water appears to be related to dissolution in the volcanic tuffs and the Ca-rich water to the Paleozoic carbonates. Increases in dissolved Si also seems to be indicative of groundwater that resides in the volcanic tuffs. Processes controlling the Na/Ca ratios are complex and may include ion exchange reactions with clays, evaporative concentration in the vadose zone, and lithological heterogeneities in addition to simple differential dissolution between the volcanic tuffs and the Paleozoic carbonates. Apparent {sup 14}C ages range between 4000 and 38,000 years for groundwaters at the NTS. The uncertainty is large for exact age determinations at this time. The {sup 14}C abundance decreases with increased dissolved HCO{sub 3}, and {sup 13}C suggests dissolution of the ``dead`` Paleozoic carbonates significantly influence the ages, but more work is needed to investigate the influence of vadose zone carbonate.

  15. The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program.

    Science.gov (United States)

    Brosig, Cheryl; Yang, Kai; Hoffmann, Raymond G; Dasgupta, Mahua; Mussatto, Kathleen

    2014-12-01

    The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.

  16. Installation Restoration Program. Preliminary Assessment: Gulfport Air National Guard Field Training Site Gulfport - Biloxi Regional Airport, Gulfport, Mississippi

    Science.gov (United States)

    1988-04-01

    Mississippi. The study was conducted under the Air National Guard’s iInstallation Restoration Program. 14. -UBJEC- 7 RMWS 115. NUMBER UF PAGES Installation...B-i APPNDIX C - USAF Hazard Assesinnt Rating Metodology . . . . . . . C-i APPENDIX D - Site Hazardous Assessent Rating Forms and Factor Rating...raemval of fuel sludge fran the storage tanks durir periodic tank cleaning activities. In both cases , wates were discarded within the benlmd areas of the

  17. Aquatic monitoring programs conducted during environmental impact assessments in Canada: preliminary assessment before and after weakened environmental regulation.

    Science.gov (United States)

    Roach, Brynn; Walker, Tony R

    2017-03-01

    Aquatic monitoring programs are imperative for the functioning of the environmental impact assessment (EIA) process and a cornerstone for industrial compliance in Canada. However, in 2012, several leading pieces of federal environmental legislation (e.g., Canadian Environmental Assessment Act c.19, s. 52, 2012) were drastically altered, effectively weakening levels of environmental protection for aquatic ecosystems during project developments. This paper assesses the impact of CEAA 2012 on aquatic monitoring programs (and subsequent monitoring data reporting) across Canada for ten projects (five completed pre-CEAA 2012 and five completed post-CEAA 2012). Projects included four energy and six mining projects and were selected based on the following criteria: (i) representative of Canada's resource economy; (ii) project information was publicly available; and (iii) strong public interest. Projects pre- and post-CEAA 2012 exhibited few apparent differences before and after environmental regulatory changes. However, wide discrepancies exist in numbers and types of parameters reported, along with a lack of consistency in reporting. Projects pre-CEAA 2012 provided more follow-up monitoring commitments. Although qualitative differences remain inconclusive, this paper highlights requirements for further assessment of aquatic monitoring and follow-up programs in Canada. Recommendations for the government to consider during reviews of the federal environmental assessment processes include (i) improved transparency on the Canadian Environmental Assessment Agency website ( https://www.ceaa-acee.gc.ca/ ); (ii) creation of a legally binding standardized aquatic monitoring program framework to ensure that all Canadian aquatic ecosystems are monitored with equal rigour; and (iii) commitments and justification related to frequency of aquatic monitoring of water quality.

  18. Field Verification Program, Coastal Flooding and Storm Protection Program. Preliminary User’s Manual 3-D Mathematical Model of Coastal, Estuarine, and Lake Currents (CELC3D).

    Science.gov (United States)

    1984-04-01

    on any other virtual machine, e.g., the CDC cyber 203, or .other non-virtual machine with sufficient memory. The CELC3D program solves the mean...Princeton, NJ, 287 pp; also WES Technical Report (in Press), U.S. Army Eng. Waterways Experiment Station, - Vicksburg, MS. " Sheng, Y.P., H. Segur , and W.S

  19. Preliminary Evaluation of the Section 1603 Treasury Grant Program for Renewable Power Projects in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan; Darghouth, Naim

    2010-05-05

    This article evaluates the first year of the Section 1603 Treasury cash grant program, which enables renewable power projects in the U.S. to elect cash grants in lieu of the federal tax credits that are otherwise available. To date, the program has been heavily subscribed, particularly by wind power projects, which had received 86% of the nearly $2.6 billion in grants that had been disbursed as of March 1, 2010. As of that date, 6.2 GW of the 10 GW of new wind capacity installed in the U.S. in 2009 had applied for grants in lieu of production tax credits. Roughly 2.4 GW of this wind capacity may not have otherwise been built in 2009 absent the grant program; this 2.4 GW may have supported approximately 51,600 short-term full-time-equivalent (FTE) gross job-years in the U.S. during the construction phase of these wind projects, and 3,860 longterm FTE gross jobs during the operational phase. The program’s popularity stems from the significant economic value that it provides to renewable power projects, relative to the otherwise available tax credits. Although grants reward investment rather than efficient performance, this evaluation finds no evidence at this time of either widespread “gold-plating” or performance problems.

  20. Infection surveillance and control programs in the Department of Veterans Affairs nursing home care units: a preliminary assessment.

    Science.gov (United States)

    Tsan, Linda; Hojlo, Christa; Kearns, Martha A; Davis, Chester; Langberg, Robert; Claggett, Maurice; Coughlin, Nancy; Miller, Michael; Gaynes, Robert; Gibert, Cynthia; Montgomery, Ona; Richards, Chesley; Danko, Linda; Roselle, Gary

    2006-03-01

    A survey was conducted to assess the capacity and current practices of the infection surveillance and control programs at the Department of Veterans Affairs' 130 nursing home care units (VA NHCUs) covering a total of 15,006 beds in 2003. All 130 VA NHCUs responded to the survey, although not all NHCUs answered every question. The majority of the VA NHCUs provided specialized services that might pose increased risks of infection. For every 8 to 10 VA NHCU beds, there was 1 regular-pressure or negative-pressure infection control room available. Each VA NHCU had an active ongoing infection surveillance and control program managed by highly educated infection control personnel (ICP), of which 96% had a minimum of a bachelor degree. A median of 12 hours per week of these ICP efforts was devoted to the infection surveillance and control activities. The most frequently used surveillance methods were targeted surveillance for specific infections and for specific organisms. Most VA NHCUs conducted surveillance for antibiotic-resistant organisms. However, VA NHCUs did not use a uniform set of definitions for nosocomial infections for their infection surveillance and control purposes. We conclude that VA NHCUs have a considerable infrastructure and capacity for infection surveillance and control. This information can be used to develop a nationwide VA NHCU nosocomial infection surveillance system.

  1. E-learning for grass-roots emergency public health personnel: Preliminary lessons from a national program in China.

    Science.gov (United States)

    Xu, Wangquan; Jiang, Qicheng; Qin, Xia; Fang, Guixia; Hu, Zhi

    2016-07-19

    In China, grass-roots emergency public health personnel have relatively limited emergency response capabilities and they are constantly required to update their professional knowledge and skills due to recurring and new public health emergencies. However, professional training, a principal solution to this problem, is inadequate because of limitations in manpower and financial resources at grass-roots public health agencies. In order to provide a cost-effective and easily expandable way for grass-roots personnel to acquire knowledge and skills, the National Health Planning Commission of China developed an emergency response information platform and provided trial access to this platform in Anhui and Heilongjiang provinces in China. E-learning was one of the modules of the platform and this paper has focused on an e-learning pilot program. Results indicated that e-learning had satisfactorily improved the knowledge and ability of grass-roots emergency public health personnel, and the program provided an opportunity to gain experience in e-course design and implementing e-learning. Issues such as the lack of personalized e-courses and the difficulty of evaluating the effectiveness of e-learning are topics for further study.

  2. The longitudinal time course of QTc in early infancy. Preliminary results of a prospective sudden infant death syndrome surveillance program.

    Science.gov (United States)

    Schaffer, M S; Trippel, D L; Buckles, D S; Young, R H; Dolan, P L; Gillette, P C

    1991-03-01

    Eleven hundred one healthy neonates in Charleston County, SC, were enrolled in a prospective, serial measurement sudden infant death syndrome/QT surveillance program. Automated computer-enhanced ECGs were recorded at 1 day of age in the hospital nursery and again at 1 week and 1, 2, and 3 months in the participant's home. At 1 year, the families were contacted by phone or mail and questioned as to the health of the child. Validation studies demonstrated the computer-enhanced ECGs to be 96% accurate, whereas traditional ECG recording and measurement was 94% accurate. No systematic differences in the QTc according to race and sex were observed. There were parallel longitudinal time courses for each race and sex group with a significant (P less than .001) shortening of the QTc at 1 week. There was no evidence of tracking of the QTc during the first 3 months of life. In conclusion, (1) automated, enhanced ECG QTc intervals are superior to traditional electrocardiography while retaining the advantages of automation; (2) there is a significant shortening of the QTc during the first month of life; and (3) a home follow-up sudden infant death syndrome surveillance program is feasible and produces accurate, reliable information.

  3. An analysis of Chemical Stockpile Emergency Preparedness Program exercise results. Volume 2: Preliminary evaluation and analysis of CSEPP exercise database

    Energy Technology Data Exchange (ETDEWEB)

    Wernette, D.; Lerner, K.

    1998-06-01

    This study investigated the quality and usefulness of the information in the Chemical Stockpile Emergency Preparedness Program (CSEPP) exercise database. It incorporates the results of two separate analytical efforts. The first effort investigated the process of assigning standardized codes to issues identified in CSEPP exercise reports. A small group of issues was coded independently by each of several individuals, and the results of the individual codings were compared. Considerable differences were found among the individuals` codings. The second effort consisted of a statistical multivariate analysis, to investigate whether exercise issues are evenly distributed among exercise tabs, sites, and objectives. It was found that certain tabs, sites, and objectives were disproportionately associated with problem areas in exercises. In some cases, these problem areas have persisted over time, but in other cases they have undergone significant shifts over the time span of the investigation. The study concludes that the database can be a useful resource for analyzing problem areas and setting priorities for CSEPP program resources. However, some further analyses should be performed in order to more fully explore the data and increase confidence in the results.

  4. [The robotization of neurosurgery: state of the art and future outlook].

    Science.gov (United States)

    Benabid, A L; Hoffmann, D; Ashraf, A; Koudsie, A; Esteve, F; Le-Bas, J F

    1997-11-01

    Neurosurgery is by excellence a field of application for robots, based on multimodal image guidance. Specific motorized tools have been already developed and routinely applied in stereotaxy to position a probe holder or in conventional neurosurgery to hold a microscope oriented towards a given target. The potentialities of these approaches have triggered industrial developments currently commercially available. These systems use data bases, primarily coming from multimodal numerical images from X-ray radiology to magnetic resonance imaging. These spatially encoded data are transferred through digital networks to workstations where images can be processed and surgical procedures are preplanned, then transferred to the robotic systems to which they are connected. We have been using a stereotactic robot since 1989 and a microscope robot since 1995 in various surgical routine procedures. The future of these applications mainly rely on the technical progress in informatics, about image recognition to adapt the preplanning to the actual surgical situation, to correct brain shifts for instance, about image fusion, integrated knowledge such such as brain atlases, as well as virtual reality. The future developments, covering surgical procedure, research and teaching, will sure be far beyond our wildest expectations.

  5. [The history of Spanish neurosurgery: the Valencian school: J.J. Barcia Goyanes].

    Science.gov (United States)

    Barcia-Mariño, Carlos; Rodríguez-Mena, Ruben

    2013-01-01

    Professor Juan José Barcia-Goyanes started neurosurgical practice from anatomy and neuropsychiatry in response to a vacancy at a department known as "Nervous diseases", in 1931 at Hospital General in Valencia, Spain. Since the first intervention, based on the methods and surgical instruments already used in Europe and the U.S.A., the neurosurgical practice became the mainstay of the department, from which other auxiliary specialties emerged, such as neuroradiology, neurophysiology, neuropathology and also new techniques such as stereotactic surgery, functional neurosurgery and palencephalography. This year, the department celebrates its 80th anniversary. The broad spectrum of Prof. Barcia's scientific work included fields like neurology, neurosurgery and psychiatry, as well as anthropology, medical thought, history of medicine, morphology and history of anatomical language in his work "Onomatologica anatomica nova", in addition to an interesting poetic work. He was a founding member of the Luso-Spanish Neurosurgical Society and the Neurosurgical Society of Levante. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  6. da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety.

    Science.gov (United States)

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

    2015-04-01

    The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.

  7. Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery.

    Science.gov (United States)

    Masamune, K; Kobayashi, E; Masutani, Y; Suzuki, M; Dohi, T; Iseki, H; Takakura, K

    1995-01-01

    A variety of medical robots for stereotactic neurosurgery has been developed in recent years. Almost of all these robots use computed tomography (CT) to scan the brain of the patient before and during surgery. Currently, we are developing a needle insertion manipulator for magnetic resonance imaging (MRI)-guided neurosurgery. MRI techniques, including MRI angiography and functional MRI, are attractive for the development of interventional MRI therapies and operations. If a robot were available, these therapies would be minimally invasive, with more accurate guidance than is possible with current CT-guided systems. Actuation of a robot in an MRI environment is difficult because of the presence of strong magnetic fields. Therefore, the robot must be constructed of nonmagnetic materials. The system frame was manufactured using polyethylene terephthalate (PET) and was actuated using ultrasonic motors. Accuracy-evaluation procedures and phantom tests have been performed. The total accuracy of the system was approximately 3.0 mm. No artifacts caused by the manipulator were observed in the images.

  8. Schizophrenia and neurosurgery: A dark past with hope of a brighter future.

    Science.gov (United States)

    Agarwal, Prateek; Sarris, Christina E; Herschman, Yehuda; Agarwal, Nitin; Mammis, Antonios

    2016-12-01

    Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients. The history of neurosurgery for schizophrenia, among other psychiatric diseases, has a very dark past. Therefore, this review examines peer-reviewed studies on the history of schizophrenia, its medical and surgical therapies, financial costs, and future directions for disease management. We highlight the historically poor relationship between neurosurgery and psychiatric disease and discuss current research in the understandings of schizophrenia. Guided by a strong code of ethics and new technology, including the use of stereotaxis and deep brain stimulation (DBS), the medical communities treating psychiatric disease are beginning to overcome the horrors of the past. DBS is currently being used with moderate success in the treatment of depression, obsessive compulsive disorder, Tourette's syndrome, and anorexia nervosa. With greater understanding of the neural circuitry of schizophrenia and the evolving role for DBS in psychiatric disease, the authors believe that schizophrenia, like other psychiatric diseases, can be treated with DBS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Neurosurgery during the Bronze Age: a skull trepanation in 1900 BC Greece.

    Science.gov (United States)

    Papagrigorakis, Manolis J; Toulas, Panagiotis; Tsilivakos, Manolis G; Kousoulis, Antonis A; Skorda, Despoina; Orfanidis, George; Synodinos, Philippos N

    2014-02-01

    Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Trepanation of the cranial vault was a widespread surgical procedure in antiquity and the most convincing evidence of the ancient origin of neurosurgery. The present study considers a case of trepanation from the Middle Bronze Age Greece (1900-1600 B.C.). The skull under study belongs to skeletal material unearthed from Kirra, Delphi (Central Greece). Macroscopic examination and palpation, as well as three-dimensional computed tomography, were used in this study. There is osteological evidence that the skull belongs to a man who died at 30-35 years of age. The procedure of trepanation was performed on the right parietal bone. Both macroscopic and computed tomography evaluation demonstrate an intravital bone reaction at the edges of the aperture. Projected on the right surface of the brain, the trepanation is located on the level of the central groove. The small dimensions and the symmetrical shape of this hole give us an indication that it was made by a metal tool. We conclude that this paleopathological case provides valuable information about the condition of life and the pre-Hippocratic neurosurgical practice in Bronze Age Greece. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Development of computer-aided functions in clinical neurosurgery with PACS

    Science.gov (United States)

    Mukasa, Minoru; Aoki, Makoto; Satoh, Minoru; Kowada, Masayoshi; Kikuchi, K.

    1991-07-01

    The introduction of the "Picture Archiving and Communications System (known as PACS)," provides many benefits, including the application of C.A.D., (Computer Aided Diagnosis). Clinically, this allows for the measurement and design of an operation to be easily completed with the CRT monitors of PACS rather than with film, as has been customary in the past. Under the leadership of the Department of Neurosurgery, Akita University School of Medicine, and Southern Tohoku Research Institute for Neuroscience, Koriyama, new computer aided functions with EFPACS (Fuji Electric's PACS) have been developed for use in clinical neurosurgery. This image processing is composed of three parts as follows: (1) Automatic mapping of small lesions depicted on Magnetic Resonance (or MR) images on the brain atlas. (2) Superimposition of two angiographic films onto a single synthesized image. (3) Automatic mapping of the lesion's position (as shown on the. CT images) on the processing image referred to in the foregoing clause 2. The processing in the clause (1) provides a reference for anatomical estimation. The processing in the clause (2) is used for general analysis of the condition of a disease. The processing in the clause (3) is used to design the operation. This image processing is currently being used with good results.

  11. Current state-of-the-art and future perspectives of robotic technology in neurosurgery.

    Science.gov (United States)

    Mattei, Tobias A; Rodriguez, Abraham Hafiz; Sambhara, Deepak; Mendel, Ehud

    2014-07-01

    Neurosurgery is one of the most demanding surgical specialties in terms of precision requirements and surgical field limitations. Recent advancements in robotic technology have generated the possibility of incorporating advanced technological tools to the neurosurgical operating room. Although previous studies have addressed the specific details of new robotic systems, there is very little literature on the strengths and drawbacks of past attempts, currently available platforms and prototypes in development. In this review, the authors present a critical historical analysis of the development of robotic technology in neurosurgery as well as a comprehensive summary of the currently available systems that can be expected to be incorporated to the neurosurgical armamentarium in the near future. Finally, the authors present a critical analysis of the main technical challenges in robotic technology development at the present time (such as the design of improved systems for haptic feedback and the necessity of incorporating intraoperative imaging data) as well as the benefits which robotic technology is expected to bring to specific neurosurgical subspecialties in the near future.

  12. Straight trajectory planning for keyhole neurosurgery in sheep with automatic brain structures segmentation

    Science.gov (United States)

    Favaro, Alberto; Lad, Akash; Formenti, Davide; Zani, Davide Danilo; De Momi, Elena

    2017-03-01

    In a translational neuroscience/neurosurgery perspective, sheep are considered good candidates to study because of the similarity between their brain and the human one. Automatic planning systems for safe keyhole neurosurgery maximize the probe/catheter distance from vessels and risky structures. This work consists in the development of a trajectories planner for straight catheters placement intended to be used for investigating the drug diffusivity mechanisms in sheep brain. Automatic brain segmentation of gray matter, white matter and cerebrospinal fluid is achieved using an online available sheep atlas. Ventricles, midbrain and cerebellum segmentation have been also carried out. The veterinary surgeon is asked to select a target point within the white matter to be reached by the probe and to define an entry area on the brain cortex. To mitigate the risk of hemorrhage during the insertion process, which can prevent the success of the insertion procedure, the trajectory planner performs a curvature analysis of the brain cortex and wipes out from the poll of possible entry points the sulci, as part of brain cortex where superficial blood vessels are naturally located. A limited set of trajectories is then computed and presented to the surgeon, satisfying an optimality criteria based on a cost function which considers the distance from critical brain areas and the whole trajectory length. The planner proved to be effective in defining rectilinear trajectories accounting for the safety constraints determined by the brain morphology. It also demonstrated a short computational time and good capability in segmenting gyri and sulci surfaces.

  13. Quantifying cortical surface harmonic deformation with stereovision during open cranial neurosurgery

    Science.gov (United States)

    Ji, Songbai; Fan, Xiaoyao; Roberts, David W.; Paulsen, Keith D.

    2012-02-01

    Cortical surface harmonic motion during open cranial neurosurgery is well observed in image-guided neurosurgery. Recently, we quantified cortical surface deformation noninvasively with synchronized blood pressure pulsation (BPP) from a sequence of stereo image pairs using optical flow motion tracking. With three subjects, we found the average cortical surface displacement can reach more than 1 mm and in-plane principal strains of up to 7% relative to the first image pair. In addition, the temporal changes in deformation and strain were in concert with BPP and patient respiration [1]. However, because deformation was essentially computed relative to an arbitrary reference, comparing cortical surface deformation at different times was not possible. In this study, we extend the technique developed earlier by establishing a more reliable reference profile of the cortical surface for each sequence of stereo image acquisitions. Specifically, fast Fourier transform (FFT) was applied to the dynamic cortical surface deformation, and the fundamental frequencies corresponding to patient respiration and BPP were identified, which were used to determine the number of image acquisitions for use in averaging cortical surface images. This technique is important because it potentially allows in vivo characterization of soft tissue biomechanical properties using intraoperative stereovision and motion tracking.

  14. Josef Klingler's models of white matter tracts: influences on neuroanatomy, neurosurgery, and neuroimaging.

    Science.gov (United States)

    Agrawal, Abhishek; Kapfhammer, Josef P; Kress, Annetrudi; Wichers, Hermann; Deep, Aman; Feindel, William; Sonntag, Volker K H; Spetzler, Robert F; Preul, Mark C

    2011-08-01

    During the 1930s, white matter tracts began to assume relevance for neurosurgery, especially after Cajal's work. In many reviews of white matter neurobiology, the seminal contributions of Josef Klingler (1888-1963) and their neurological applications have been overlooked. In 1934 at the University of Basel under Eugen Ludwig, Klingler developed a new method of dissection based on a freezing technique for brain tissue that eloquently revealed the white matter tracts. Klingler worked with anatomists, surgeons, and other scientists, and his models and dissections of white matter tracts remain arguably the most elegant ever created. He stressed 3-dimensional anatomic relationships and laid the foundation for defining mesial temporal, limbic, insular, and thalamic fiber and functional relationships and contributed to the potential of stereotactic neurosurgery. Around 1947, Klingler was part of a Swiss-German group that independently performed the first stereotactic thalamotomies, basing their targeting and logic on Klingler's white matter studies, describing various applications of stereotaxy and showing Klingler's work integrated into a craniocerebral topographic system for targeting with external localization of eloquent brain structures and stimulation of deep thalamic nuclei. Klingler's work has received renewed interest because it is applicable for correlating the results of the fiber-mapping paradigms from diffusion tensor imaging to actual anatomic evidence. Although others have described white matter tracts, none have had as much practical impact on neuroscience as Klinger's work. More importantly, Josef Klingler was an encouraging mentor, influencing neurosurgeons, neuroscientists, and brain imaging for more than three quarters of a century.

  15. Experience of a Maastrich type II non heart beating donor program in a small city: preliminary results.

    Science.gov (United States)

    Miñambres, E; Suberviola, B; Guerra, C; Lavid, N; Lassalle, M; González-Castro, A; Ballesteros, M A

    2015-10-01

    To study the results of a non-controlled cardiac death (Maastricht type II) donor program in a city of 200,000 inhabitants. The study was initially focused on lung donation and was extended to kidney donation after 9 months. A prospective observational study was conducted between October 2012 and December 2013. The Intensive Care Unit of Marqués de Valdecilla University Hospital in Santander (Spain), and surrounding areas. Patients (< 55 years) who died of out-of-hospital cardiac arrest. All out-of-hospital cardiac arrests were treated with mechanical cardiac compression (LUCAS II). The diagnosis of death and organ preservation were performed in the ICU. A total of 14 calls were received, of which three were discarded. Of the 11 potential donors, 7 were effective donors with a median age of 39.5 years (range: 32-48). A total of 5 single lung transplants and four kidney transplants were performed. In addition, corneas and tissues were harvested. The non-valid donors were rejected mainly due to technical problems. There were no donation refusals on the part of the patient relatives. The lung transplant patient survival rate was 100% after one month and 80% after one year. One month after transplantation, the kidney recipients had a serum creatinine concentration of<2mg/dl. The interval from cardiac arrest to renal preservation was 80minutes (range: 71-89), and the interval from cardiac arrest to lung preservation was 84minutes (range: 77-94). A Maastricht type II donation program in a small city is viable for both abdominal and thoracic organs. The program was initially very cautious, but its potential is easily improvable by increasing donor and by equipping mobile ICU ambulances with mechanical cardiac compression systems. Full management of the donor in the ICU, avoiding the emergency department or operating rooms, reduces the warm ischemia time, thereby improving transplant outcomes. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  16. Characteristics of drug-abusing women with children in residential treatment: a preliminary evaluation of program retention and treatment completion.

    Science.gov (United States)

    Simons, Lori

    2008-01-01

    An ex post facto study was conducted to investigate treatment outcomes for 80 women and 168 children admitted into a residential substance-abuse treatment program. The results indicated childhood emotional neglect is a barrier for remaining in and completing treatment for African-American women with comorbid psychological disorders but not for those with crack cocaine dependent disorders. African-American women with comorbid psychological disorders were also three times more likely to dropout of treatment. In addition, there were relatively few differences for between drug-exposed and nonexposed children. However, the results indicated that children of substance-abusing women who completed treatment were more likely to have behavioral problems, to receive early intervention services, and to have mothers as legal guardians by the end of treatment. Implications for gender-specific interventions for African-American women and their children in residential treatment are discussed.

  17. Preliminary Evaluation of the Impact of the Section 1603 Treasury Grant Program on Renewable Energy Deployment in 2009

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan; Darghouth, Naim

    2010-03-31

    achieve 'the near term goal of creating and retaining jobs - as well as the long-term benefit of expanding the use of clean and renewable energy and decreasing our dependency on non-renewable energy sources' (U.S. Department of the Treasury 2009). More than a year has now passed since the Recovery Act became law. Although the Section 1603 program has been operational for only part of that time - roughly eight months - the program faces a looming milestone in just another nine months. Specifically, in order to qualify for the Section 1603 grant, eligible projects must have commenced construction by the end of 2010. With this deadline approaching, the Committee on Ways and Means of the U.S. House of Representatives requested that Lawrence Berkeley National Laboratory evaluate the effectiveness of the Section 1603 grant program to date (see Attachment 1), focusing on specific elements of the program that were subsequently agreed upon by Committee staff, the U.S. Department of Energy, and Berkeley Lab. This report responds to the Committee's request. The evaluation focuses primarily on the commercial wind power sector, for two reasons: (1) commercial wind power projects had received nearly 86% of all grant money awarded as of March 1, 2010; and (2) there is substantially more market-related information available for the commercial wind power sector than there is for other renewable power sectors, thereby facilitating analysis. Despite the focus on wind power, this initial analysis does endeavor to provide relevant information on other technologies, and in particular geothermal (the second-largest recipient of grant money), where possible.

  18. A national collaboration to disseminate skills for outpatient teaching in internal medicine: program description and preliminary evaluation.

    Science.gov (United States)

    Bowen, Judith L; Clark, Jeanne M; Houston, Thomas K; Levine, Rachel; Branch, William; Clayton, Charles P; Alguire, Patrick; Esham, Richard; Boulware, Dennis W; Ferenchick, Gary; Kern, David E

    2006-02-01

    The shift of clinical care and teaching to outpatient settings has challenged ambulatory and community-based teachers. To address this challenge, U.S. internal medicine organizations devised "Faculty Development for General Internal Medicine: Generalist Faculty Teaching in Ambulatory Settings," a national program to train leaders to create local faculty development projects. In 1999, teams from all 386 internal medicine training institutions were invited to apply. Participation required an acceptable plan for a local project and inclusion of an institutional leader, residency or clerkship director, and a community-based faculty member on the project team. Team members attended one of three national training conferences held in 1999 and 2000 that included plenary sessions, workshops, and team meetings. Participants were invited to a wrap-up conference to present their accomplishments. One hundred ten teams from 57 university and 53 non-university hospitals attended the training conferences; 412 (93%) participants returned conference evaluations. All sessions were rated highly. Participants preferred workshops and team meetings to plenary sessions. Two hundred thirty-five (57%) would have recommended the training conference to colleagues as an outstanding experience; 148 (36%) as a good experience; and 25 (6%) as a satisfactory experience. Forty-nine teams (122 participants) returned for the wrap up conference where 35 teams presented their local faculty development projects. Cost per team trained was US$11,818. This program demonstrated a national desire for training in teaching skills, reached a broad audience of ambulatory-based clinical teachers, provided highly rated faculty development conferences in teaching skills, and facilitated development of a variety of local projects at modest expense. Partnerships were forged between academic leaders and community-based teachers.

  19. Master's Degree Program in Scientific and Cultural Communication: Preliminary reports on an innovative experience in Brazil (Portuguese original version

    Directory of Open Access Journals (Sweden)

    Carlos A. Vogt

    2009-03-01

    Full Text Available The multidisiciplinary Master’s Degree Program in Scientific and Cultural Communication (MDCC began in the first semester of 2007. It is offered by the Laboratory of Advanced Studies in Journalism (Labjor of the Creativity Development Nucleus (NUDECRI and by the Institute of Language Studies (IEL, both of which are entities the State University of Campinas (UNICAMP. The program is also supported by the Department of Scientific and Technological Policy (DPCT of the Geosciences Institute (IG and by MediaTec – Media and Communication Technologies Laboratory of the Multimedia Department (DMM of the Art Institute (IA. The objective of the MDCC is to train and enable researchers with in-depth theoretical knowledge about current questions related to science communication. A global vision of the systems of science and technology are joined together with an understanding of a solid, contemporary literary and cultural repertoire. The interaction among subjects offered in the MDCC seeks to provide an education that allows critical reflection about the main accomplishments of science, technology and culture in our current society and the way in which the mass or specialized media have worked in order to communicate these accomplishments. The areas of research focus on the analysis of cultural production and science communication within the most diverse means of information, such as print, radio, television and electronic media. There is a special emphasis on areas such as science and technical history and the sociology of science, as well as other spaces of science and cultural communication, such as museums, forums and events.

  20. The prevention of occupational hand dermatitis in bakers, confectioners and employees in the catering trades. Preliminary results of a skin prevention program.

    Science.gov (United States)

    Bauer, A; Kelterer, D; Stadeler, M; Schneider, W; Kleesz, P; Wollina, U; Elsner, P

    2001-02-01

    Occupational skin diseases (OSD) are among the most frequent occupational diseases (OD). Compared to other occupations, bakers, confectioners and employees in the catering trades are at a high risk of developing OSD. In January 1999, the interdisciplinary Skin Disease Prevention Program in the Baking, Hotel and Catering Industries (SDPP) conducted by the Department of Dermatology and Allergology at the Friedrich Schiller University, Jena, in cooperation with the Research Center for Applied System Safety and Industrial Medicine, Erfurt, and the technical experts at the Social Insurance for the Food Industry and Related Professions (Berufsgenossenschaft für Nahrungsmittel und Gaststätten--(BGN)), Erfurt, was initiated. Following detailed analysis of the occupational exposure of the employees and their personal occupational disease history, the patients' diagnosis and therapy was re-evaluated and supplemented if necessary. Individual skin care and protection regimes were demonstrated and practically trained. Skin care and protection products were supplied. Skin-care and protection seminars were offered to volunteering participants. From January to December 1999, 29 affected employees were examined in the OSD clinic. 22 employees (76%) suffered from irritant contact dermatitis. The follow-up data of 11 employees are available. In 8 employees (73%), the skin disease improved or disappeared. Moreover, in 1 employee (9%), the skin condition was stabilized even though he continued working. In only 2 employees (18%) did the skin condition worsen. These preliminary results showed that most of the OSD were due to lack of or unsuitable skin care and protection. The program will be extended to cover a larger number of food industry employees with OSD.

  1. A neurologist in the origin of European and International neurosurgery: Clovis-Julien-Désiré Vincent (1879-1947).

    Science.gov (United States)

    Androutsos, G; Karamanou, M; Lymberi, M; Zambelis, T; Stamboulis, E

    2011-01-01

    Vincent Clovis began his carrier as a neurologist and finally became neurosurgeon at an advanced age. He is considered the founder of French neurosurgery, and after Harvey Williams Cushing, Europe's first neurosurgeon. He was mainly interested in pituitary tumors, in cerebral abscesses and in cerebral oedema.

  2. Publication performance and research output of Neurology and Neurosurgery training institutes in India: A 5-year analysis

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2015-01-01

    Conclusions: This evaluation of the publication performance and research output of neurology and neurosurgery training institutes would serve as a baseline data for future evaluations and comparisons. The absence of any publication and research output from several training institutes is a matter of concern.

  3. The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field.

    Science.gov (United States)

    Lai, Hung-Yi; Lee, Ching-Yi; Chiu, Angela; Lee, Shih-Tseng

    2014-01-01

    To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurology residents employed at Chang Gung Memorial Hospital, an institution that provides primary and tertiary clinical care in 3 locations, Linkou, Kaohsiung, and Chiayi. There were 81 participants who entered the study, and all completed the study. Neurosurgeons preferred the assimilating learning style (52%), followed by the diverging learning style (39%). Neurosurgery residents were slightly more evenly distributed across the learning styles; however, they still favored assimilating (32%) and diverging (41%). Neurology residents had the most clearly defined preferred learning style with assimilating (76%) obtaining the large majority and diverging (12%) being a distant second. The assimilating and diverging learning styles are the preferred learning styles among neurosurgeons, neurosurgery residents, and neurology residents. The assimilating learning style typically is the primary learning style for neurosurgeons and neurology residents. Neurosurgical residents start off with a diverging learning style and progress toward an assimilating learning style as they work toward becoming practicing neurosurgeons. The field of neurosurgery has limited opportunities for active experimentation, which may explain why individuals who prefer reflective observation are more likely to succeed in this field. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Validation of model-based brain shift correction in neurosurgery via intraoperative magnetic resonance imaging: preliminary results

    Science.gov (United States)

    Luo, Ma; Frisken, Sarah F.; Weis, Jared A.; Clements, Logan W.; Unadkat, Prashin; Thompson, Reid C.; Golby, Alexandra J.; Miga, Michael I.

    2017-03-01

    The quality of brain tumor resection surgery is dependent on the spatial agreement between preoperative image and intraoperative anatomy. However, brain shift compromises the aforementioned alignment. Currently, the clinical standard to monitor brain shift is intraoperative magnetic resonance (iMR). While iMR provides better understanding of brain shift, its cost and encumbrance is a consideration for medical centers. Hence, we are developing a model-based method that can be a complementary technology to address brain shift in standard resections, with resource-intensive cases as referrals for iMR facilities. Our strategy constructs a deformation `atlas' containing potential deformation solutions derived from a biomechanical model that account for variables such as cerebrospinal fluid drainage and mannitol effects. Volumetric deformation is estimated with an inverse approach that determines the optimal combinatory `atlas' solution fit to best match measured surface deformation. Accordingly, preoperative image is updated based on the computed deformation field. This study is the latest development to validate our methodology with iMR. Briefly, preoperative and intraoperative MR images of 2 patients were acquired. Homologous surface points were selected on preoperative and intraoperative scans as measurement of surface deformation and used to drive the inverse problem. To assess the model accuracy, subsurface shift of targets between preoperative and intraoperative states was measured and compared to model prediction. Considering subsurface shift above 3 mm, the proposed strategy provides an average shift correction of 59% across 2 cases. While further improvements in both the model and ability to validate with iMR are desired, the results reported are encouraging.

  5. Patient protection in radiotherapy (Radio neurosurgery National Service of the Social Security Mexican Institute); Proteccion del paciente en radioterapia (Servicio Nacional de Radioneurocirugia del IMSS)

    Energy Technology Data Exchange (ETDEWEB)

    Espiritu R, R. [Centro Medico Nacional de Occidente, IMSS, Servicio Nacional de Radioneurocirugia, Belisario Dominguez 735, Sector Libertad, 44340 Guadalajara, Jalisco (Mexico)

    2008-12-15

    The perspective of patient protection at the Radio neurosurgery National Service of the Social Security Mexican Institute is divided into three parts: the testing program for equipment acceptance, an assurance quality program based on periodic tests, an also other assurance quality based on tests during the application. Among the technical aspects that influence in the equipment acceptance tests, it is the collimation type, the characteristics of the lineal accelerator, the platform for planning and the network type. In the case of the collimation system and the accelerator characteristics, we consider the manufacturer's specifications and requirements of Mexican Official Standard NOM-033-NUCL-1999, {sup T}echnical Specifications for the Teletherapy Units Operation, Linear Accelerators{sup .} Planning for the platform takes into account the manufacturer's specifications. In the case of computed tomography as well as review the calibration according to manufacturer's specifications should be considered the standard NOM-229-SSA1-2002. In the case of the linear accelerator must be the radiological characterization of radiation beam as part of this, the absolute dose determination. As for the periodic tests is verified the dose constancy, as well as the flattening and symmetry of X-rays beam. There are also tests battery with daily, monthly and yearly frequencies, which make up the assurance quality program. (Author)

  6. 42 CFR 457.925 - Preliminary investigation.

    Science.gov (United States)

    2010-10-01

    ... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Program Integrity § 457.925 Preliminary investigation. If the State agency receives a complaint of fraud or abuse...

  7. The historical origin of the term "meningioma" and the rise of nationalistic neurosurgery.

    Science.gov (United States)

    Barthélemy, Ernest Joseph; Sarkiss, Christopher A; Lee, James; Shrivastava, Raj K

    2016-11-01

    The historical origin of the meningioma nomenclature unravels interesting social and political aspects about the development of neurosurgery in the late 19th century. The meningioma terminology itself was the subject of nationalistic pride and coincided with the advancement in the rise of medicine in Continental Europe as a professional social enterprise. Progress in naming and understanding these types of tumor was most evident in the nations that successively assumed global leadership in medicine and biomedical science throughout the 19th and 20th centuries, that is, France, Germany, and the United States. In this vignette, the authors delineate the uniqueness of the term "meningioma" as it developed within the historical framework of Continental European concepts of tumor genesis, disease states, and neurosurgery as an emerging discipline culminating in Cushing's Meningiomas text. During the intellectual apogee of the French Enlightenment, Antoine Louis published the first known scientific treatise on meningiomas. Like his father, Jean-Baptiste Louis, Antoine Louis was a renowned military surgeon whose accomplishments were honored with an admission to the Académie royale de chirurgie in 1749. His treatise, Sur les tumeurs fongueuses de la duremère, appeared in 1774. Following this era, growing economic depression affecting a frustrated bourgeoisie triggered a tumultuous revolutionary period that destroyed France's Ancien Régime and abolished its university and medical systems. The resulting anarchy was eventually quelled through legislation aiming to satisfy Napoleon's need for qualified military professionals, including physicians and surgeons. These laws laid the foundations for the subsequent flourishing of French medicine throughout the mid-19th century. Subsequent changes to the meningioma nomenclature were authored by intellectual giants of this postrevolutionary period, for example, by the Limogesborn pathologist Jean Cruveilhier known for the term

  8. Intraspinal Pathology Associated With Pediatric Scoliosis: A Ten-year Review Analyzing the Effect of Neurosurgery on Scoliosis Curve Progression.

    Science.gov (United States)

    Jankowski, Pawel P; Bastrom, Tracey; Ciacci, Joseph D; Yaszay, Burt; Levy, Michael L; Newton, Peter O

    2016-10-15

    This was a retrospective study of patients with Chiari I (CM I) and Chiari II (CM II) malformations, tethered cord syndrome, and syringomyelia examining the effect of neurosurgery on scoliosis. The aim of this study was to determine the factors affecting spinal deformity progression in patients with diseases of the neural axis following neurosurgical management. There have been attempts to explain which factors influence the spinal deformity in diseases of the neural axis with varying results. Debate still exists as to the effectiveness of neurosurgery in curve stabilization. The medical records for patients treated over the past 10 years were reviewed. The spinal deformity surgical group consisted of patients who received surgery or progressed to surgical range (50°) and the nonsurgical group those who did not undergo fusion. Fifteen patients (eight females and seven males) with scoliosis who underwent neurosurgical intervention were identified. Ten had tethered cord, six CM II, four CM I, and 11 syrinx. Average age at the time of neurosurgery was 7 ± 4 years (range 0.7-14 yrs). Following neurosurgery, no patients experienced improvement in their curves (defined as >10° decrease in Cobb angle), eight patients experienced stabilization (10° increase). The group that went on to spinal deformity surgery possessed larger curves before neurosurgery (mean 42°, range 20°-63°) than the nonsurgical group (19°, range 15°-26°; P = 0.004). CM II patients had the greatest magnitude of curve progression, mean of 49°, compared with patients with CM I (6°) or tether cord without CM I or II (11°, P = 0.01). Neurosurgical intervention may prevent curve progression in patients with scoliosis and Cobb angles < 30° if they do not have a complex CM II malformation. Patients with CM II are at a higher risk of curve progression and undergoing spinal fusion than patients with CM I, tethered cord syndrome, or syringomyelia. 4.

  9. Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in the United States. Preliminary background report

    Energy Technology Data Exchange (ETDEWEB)

    Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.; Hejna, D.; Rielley, K.J.

    1980-01-01

    This report is a summary of a series of preliminary reports describing the laws and regulatory programs of the United states and each of the 50 states affecting the siting and operation of energy generating facilities likely to be used in Integrated Community Energy Systems (ICES). A brief summary of public utility regulatory programs, energy facility siting programs, and municipal franchising authority is presented in this report to identify how such programs and authority may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. Subsequent reports will (1) describe public utility rate regulatory procedures and practices as they might affect an ICES, (2) analyze each of the aforementioned regulatory programs to identify impediments to the development of ICES, and (3) recommend potential changes in legislation and regulatory practices and procedures to overcome such impediments.

  10. ROBO-SIM: a simulator for minimally invasive neurosurgery using an active manipulator.

    Science.gov (United States)

    Radetzky, A; Rudolph, M; Starkie, S; Davies, B; Auer, L M

    2000-01-01

    This application report describes the software system ROBO-SIM, which is a planning and simulation tool for minimally invasive neurosurgery. Using actual patient's datasets, ROBO-SIM includes all planning steps necessary. These are; defining the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track, performing virtual trepanations (virtual craniotomy), and defining sanctioned volumes for use with an intra-operative active manipulator. With the additional simulation part, neurosurgeons are able to simulate whole surgical interventions directly on the patient's anatomy using the same instruments as for the real operation. First tests with ROBO-SIM are performed on actual patient's datasets with ventricular tumours.

  11. Multiple sclerosis in Mexico: hospital cases at the National Institute of Neurology and Neurosurgery, Mexico City.

    Science.gov (United States)

    Corona, T; Rodrigues, J L; Otero, E; Stopp, L

    1996-05-01

    The frequency and clinical features of multiple sclerosis (MS) at the National Institute of Neurology and Neurosurgery in Mexico City for the period spanning 1984-1993 is presented. Hospital records of patients with clinically diagnosed MS were selected, the frequency and cumulative frequency of this diagnosis were determined and demographic information and clinical features were recorded. It was found that 70% of the patients were women, 25% were professionals, and 95% were of mixed race. The clinical features of our patients and their neuroimages were consistent with those of MS patients in other populations. Importantly, we found that the frequency of MS has almost doubled over the last 10 years. The reason for this phenomenon is discussed as resulting from better health screening, the availability of nuclear magnetic resonance imaging, and the cultural, demographic and dietary changes that have occurred due to the rapid urbanization of our country.

  12. Controlled Suction with Venous Catheter Irrigation in Neurosurgery: A Cost Effective Technique.

    Science.gov (United States)

    Panigrahi, Manas; Kumari, Manoranjitha; Vooturi, Sudhindra

    2017-01-01

    Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. We used a controlled suction cannula attached to a central suction system. A single lumen central venous catheter is passed through the keyhole of a controlled suction cannula, which is connected to a continuous irrigation system. The operative field was clean throughout the procedure, obviating the need for an assisting surgeon to irrigate into the deep operating field and, hence, reducing the duration of surgery. The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors.

    Science.gov (United States)

    Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T

    2015-09-01

    We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

  14. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique.

    Science.gov (United States)

    Besharati Tabrizi, Leila; Mahvash, Mehran

    2015-07-01

    An augmented reality system has been developed for image-guided neurosurgery to project images with regions of interest onto the patient's head, skull, or brain surface in real time. The aim of this study was to evaluate system accuracy and to perform the first intraoperative application. Images of segmented brain tumors in different localizations and sizes were created in 10 cases and were projected to a head phantom using a video projector. Registration was performed using 5 fiducial markers. After each registration, the distance of the 5 fiducial markers from the visualized tumor borders was measured on the virtual image and on the phantom. The difference was considered a projection error. Moreover, the image projection technique was intraoperatively applied in 5 patients and was compared with a standard navigation system. Augmented reality visualization of the tumors succeeded in all cases. The mean time for registration was 3.8 minutes (range 2-7 minutes). The mean projection error was 0.8 ± 0.25 mm. There were no significant differences in accuracy according to the localization and size of the tumor. Clinical feasibility and reliability of the augmented reality system could be proved intraoperatively in 5 patients (projection error 1.2 ± 0.54 mm). The augmented reality system is accurate and reliable for the intraoperative projection of images to the head, skull, and brain surface. The ergonomic advantage of this technique improves the planning of neurosurgical procedures and enables the surgeon to use direct visualization for image-guided neurosurgery.

  15. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    Directory of Open Access Journals (Sweden)

    Afolabi Muyiwa Owojuyigbe

    2016-01-01

    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  16. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    Science.gov (United States)

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  17. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2011-01-01

    Full Text Available Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a "before-after" design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1-125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6% of 177 in the control group and 73 (41.7% of 175 among the intervention group (P = 0.195. The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08. The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control and 92% (intervention. Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant.

  18. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    Science.gov (United States)

    Saramma, P. P.; Krishnakumar, K.; Dash, P. K.; Sarma, P. S.

    2011-01-01

    Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a “before–after” design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1–125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention). Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant. PMID:22346030

  19. Impact of insurance precertification on neurosurgery practice and health care delivery.

    Science.gov (United States)

    Menger, Richard P; Thakur, Jai Deep; Jain, Gary; Nanda, Anil

    2017-08-01

    OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables. RESULTS The most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and

  20. Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in the United States. Preliminary background report

    Energy Technology Data Exchange (ETDEWEB)

    Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.; Hejna, D.; Rielley, K.J.

    1980-01-01

    This report is one of a series of preliminary reports describing the laws and regulatory programs of the United States and each of the 50 states affecting the siting and operation of energy generating facilities likely to be used in Integrated Community Energy Systems (ICES). Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. This report describes laws and regulatory programs in the United States. Subsequent reports will (1) describe public utility rate regulatory procedures and practices as they might affect an ICES, (2) analyze each of the aforementioned regulatory programs to identify impediments to the development of ICES, and (3) recommend potential changes in legislation and regulatory practices and procedures to overcome such impediments.

  1. Seeking tools for image fusion between computed tomography, structural and functional magnetic resonance methods for applications in neurosurgery; Ferramentas para fusao de imagens dos metodos de tomografia computadorizada, ressonancia magnetica e ressonancia magnetica funcional para aplicacao pre-neurocirurgica

    Energy Technology Data Exchange (ETDEWEB)

    Rocha, Liana Guerra Sanches da, E-mail: liana@einstein.br [Departamento de Diagnostico por Imagem, Hospital Israelita Albert Einstein - HIAE, Sao Paulo (SP) (Brazil); Amaro Junior, Edson [Faculdade de Medicina, Universidade de Sao Paulo - USP, Sao Paulo, SP (Brazil). Deptartamento de Diagnostico por Imagem; Instituto do Cerebro - InCe, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil)

    2012-04-15

    To evaluate tools for the fusion of images generated by tomography and structural and functional magnetic resonance imaging. Methods: Magnetic resonance and functional magnetic resonance imaging were performed while a volunteer who had previously undergone cranial tomography performed motor and somatosensory tasks in a 3-Tesla scanner. Image data were analyzed with different programs, and the results were compared. Results: We constructed a flow chart of computational processes that allowed measurement of the spatial congruence between the methods. There was no single computational tool that contained the entire set of functions necessary to achieve the goal. Conclusion: The fusion of the images from the three methods proved to be feasible with the use of four free-access software programs (OsiriX, Register, MRIcro and FSL). Our results may serve as a basis for building software that will be useful as a virtual tool prior to neurosurgery. (author)

  2. The LARASE research program. State of the art on Modelling and Measurements of General Relativity effects in the field of the Earth: a preliminary measurement of the Lense-Thirring effect

    Science.gov (United States)

    Lucchesi, David M.; Magnafico, Carmelo; Peron, Roberto; Visco, Massimo; Anselmo, Luciano; Pardini, Carmen; Bassan, Massimo; Pucacco, Giuseppe; Stanga, Ruggero

    2017-08-01

    The LARASE research program is funded by the Italian National Institute for Nuclear Physics and it is a collaboration between different institutions. LARASE aims to provide very precise and accurate measurements of the General Relativity effects that perturb, from the Newtonian point of view, the trajectory of a satellite orbiting the Earth. The improvements obtained by the LARASE collaboration with respect to the previous year are presented in terms of orbit modelling, precise orbit determination and a preliminary measurement of the Lense-Thirring precession. A preliminary and partial estimate of the corresponding error budget is given and it is discussed with the main difficulties present, and to overcome in order to provide a definitive, robust and reliable estimate of the main systematic sources of error.

  3. The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up.

    Science.gov (United States)

    Sutiono, Agung Budi; Faried, Ahmad; McAllister, Susan; Ganefianty, Amelia; Sarjono, Kalih; Arifin, Muhammad Zafrullah; Derrett, Sarah

    2017-03-02

    Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients. Copyright © 2017 John Wiley & Sons, Ltd.

  4. The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care.

    Science.gov (United States)

    Asher, Anthony L; Speroff, Ted; Dittus, Robert S; Parker, Scott L; Davies, Jason M; Selden, Nathan; Nian, Hui; Glassman, Steven; Mummaneni, Praveen; Shaffrey, Christopher; Watridge, Clarence; Cheng, Joseph S; McGirt, Mathew J

    2014-10-15

    National Prospective Observational Registry. Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery. All major health care stakeholders are now requiring objective data regarding the value of medical services. Surgical therapies for spinal disorders have faced particular scrutiny in recent value-based discussions, in large part due to the dramatic growth in the cost and application of these procedures. Reliable data are fundamental to understanding the value of delivered health care. Clinical registries are increasingly used to provide such data. The NQOD is a prospective observational registry designed to establish risk-adjusted expected morbidity and 1-year outcomes for the most common lumbar surgical procedures performed by spine surgeons; provide practice groups and hospitals immediate infrastructure for analyzing their 30-day morbidity and mortality and 3- and 12-month quality data in real-time; generate surgeon-, practice-, and specialty-specific quality and efficacy data; and generate nationwide quality and effectiveness data on specific surgical treatments. In its first 2 years of operation, the NQOD has proven to be a robust data collection platform that has helped demonstrate the objective quality of surgical interventions for medically refractory disorders of the lumbar spine. Lumbar spine surgery was found to be safe and effective at the group mean level in routine practice. Subgroups of patients did not report improvement using validated outcome measures. Substantial variation in treatment response was observed among individual patients. The NQOD is now positioned to determine the combined contribution of patient variables to specific clinical and patient-reported outcomes. These analyses will ultimately facilitate shared decision making and encourage efficient allocation of health care resources, thus

  5. 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 neurosurgery curriculum is feasible and may enhance resident knowledge and technical proficiency. Copyright © 2015. Published by Elsevier Inc.

  6. CT-MR image data fusion for computer assisted navigated neurosurgery of temporal bone tumors

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, Stefan Franz [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria)]. E-mail: stefan.nemec@meduniwien.ac.at; Donat, Markus Alexander [Department of Neurosurgery, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Mehrain, Sheida [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Friedrich, Klaus [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Krestan, Christian [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Matula, Christian [Department of Neurosurgery, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Imhof, Herwig [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Czerny, Christian [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria)

    2007-05-15

    Purpose: To demonstrate the value of multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative work up of temporal bone tumors and to present, especially, CT and MR image fusion for surgical planning and performance in computer assisted navigated neurosurgery of temporal bone tumors. Materials and methods: Fifteen patients with temporal bone tumors underwent MDCT and MRI. MDCT was performed in high-resolution bone window level setting in axial plane. The reconstructed MDCT slice thickness was 0.8 mm. MRI was performed in axial and coronal plane with T2-weighted fast spin-echo (FSE) sequences, un-enhanced and contrast-enhanced T1-weighted spin-echo (SE) sequences, and coronal T1-weighted SE sequences with fat suppression and with 3D T1-weighted gradient-echo (GE) contrast-enhanced sequences in axial plane. The 3D T1-weighted GE sequence had a slice thickness of 1 mm. Image data sets of CT and 3D T1-weighted GE sequences were merged utilizing a workstation to create CT-MR fusion images. MDCT and MR images were separately used to depict and characterize lesions. The fusion images were utilized for interventional planning and intraoperative image guidance. The intraoperative accuracy of the navigation unit was measured, defined as the deviation between the same landmark in the navigation image and the patient. Results: Tumorous lesions of bone and soft tissue were well delineated and characterized by CT and MR images. The images played a crucial role in the differentiation of benign and malignant pathologies, which consisted of 13 benign and 2 malignant tumors. The CT-MR fusion images supported the surgeon in preoperative planning and improved surgical performance. The mean intraoperative accuracy of the navigation system was 1.25 mm. Conclusion: CT and MRI are essential in the preoperative work up of temporal bone tumors. CT-MR image data fusion presents an accurate tool for planning the correct surgical procedure and is a

  7. Health impact and economic analysis of NGO-supported neurosurgery in Bolivia.

    Science.gov (United States)

    Ament, Jared D; Greene, Kevin R; Flores, Ivan; Capobianco, Fernando; Salas, Gueider; Uriona, Maria Ines; Weaver, John P; Moser, Richard

    2014-04-01

    Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation. A non-governmental organization (NGO) supports spinal procedures in Bolivia (Solidarity Bridge), and the authors sought to determine its impact and cost-effectiveness. In a retrospective review of prospectively collected data, 19 patients were identified prior to spinal instrumentation and followed over 12 months. For inclusion, patients required interviewing prior to surgery and during at least 2 follow-up visits. All causes of spinal pathology were included. Sixteen patients met inclusion criteria and were therefore part of the analysis. Outcomes measured included assessment of activities of daily living, pain, ambulation, return to work/school, and satisfaction. Cost-effectiveness was determined by cost-utility analysis. Utilities were derived using the Health Utilities Index. Complications were incorporated into an expected value decision tree. Median (± SD) preoperative satisfaction was 2.0 ± 0.3 (on a scale of 0-10), while 6-month postoperative satisfaction was 7 ± 1.4 (p Bolivia appears to be cost-effective, especially when compared with the conventional $50,000/QALY benchmark and the WHO endorsed country-specific threshold of $16,026/QALY. However, with a gross domestic product per capita in Bolivia equaling $4800 per year and 30.3% of the population living on less than $2 per day, this cost continues to appear unrealistic. Additionally, the study has several significant limitations, namely its limited sample size, follow-up period, the assumption that patients not receiving surgical intervention would not make any clinical improvement, the reliance on the NGO for patient selection and sustainable practices

  8. Minimally invasive neurosurgery with interventional magnetic resonance. Its present and future

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo [Jikei Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    We have used X-ray fluoroscopy, ultrasonography, and computed tomography in treatment. However, these methods do not provide precise image. Since magnetic resonance (MR) provides high-resolution images, it is more suitable in treatment. Recently open-type MR has been introduced for clinical diagnosis and treatment. Interventional MR provides a real-time images, high-resolutional images, and thermal distribution. Open MR can be used for minimally invasive neurosurgery. Interventional MR (I-MR) can be used in treatment and is extremely useful for minimally invasive surgery of the brain and spinal cord. We have used an open-type permanent MR scanner (Airis, Hitachi), for minimally invasive neurosurgery. Stereotactic brain tumor biopsy, aspiration of intracerebral hematoma, and percutaneous laser disc hernia ablation under MR guidance has been performed in our department. I-MR provided precise, and less-invasive treatment. Stereotactic biopsy was done in 12 patients with brain tumors. Precise, accurate biopsy is possible with MR fluoroscopic guidance. Hematomas were also aspirated safely and precisely by monitoring real-time image. Percutaneous laser disc hernia ablation (PLDA) was done in 201 patients with lumbar disc herniation (127 at L4/5 and 48 at L5/S1). Patients ranged in age from 17 to 72 years. A MR-compatible 18-gauge 15-cm-long titanium needle was clearly visualized and safety and accurately inserted into the disc herniation from multiple directions. Laser ablation was done (mean, 1,000 J). Signs and symptoms improved immediately after ablation. The overall success rate was 90.5% (MacNab's criteria). Two patients (1.0%) had discitis after PLDA. I-MR and fluoroscopy provide near-real-time images for treatment of brain tumors and hematoma. Precise treatment can be performed with the Patil MR-compatible stereotactic system. PLDA was performed safety and accurately with I-MR. The results were satisfactory. I-MR-PLDA is a safe, precise, and minimally

  9. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Science.gov (United States)

    Phan, Pho Nh; Patel, Keyur; Bhavsar, Amar; Acharya, Vikas

    2016-01-01

    Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies - this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments.

  10. Knowledge modeling in image-guided neurosurgery: application in understanding intraoperative brain shift

    Science.gov (United States)

    Cohen-Adad, Julien; Paul, Perrine; Morandi, Xavier; Jannin, Pierre

    2006-03-01

    During an image-guided neurosurgery procedure, the neuronavigation system is subject to inaccuracy because of anatomical deformations which induce a gap between the preoperative images and their anatomical reality. Thus, the objective of many research teams is to succeed in quantifying these deformations in order to update preoperative images. Anatomical intraoperative deformations correspond to a complex spatio-temporal phenomenon. Our objective is to identify the parameters implicated in these deformations and to use these parameters as constrains for systems dedicated to updating preoperative images. In order to identify these parameters of deformation we followed the iterative methodology used for cognitive system conception: identification, conceptualization, formalization, implementation and validation. A state of the art about cortical deformations has been established in order to identify relevant parameters probably involved in the deformations. As a first step, 30 parameters have been identified and described following an ontological approach. They were formalized into a Unified Modeling Language (UML) class diagram. We implemented that model into a web-based application in order to fill a database. Two surgical cases have been studied at this moment. After having entered enough surgical cases for data mining purposes, we expect to identify the most relevant and influential parameters and to gain a better ability to understand the deformation phenomenon. This original approach is part of a global system aiming at quantifying and correcting anatomical deformations.

  11. Augmented-reality integrated robotics in neurosurgery: are we there yet?

    Science.gov (United States)

    Madhavan, Karthik; Kolcun, John Paul G; Chieng, Lee Onn; Wang, Michael Y

    2017-05-01

    Surgical robots have captured the interest-if not the widespread acceptance-of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. "Faster, better, cheaper" products should in theory conquer the market, but often fail. The psychology of change is complex, and the "follow the leader" mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons' dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots ("cobots"), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a "follow the leader" phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon's hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

  12. Computational and in vivo investigation of optical reflectance from human brain to assist neurosurgery.

    Science.gov (United States)

    Johns, M; Giller, C; Liu, H

    1998-10-01

    Parkinson's disease (PD) is a chronic, progressive disease involving the globus pallidus (GP), which is a gray matter mass, surrounded by white matter deep within the brain. During a neurosurgery procedure, a thin probe is inserted into the GP to create a lesion that often relieves the cardinal symptoms of PD. The goal of this study is to develop an optical method to accurately locate the GP border. In theory, Monte Carlo simulations were performed to predict the optical reflectance from brain tissue. In experiment, a portable, real-time display spectrometer with a fiber optic reflectance probe was developed and used during human surgery. Optical reflectance values were recorded at 1 mm intervals to obtain a spatial profile of the tissue as the probe passed through regions of gray and white matter. The simulation and in vivo studies of the reflectance from the brain are in good agreement with one another. The clinical data show that the reflectance from gray matter is approximately 50% or less than that from white matter between 650 and 800 nm. A slope algorithm is developed to distinguish gray and white matter in vivo. This study provides previously unknown optical reflectance of the human brain. © 1998 Society of Photo-Optical Instrumentation Engineers.

  13. Recording stereoscopic 3D neurosurgery with a head-mounted 3D camera system.

    Science.gov (United States)

    Lee, Brian; Chen, Brian R; Chen, Beverly B; Lu, James Y; Giannotta, Steven L

    2015-06-01

    Stereoscopic three-dimensional (3D) imaging can present more information to the viewer and further enhance the learning experience over traditional two-dimensional (2D) video. Most 3D surgical videos are recorded from the operating microscope and only feature the crux, or the most important part of the surgery, leaving out other crucial parts of surgery including the opening, approach, and closing of the surgical site. In addition, many other surgeries including complex spine, trauma, and intensive care unit procedures are also rarely recorded. We describe and share our experience with a commercially available head-mounted stereoscopic 3D camera system to obtain stereoscopic 3D recordings of these seldom recorded aspects of neurosurgery. The strengths and limitations of using the GoPro(®) 3D system as a head-mounted stereoscopic 3D camera system in the operating room are reviewed in detail. Over the past several years, we have recorded in stereoscopic 3D over 50 cranial and spinal surgeries and created a library for education purposes. We have found the head-mounted stereoscopic 3D camera system to be a valuable asset to supplement 3D footage from a 3D microscope. We expect that these comprehensive 3D surgical videos will become an important facet of resident education and ultimately lead to improved patient care.

  14. Foramen magnum meningioma’s management: the experience of the department of neurosurgery in Marrakesh

    Science.gov (United States)

    Hajhouji, Farouk; Lmejjati, Mohammed; Aniba, Khalid; Laghmari, Mehdi; Ghannane, Houssine; Benali, Said Ait

    2017-01-01

    Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer. PMID:28451020

  15. Foramen magnum meningioma's management: the experience of the department of neurosurgery in Marrakesh.

    Science.gov (United States)

    Hajhouji, Farouk; Lmejjati, Mohammed; Aniba, Khalid; Laghmari, Mehdi; Ghannane, Houssine; Benali, Said Ait

    2017-01-01

    Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.

  16. Center of excellence in research reporting in neurosurgery--diagnostic ontology.

    Directory of Open Access Journals (Sweden)

    Amrapali Zaveri

    Full Text Available MOTIVATION: Evidence-based medicine (EBM, in the field of neurosurgery, relies on diagnostic studies since Randomized Controlled Trials (RCTs are uncommon. However, diagnostic study reporting is less standardized which increases the difficulty in reliably aggregating results. Although there have been several initiatives to standardize reporting, they have shown to be sub-optimal. Additionally, there is no central repository for storing and retrieving related articles. RESULTS: In our approach we formulate a computational diagnostic ontology containing 91 elements, including classes and sub-classes, which are required to conduct Systematic Reviews-Meta Analysis (SR-MA for diagnostic studies, which will assist in standardized reporting of diagnostic articles. SR-MA are studies that aggregate several studies to come to one conclusion for a particular research question. We also report high percentage of agreement among five observers as a result of the interobserver agreement test that we conducted among them to annotate 13 articles using the diagnostic ontology. Moreover, we extend our existing repository CERR-N to include diagnostic studies. AVAILABILITY: The ontology is available for download as an.owl file at: http://bioportal.bioontology.org/ontologies/3013.

  17. A meningioma and its consequences for American history and the rise of neurosurgery.

    Science.gov (United States)

    Ansari, Shaheryar F; Gianaris, Nicholas G; Cohen-Gadol, Aaron A

    2011-12-01

    The case of General Leonard Wood is notable both for its contribution to the field of neurosurgery and its historical significance. As one of Harvey Cushing's first successful brain tumor operations in 1910, Wood's surgery was part of the case series that culminated in Cushing's monograph Meningioma. This case was important to the rise of Cushing's career and his recognition as a member of the next generation of neurosurgeons who did not settle for mere bony decompression to taper intracranial tension but who dared to pursue intradural resections-operations that had been performed by surgeons for decades but were frowned upon because of the attendant risks. Cushing's operation to remove a recurrent brain tumor ended Wood's life in 1927. The authors discuss the effects the tumor may have had on Wood's life and career, explore an alternate explanation for the cause of Wood's death, and provide a brief account of the life of General Wood, highlighting events in his military and administrative career juxtaposed against the progression of his illness. Furthermore, the case history of the General is reviewed, using information drawn from the original patient notes and recently discovered images from the Cushing Brain Tumor Registry that elucidate more details about General Wood's story, from the injury that caused his first tumor to his final surgery, leading to his demise.

  18. [Modern day psychosurgery: a new approach to neurosurgery in psychiatric disease].

    Science.gov (United States)

    Pedrosa-Sánchez, M; Sola, R G

    To obtain an up to date review of the different possible surgical approaches in the management of certain psychiatric disorders that are refractory to conservative treatment (pharmacotherapy, psychotherapy, electroconvulsive therapy). In order to conduct this research we reviewed the work published by centres with the most experience in this type of surgery, mainly in North America and Europe, since its beginnings in the 1930s, with the controversy concerning prefrontal leucotomy, until the appearance of modern stereotactic techniques. We analyse the anatomophysiological bases, their main clinical indications, the surgical techniques used and their results, as well as perspectives for the future of this neurosurgical treatment. The most noteworthy progress in psychosurgery in recent years has been the combination of a more rigorous selection of patients and the higher degree of specificity with which treatment is performed on the brain structures involved in psychiatric disease. The most widely employed psychosurgical procedures at present are cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy and postero medial hypothalamotomy, with favourable responses in about 35 70% of cases. The psychiatric diagnoses where the best results are to be found are obsessive compulsive disorder, chronic anxiety states and major depression. Current progress in neuroimaging techniques, increased neurophysiological knowledge and the revolutionary neuromodulation techniques, especially deep brain stimulation, offer an even more promising future for psychiatric neurosurgery.

  19. From trephination to tailored resection: neurosurgery in Germany before World War II.

    Science.gov (United States)

    Buchfelder, Michael

    2005-03-01

    Evidence exists that trephination was performed in Germany as early as the Stone Age. Late medieval barber surgeons further developed instruments and techniques for this procedure. Various surgeons performed individual cranial operations before the 1870s, and neurosurgery evolved as a distinct discipline in Germany around 1934. Before the 20th century, most cranial operations in Germany, as in other European countries, were performed for trauma. Since approximately 1870, a few individuals with a devoted interest in surgery of the nervous system have developed operative techniques for the brain and spinal cord. Wilhelm Wagner, Fedor Krause, Ernst von Bergmann, and Otfrid Foerster were among these pioneers. Through independent research based on careful clinical observation, these physicians contributed significantly to an understanding of the pathophysiology of nervous system disorders that could be treated surgically. They designed techniques, such as those used for intracranial pressure regulation, and developed operative procedures, such as the osteoplastic flap of Wagner, and cortical stimulation, which was performed by Krause and Foerster.

  20. Accurate multi-robot targeting for keyhole neurosurgery based on external sensor monitoring.

    Science.gov (United States)

    Comparetti, Mirko Daniele; Vaccarella, Alberto; Dyagilev, Ilya; Shoham, Moshe; Ferrigno, Giancarlo; De Momi, Elena

    2012-05-01

    Robotics has recently been introduced in surgery to improve intervention accuracy, to reduce invasiveness and to allow new surgical procedures. In this framework, the ROBOCAST system is an optically surveyed multi-robot chain aimed at enhancing the accuracy of surgical probe insertion during keyhole neurosurgery procedures. The system encompasses three robots, connected as a multiple kinematic chain (serial and parallel), totalling 13 degrees of freedom, and it is used to automatically align the probe onto a desired planned trajectory. The probe is then inserted in the brain, towards the planned target, by means of a haptic interface. This paper presents a new iterative targeting approach to be used in surgical robotic navigation, where the multi-robot chain is used to align the surgical probe to the planned pose, and an external sensor is used to decrease the alignment errors. The iterative targeting was tested in an operating room environment using a skull phantom, and the targets were selected on magnetic resonance images. The proposed targeting procedure allows about 0.3 mm to be obtained as the residual median Euclidean distance between the planned and the desired targets, thus satisfying the surgical accuracy requirements (1 mm), due to the resolution of the diffused medical images. The performances proved to be independent of the robot optical sensor calibration accuracy.

  1. Neurosurgery Simulation Using Non-linear Finite Element Modeling and Haptic Interaction.

    Science.gov (United States)

    Lee, Huai-Ping; Audette, Michel; Joldes, Grand Roman; Enquobahrie, Andinet

    2012-02-23

    Real-time surgical simulation is becoming an important component of surgical training. To meet the real-time requirement, however, the accuracy of the biomechancial modeling of soft tissue is often compromised due to computing resource constraints. Furthermore, haptic integration presents an additional challenge with its requirement for a high update rate. As a result, most real-time surgical simulation systems employ a linear elasticity model, simplified numerical methods such as the boundary element method or spring-particle systems, and coarse volumetric meshes. However, these systems are not clinically realistic. We present here an ongoing work aimed at developing an efficient and physically realistic neurosurgery simulator using a non-linear finite element method (FEM) with haptic interaction. Real-time finite element analysis is achieved by utilizing the total Lagrangian explicit dynamic (TLED) formulation and GPU acceleration of per-node and per-element operations. We employ a virtual coupling method for separating deformable body simulation and collision detection from haptic rendering, which needs to be updated at a much higher rate than the visual simulation. The system provides accurate biomechancial modeling of soft tissue while retaining a real-time performance with haptic interaction. However, our experiments showed that the stability of the simulator depends heavily on the material property of the tissue and the speed of colliding objects. Hence, additional efforts including dynamic relaxation are required to improve the stability of the system.

  2. Rivaling Paradigms in Psychiatric Neurosurgery: Adjustability versus Quick Fix versus Minimal-Invasiveness

    Directory of Open Access Journals (Sweden)

    Müller eSabine

    2015-04-01

    Full Text Available In the wake of deep brain stimulation (DBS development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970ies because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: Microsurgical ablative procedures is based on the paradigm ‘quick fix’, radiosurgery on the paradigm ‘minimal-invasiveness’, and DBS on the paradigm ‘adjustability’.From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients’ social situation, individual preferences, and individual attitudes.The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.

  3. Rivaling paradigms in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness.

    Science.gov (United States)

    Müller, Sabine; Riedmüller, Rita; van Oosterhout, Ansel

    2015-01-01

    In the wake of deep brain stimulation (DBS) development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970s because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife) are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: microsurgical ablative procedures is based on the paradigm 'quick fix,' radiosurgery on the paradigm 'minimal-invasiveness,' and DBS on the paradigm 'adjustability.' From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients' social situation, individual preferences, and individual attitudes. The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.

  4. High risk factors for pulmonary fungous infection in intensive care units of neurosurgery

    Institute of Scientific and Technical Information of China (English)

    ZHU Wenyu; TAN Liping; CHEN Xiangfeng; HUANG Qiang; LAN Qing

    2007-01-01

    By analyzing the high risk factors for pulmonary fungous infection in intensive care units of neurosurgery,the strategy of early diagnosis and treatment was explored.According to the domestic diagnostic standard on pulmonary fungous infection.clinical data on 58 patients with the infection in our department were analyzed.One hundred and seventeen strains of fungi were separated from the 58 cases.Candidiasis was the most frequent type,accounting for 92.3% of the cases.Conditions such as the severity of primary diseases,long-time coma,long-term use of broad-spectrum antibiotic,abuse of glucocorticoid,the open airway,and some invasive intubations,may be regarded as high risk factors for pulmonary fungous infection.Fluconazole showed good clinical effects on the treatment of fungous infection.Tb eliminate these high risk factors,early diagnosis and the use of prophylactic antifungal agents can help reduce the incidence of pulmonary fungous infection.

  5. Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities.

    Science.gov (United States)

    Kahn, Elyne N; La Marca, Frank; Mazzola, Catherine A

    2016-05-01

    Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies. Despite technologic development, growing interest, and increasing reimbursement opportunities, telemedicine's utilization remains limited because of concerns regarding an apparent lack of need for telemedicine services, lack of widespread reimbursement, lack of interstate licensure reciprocity, lack of universal access to necessary technology, concerns about maintaining patient confidentiality, and concerns and limited precedent regarding liability issues. The Veterans Health Administration, a component of the U.S. Department of Veterans Affairs, represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurologic conditions. Overall, the economic and clinical benefits of telemedicine will likely come from 1) diminished travel times and lost work time for patients; 2) remote consultation of subspecialty experts, such as neurosurgeons; and 3) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and "teletrauma." Telemedicine is effective in many health care scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine's growth. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Fiber-based tissue identification for electrode placement in deep brain stimulation neurosurgery (Conference Presentation)

    Science.gov (United States)

    DePaoli, Damon T.; Lapointe, Nicolas; Goetz, Laurent; Parent, Martin; Prudhomme, Michel; Cantin, Léo.; Galstian, Tigran; Messaddeq, Younès.; Côté, Daniel C.

    2016-03-01

    Deep brain stimulation's effectiveness relies on the ability of the stimulating electrode to be properly placed within a specific target area of the brain. Optical guidance techniques that can increase the accuracy of the procedure, without causing any additional harm, are therefore of great interest. We have designed a cheap optical fiber-based device that is small enough to be placed within commercially available DBS stimulating electrodes' hollow cores and that is capable of sensing biological information from the surrounding tissue, using low power white light. With this probe we have shown the ability to distinguish white and grey matter as well as blood vessels, in vitro, in human brain samples and in vivo, in rats. We have also repeated the in vitro procedure with the probe inserted in a DBS stimulating electrode and found the results were in good agreement. We are currently validating a second fiber optic device, with micro-optical components, that will result in label free, molecular level sensing capabilities, using CARS spectroscopy. The final objective will be to use this data in real time, during deep brain stimulation neurosurgery, to increase the safety and accuracy of the procedure.

  7. Neurosurgery simulation using non-linear finite element modeling and haptic interaction

    Science.gov (United States)

    Lee, Huai-Ping; Audette, Michel; Joldes, Grand R.; Enquobahrie, Andinet

    2012-02-01

    Real-time surgical simulation is becoming an important component of surgical training. To meet the realtime requirement, however, the accuracy of the biomechancial modeling of soft tissue is often compromised due to computing resource constraints. Furthermore, haptic integration presents an additional challenge with its requirement for a high update rate. As a result, most real-time surgical simulation systems employ a linear elasticity model, simplified numerical methods such as the boundary element method or spring-particle systems, and coarse volumetric meshes. However, these systems are not clinically realistic. We present here an ongoing work aimed at developing an efficient and physically realistic neurosurgery simulator using a non-linear finite element method (FEM) with haptic interaction. Real-time finite element analysis is achieved by utilizing the total Lagrangian explicit dynamic (TLED) formulation and GPU acceleration of per-node and per-element operations. We employ a virtual coupling method for separating deformable body simulation and collision detection from haptic rendering, which needs to be updated at a much higher rate than the visual simulation. The system provides accurate biomechancial modeling of soft tissue while retaining a real-time performance with haptic interaction. However, our experiments showed that the stability of the simulator depends heavily on the material property of the tissue and the speed of colliding objects. Hence, additional efforts including dynamic relaxation are required to improve the stability of the system.

  8. Preliminary comparison of the Essie and PubMed search engines for answering clinical questions using MD on Tap, a PDA-based program for accessing biomedical literature.

    Science.gov (United States)

    Sutton, Victoria R; Hauser, Susan E

    2005-01-01

    MD on Tap, a PDA application that searches and retrieves biomedical literature, is specifically designed for use by mobile healthcare professionals. With the goal of improving the usability of the application, a preliminary comparison was made of two search engines (PubMed and Essie) to determine which provided most efficient path to the desired clinically-relevant information.

  9. Use of viber app: A fast, easy and cost effective method of communication in neurosurgery

    Directory of Open Access Journals (Sweden)

    Amit Thapa

    2013-01-01

    Full Text Available Objective: Neurosurgeons often have to rely on judgments of junior staffs to decide on patients whom they cannot attend immediately. Viber is a free to use application for image transfer on Internet. We evaluated the use of viber in neurosurgical scenario, to show it is cheap, fast, accessible, reliable and feasible. Materials and Methods: We conducted a prospective study from March 2013 to July 2013. Residents were taught to take sharp pictures and upload them immediately using viber on Internet. Primary endpoints were discordance between opinion of residents and consultants on viber images and subsequent actual image evaluation and time delay in decision-making. Discordance was considered significant if it changed management decision. Results: During the study period, 120 (mean age: 42 years, 58% males patients were enrolled. Wi-Fi is freely available in the institute and thus no costs were involved. Decision could be made on images received on viber at an average of 20 min. There was discordance in 56.7% cases between residents′ reports and images on viber, which was significant in 88.2% cases. However in 5% cases decision changed after actual images were reviewed. Of all imaging modalities, computed tomography angiographic images were associated with statistically significant discordance (P <0.05. Conclusion: This study suggests that the use of viber app in neurosurgery can be an easy fast reliable and almost free mode of communicating images enabling a quick decision. However this cost-effective method should be used with caution particularly with imaging modalities, which require processing and review on console.

  10. Developing a new model for the invention and translation of neurotechnologies in academic neurosurgery.

    Science.gov (United States)

    Leuthardt, Eric C

    2013-01-01

    There is currently an acceleration of new scientific and technical capabilities that create new opportunities for academic neurosurgery. To engage these changing dynamics, the Center for Innovation in Neuroscience and Technology (CINT) was created on the premise that successful innovation of device-related ideas relies on collaboration between multiple disciplines. The CINT has created a unique model that integrates scientific, medical, engineering, and legal/business experts to participate in the continuum from idea generation to translation. To detail the method by which this model has been implemented in the Department of Neurological Surgery at Washington University in St. Louis and the experience that has been accrued thus far. The workflow is structured to enable cross-disciplinary interaction, both intramurally and extramurally between academia and industry. This involves a structured method for generating, evaluating, and prototyping promising device concepts. The process begins with the "invention session," which consists of a structured exchange between inventors from diverse technical and medical backgrounds. Successful ideas, which pass a separate triage mechanism, are then sent to industry-sponsored multidisciplinary fellowships to create functioning prototypes. After 3 years, the CINT has engaged 32 clinical and nonclinical inventors, resulting in 47 ideas, 16 fellowships, and 12 patents, for which 7 have been licensed to industry. Financial models project that if commercially successful, device sales could have a notable impact on departmental revenue. The CINT is a model that supports an integrated approach from the time an idea is created through its translational development. To date, the approach has been successful in creating numerous concepts that have led to industry licenses. In the long term, this model will create a novel revenue stream to support the academic neurosurgical mission.

  11. Max Brödel: his art, legacy, and contributions to neurosurgery through medical illustration.

    Science.gov (United States)

    Patel, Smruti K; Couldwell, William T; Liu, James K

    2011-07-01

    Max Brödel is considered the father of modern medical illustration. This report reviews his contributions to neurosurgery as a medical illustrator. Max Brödel, a young artist from Leipzig, Germany, was hired at Johns Hopkins Hospital in 1894, where he illustrated an operative textbook of gynecology for Howard A. Kelly. Although Brödel did not have any formal medical training, he quickly acquired knowledge of anatomy, pathology, physiology, and surgery. Brödel's extraordinary illustrations were characterized by an aerial perspective that conveyed the surgeon's operative viewpoint and precise surgical anatomy. He masterfully incorporated tissue realism with cross-sectional anatomy to accentuate concepts while maintaining topographical accuracy. Brödel's reputation spread quickly and resulted in collaborations with prominent surgeons, such as Cushing, Halsted, and Dandy. Cushing, who also possessed artistic talent, became a pupil of Brödel and remained a very close friend. In 1911, Brödel was appointed the director of the Department of Art as Applied to Medicine at Johns Hopkins, the first academic department of its kind in the world. For the next several decades, he trained generations of renowned medical illustrators. Just as Osler, Halsted, and Cushing passed their skills and knowledge to future leaders of medicine and surgery, Brödel did the same for the field of medical illustration. The advancement of neurosurgical education has been greatly facilitated by Max Brödel's artistic contributions. His unique ability to synthesize art and medicine resulted in timeless illustrations that remain indispensable to surgeons. The art produced by his legacy of illustrators continues to flourish in neurosurgical literature today.

  12. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Science.gov (United States)

    Alva-Sánchez, Héctor; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús

    2014-11-01

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  13. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

    Directory of Open Access Journals (Sweden)

    Wilfred C Mezue

    2012-01-01

    Full Text Available Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

  14. Localization and registration accuracy in image guided neurosurgery: a clinical study.

    Science.gov (United States)

    Shamir, Reuben R; Joskowicz, Leo; Spektor, Sergey; Shoshan, Yigal

    2009-01-01

    To measure and compare the clinical localization and registration errors in image-guided neurosurgery, with the purpose of revising current assumptions. Twelve patients who underwent brain surgeries with a navigation system were randomly selected. A neurosurgeon localized and correlated the landmarks on preoperative MRI images and on the intraoperative physical anatomy with a tracked pointer. In the laboratory, we generated 612 scenarios in which one landmark pair was defined as the target and the remaining ones were used to compute the registration transformation. Four errors were measured: (1) fiducial localization error (FLE); (2) target registration error (TRE); (3) fiducial registration error (FRE); (4) Fitzpatrick's target registration error estimation (F-TRE). We compared the different errors and computed their correlation. The image and physical FLE ranges were 0.5-2.0 and 1.6-3.0 mm, respectively. The measured TRE, FRE and F-TRE were 4.1 +/- 1.6, 3.9 +/- 1.2, and 3.7 +/- 2.2 mm, respectively. Low correlations of 0.19 and 0.37 were observed between the FRE and TRE and between the F-TRE and the TRE, respectively. The differences of the FRE and F-TRE from the TRE were 1.3 +/- 1.0 mm (max = 5.5 mm) and 1.3 +/- 1.2 mm (max = 7.3 mm), respectively. Contrary to common belief, the FLE presents significant variations. Moreover, both the FRE and the F-TRE are poor indicators of the TRE in image-to-patient registration.

  15. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alva-Sánchez, Héctor, E-mail: halva@ciencias.unam.mx [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico); Reynoso-Mejía, Alberto [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F., Mexico and Departamento de Neuroimagen, Instituto Nacional de (Mexico); Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús [Departamento de Neuroimagen, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico)

    2014-11-07

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  16. Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit.

    Science.gov (United States)

    Haliasos, N; Rezajooi, K; O'neill, K S; Van Dellen, J; Hudovsky, Anita; Nouraei, Sar

    2010-04-01

    Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

  17. Impressions of neurology and neurosurgery in the People's Republic of China.

    Science.gov (United States)

    Tower, D B; Feindel, W

    1980-05-01

    During July, 1979, the authors visited the neurological and neurosurgical services of eight major hospitals and associated medical schools in Peking, Tientsin, and Shanghai, and viewed many of their teaching and research facilities. From these visits and our discussions with the staffs of these units, we came away with the impressions reported here. In the People's Republic of China today there are more than 2,000 neurologists and 1,300 neurosurgeons. At present there are two major clinical centers: the Peking Institute of Neurosurgery, directed by Prof Wang Chung-Cheng and located in the Xuan Wu Hospital affiliated with the Peking First Medical College; and the Shanghai Institute of Neurology, directed by Prof Chang Yuan-Cheng and located in the Hua San Hospital affiliated with the Shanghai First Medical College. In every hospital, patient loads are formidable (e.g., several thousand outpatients weekly), but the variety of clinical problems does not differ from those seen elsewhere in the world. The most common problems are head injuries, brain tumors, cerebrovascular disorders, infections, and epilepsy. Each of the centers is heavily engaged in undergraduate and postgraduate training, and research has been resumed after the major disruptions of the 1966-76 "Cultural Revolution." Research continues on acupuncture, but present emphasis is directed toward pain mechanisms, notably at the Shanghai Institute of Physiology, directed by Prof Feng De-Pei. We were most impressed by this, the principal neurophysiology and neuroscience research center in the country. Clearly, the People's Republic of China has a wealth of clinical material and many competent neurologists and neurosurgeons with stimulating research ideas-characteristics which offer real potentials for collaborative research.

  18. Organizing Evidence Based Medicine (EBM) Journal Clubs in Department of Neurosurgery, Tabriz University of Medical Sciences.

    Science.gov (United States)

    Shokouhi, Ghaffar; Ghojazadeh, Morteza; Sattarnezhad, Neda

    2012-01-01

    A journal club is a group of individuals who meet regularly to evaluate critically the clinical application of latest medical literature. Evidence-based medicine (EBM) is 'the use of current best evidence, in making decisions about the care of individual patients'. For this purpose, we organized journal clubs using standard EBM method, to substitute for traditional ones, evaluating efficacy of evidence based meetings in improvement of medical education in department of Neurosurgery. After six traditional journal clubs two validated questionnaires (evaluating organizing method and degree of satisfaction), were filled out by the residents. After an instructing workshop and six evidence based journal sessions, the same questionnaires were completed by the attendees. The collected data were analyzed using SPSS 17. The mean score of the first questionnaires (Evaluating the method of organizing sessions) 16.72±7.86 (median=14) for traditional journal clubs and 40.18±6.38 (median=40) for evidence based forms (P=0.003).The mean grade of the second questionnaires (degree of satisfaction) was 13.18±4.6 (median=14) and 21.90±4.27 (median=22), for traditional and evidence based ones, respectively. (P=0.006). The aim of evidence based journal club is to help individuals to evaluate the current literature critically. The best way to decide if any adjustments are necessary is to ask the participants whether they are satisfied with the conference. As improvement of critical judgment is the goal of the journal clubs, the response of the resident according to the knowledge of methodology and biostatistics, is a principle. In present study, significant improvement in critical appraisal skills was seen after holding evidence based journal clubs.

  19. Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

    Science.gov (United States)

    Davies, B M; Patel, H C

    2016-07-01

    Introduction Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. Methods We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination. Results SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02-0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24-1.5). Conclusions Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

  20. Retractor-induced brain shift compensation in image-guided neurosurgery

    Science.gov (United States)

    Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

    2013-03-01

    In image-guided neurosurgery, intraoperative brain shift significantly degrades the accuracy of neuronavigation that is solely based on preoperative magnetic resonance images (pMR). To compensate for brain deformation and to maintain the accuracy in image guidance achieved at the start of surgery, biomechanical models have been developed to simulate brain deformation and to produce model-updated MR images (uMR) to compensate for brain shift. To-date, most studies have focused on shift compensation at early stages of surgery (i.e., updated images are only produced after craniotomy and durotomy). Simulating surgical events at later stages such as retraction and tissue resection are, perhaps, clinically more relevant because of the typically much larger magnitudes of brain deformation. However, these surgical events are substantially more complex in nature, thereby posing significant challenges in model-based brain shift compensation strategies. In this study, we present results from an initial investigation to simulate retractor-induced brain deformation through a biomechanical finite element (FE) model where whole-brain deformation assimilated from intraoperative data was used produce uMR for improved accuracy in image guidance. Specifically, intensity-encoded 3D surface profiles at the exposed cortical area were reconstructed from intraoperative stereovision (iSV) images before and after tissue retraction. Retractor-induced surface displacements were then derived by coregistering the surfaces and served as sparse displacement data to drive the FE model. With one patient case, we show that our technique is able to produce uMR that agrees well with the reconstructed iSV surface after retraction. The computational cost to simulate retractor-induced brain deformation was approximately 10 min. In addition, our approach introduces minimal interruption to the surgical workflow, suggesting the potential for its clinical application.

  1. Position statement from the Italian Society of Neurosurgery on the ARUBA Study.

    Science.gov (United States)

    Cenzato, Marco; Delitala, Alberto; Delfini, Roberto; Pasqualin, Alberto; Maira, Giulio; Esposito, Vincenzo; Tomasello, Francesco; Boccardi, Edoardo

    2016-03-01

    As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated with endovascular or radiotherapy treatments, alone or in combination. Only 18 patients (19%) had surgery. It is well known that a partial treatment of arteriovenous malformations (AVMs), as is often the case with endovascular therapy, may increase the risk of bleeding. The primary endpoint (death or symptomatic stroke) in the treated group was reached in 30.7%, i.e. almost one-third of the subjects. This has no comparison in the current surgical literature. Considering permanent and transient neurological deficits along with headaches and seizures all together in the same outcome evaluation parameter may be inappropriate and misleading. The graph with all results from the ARUBA Study, which claims to be the demonstration that natural history is better that treatment, clearly shows that what is assumed to be treated has not actually been treated. If death or stroke occur a few years from treatment, it only means that the disease was not cured and patients received a partial - therefore ineffective, if not dangerous - treatment. An effective treatment, as surgery is, must have a flat follow-up curve. The ARUBA Study shows that incomplete treatment leads to negative outcome, confirming that an integrated multidisciplinary strategy has to be plotted out before starting any treatment and that a complete exclusion of the AVM must be achieved.

  2. The impact of a patient education bundle on neurosurgery patient satisfaction

    Directory of Open Access Journals (Sweden)

    Tamara Kliot

    2015-01-01

    Full Text Available Background: As reimbursements and hospital/physician performance become ever more reliant on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS and other quality metrics, physicians are increasingly incentivized to improve patient satisfaction. Methods: A faculty and resident team at the University of California, San Francisco (UCSF Department of Neurological Surgery developed and implemented a Patient Education Bundle. This consisted of two parts: The first was preoperative expectation letters (designed to inform patients of what to expect before, during, and after their hospitalization for a neurosurgical procedure; the second was a trifold brochure with names, photographs, and specialty/training information about the attending surgeons, resident physicians, and nurse practitioners on the neurosurgical service. We assessed patient satisfaction, as measured by HCAHPS scores and a brief survey tailored to our specific intervention, both before and after our Patient Education Bundle intervention. Results: Prior to our intervention, 74.6% of patients responded that the MD always explained information in a way that was easy to understand. After our intervention, 78.7% of patients responded that the MD always explained information in a way that was easy to understand. "Neurosurgery Patient Satisfaction survey" results showed that 83% remembered receiving the preoperative letter; of those received the letter, 93% found the letter helpful; and 100% thought that the letter should be continued. Conclusion: Although effects were modest, we believe that patient education strategies, as modeled in our bundle, can improve patients′ hospital experiences and have a positive impact on physician performance scores and hospital ratings.

  3. The DTI Challenge: Towards Standardized Evaluation of Diffusion Tensor Imaging Tractography for Neurosurgery

    Science.gov (United States)

    Pujol, Sonia; Wells, William; Pierpaoli, Carlo; Brun, Caroline; Gee, James; Cheng, Guang; Vemuri, Baba; Commowick, Olivier; Prima, Sylvain; Stamm, Aymeric; Goubran, Maged; Khan, Ali; Peters, Terry; Neher, Peter; Maier-Hein, Klaus H.; Shi, Yundi; Tristan-Vega, Antonio; Veni, Gopalkrishna; Whitaker, Ross; Styner, Martin; Westin, Carl-Fredrik; Gouttard, Sylvain; Norton, Isaiah; Chauvin, Laurent; Mamata, Hatsuho; Gerig, Guido; Nabavi, Arya; Golby, Alexandra; Kikinis, Ron

    2015-01-01

    Background and Purpose Diffusion tensor imaging tractography reconstruction of white matter pathways can help guide brain tumor resection. However, DTI tracts are complex mathematical objects and the validity of tractography-derived information in clinical settings has yet to be fully established. To address this issue, we initiated the DTI Challenge, an international working group of clinicians and scientists whose goal was to provide standardized evaluation of tractography methods for neurosurgery. The purpose of this empirical study was to evaluate different tractography techniques in the first DTI Challenge workshop. Methods Eight international teams from leading institutions reconstructed the pyramidal tract in four neurosurgical cases presenting with a glioma near the motor cortex. Tractography methods included deterministic, probabilistic, filtered, and global approaches. Standardized evaluation of the tracts consisted in the qualitative review of the pyramidal pathways by a panel of neurosurgeons and DTI experts and the quantitative evaluation of the degree of agreement among methods. Results The evaluation of tractography reconstructions showed a great inter-algorithm variability. Although most methods found projections of the pyramidal tract from the medial portion of the motor strip, only a few algorithms could trace the lateral projections from the hand, face, and tongue area. In addition, the structure of disagreement among methods was similar across hemispheres despite the anatomical distortions caused by pathological tissues. Conclusions The DTI Challenge provides a benchmark for the standardized evaluation of tractography methods on neurosurgical data. This study suggests that there are still limitations to the clinical use of tractography for neurosurgical decision-making. PMID:26259925

  4. The 2009 devaluation of radiosurgery and its impact on the neurosurgery-radiation oncology partnership.

    Science.gov (United States)

    Heilbrun, M Peter; Adler, John R

    2010-07-01

    Neurosurgeons, radiation oncologists, and, increasingly, other surgical specialists recognize that radiosurgery is an important tool for managing selected disorders throughout the body. The partnership between neurosurgeons and radiation oncologists has resulted in collaborative studies that have established the clinical benefits of radiosurgery. Today, however, a range of political and financial issues is straining this relationship and thereby undermining the practice of radiosurgery. Neurosurgeons and radiation oncologists recently restricted the definition of radiosurgery to include only cranial- and spine-focused radiation treatments. Meanwhile, organized radiation oncology decided unilaterally that radiosurgery administered to other parts of the body would be termed stereotactic body radiation therapy. Finally, neurosurgical and radiation oncology coding experts developed new Current Procedural Terminology codes for cranial vault and spine radiosurgery, which were approved for use by the Relative Value Scale Update Committee as of 2009. The authors suggest that the neurosurgery strategy-which included 1) reasserting that all of the tasks of a radiosurgery procedure remain bundled, and 2) agreeing to limit the definition of radiosurgery to cranial vault and spine-has failed neurosurgeons who perform radiosurgery, and it may jeopardize patient access to this procedure in the future. The authors propose that all of the involved medical specialties recognize that the application of image-guided, focused radiation therapy throughout the body requires a partnership between radiation and surgical disciplines. They also urge surgeons to reexamine their coding methods, and they maintain that Current Procedural Terminology codes should be consistent across all of the different specialties involved in these procedures. Finally, surgeons should consider appropriate training in medical physics and radiobiology to perform the tasks involved in these specific procedures

  5. First Experiences in Intensity Modulated Radiation Surgery at the National Institute of Neurology and Neurosurgery: A Dosimetric Point of View

    Science.gov (United States)

    Lárraga-Gutiérrez, José M.; Celis-López, Miguel A.

    2003-09-01

    The National Institute of Neurology and Neurosurgery in Mexico City has acquired a Novalis® shaped beam radiosurgery unit. The institute is pioneer in the use of new technologies for neuroscience. The Novalis® unit allows the use of conformal beam radiosurgery/therapy and the more advanced modality of conformal therapy: Intensity Modulated Radiation Therapy (IMRT). In the present work we present the first cases of treatments that use the IMRT technique and show its ability to protect organs at risk, such as brainstem and optical vias.

  6. Reducing children's aggressive and oppositional behaviors in the schools: Preliminary results on the effectiveness of a social-cognitive group intervention program

    NARCIS (Netherlands)

    P.E.H.M. Muris (Peter); C.M.G. Meesters (Cor); M. Vincken (Manon); A. Eijkelenboom (Anneke)

    2005-01-01

    textabstractThis study examined the effects of a social-cognitive group intervention program for children with oppositional and aggressive behaviors. Forty-two children aged between 9 and 12 years who clearly displayed behavior problems at school were treated with this program. A cross-over design

  7. A Preliminary Trial of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program for Young Women with Body Image Concerns

    Science.gov (United States)

    Stice, Eric; Rohde, Paul; Durant, Shelley; Shaw, Heather

    2012-01-01

    Objective: A group dissonance-based eating disorder prevention program, in which young women critique the thin ideal, reduces eating disorder risk factors and symptoms, but it can be difficult to identify school clinicians with the time and expertise to deliver the intervention. Thus, we developed a prototype Internet version of this program and…

  8. Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

    Science.gov (United States)

    Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

    1999-01-01

    Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

  9. [Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders].

    Science.gov (United States)

    Teijeiro, Juan; Macías, Raúl J; Maragoto, Carlos; García, Iván; Alvarez, Mario; Quintanal, Nelson E

    2014-01-01

    Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  10. Preliminary results of the U.S. Nuclear Regulatory Commission collaborative research program to assess tsunami hazard for nuclear power plants on the Atlantic and gulf coasts

    Science.gov (United States)

    Kammerer, A.M.; ten Brink, Uri S.; Twitchell, David C.; Geist, Eric L.; Chaytor, Jason D.; Locat, J.; Lee, H.J.; Buczkowski, Brian J.; Sansoucy, M.

    2018-01-01

    In response to the 2004 Indian Ocean Tsunami, the United States Nuclear Regulatory Commission (US NRC) initiated a long-term research program to improve understanding of tsunami hazard levels for nuclear facilities in the United States. For this effort, the US NRC organized a collaborative research program with the United States Geological Survey (USGS) and other key researchers for the purpose of assessing tsunami hazard on the Atlantic and Gulf Coasts of the United States. The initial phase of this work consisted principally of collection, interpretation, and analysis of available offshore data and information. Necessarily, the US NRC research program includes both seismic- and landslide-based tsunamigenic sources in both the near and the far fields. The inclusion of tsunamigenic landslides, an important category of sources that impact tsunami hazard levels for the Atlantic and Gulf Coasts over the long time periods of interest to the US NRC is a key difference between this program and most other tsunami hazard assessment programs. Although only a few years old, this program is already producing results that both support current US NRC activities and look toward the long-term goal of probabilistic tsunami hazard assessment. This paper provides a summary of results from several areas of current research. An overview of the broader US NRC research program is provided in a companion paper in this conference.

  11. Feasibility and Preliminary Outcomes From a Pilot Study of an Integrated Health-Mental Health Promotion Program in School Mental Health Services

    Science.gov (United States)

    George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.

    2014-01-01

    The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005

  12. Preliminary results of the national program of audit of quality in radiotherapy services in the Republic of Cuba; Resultados preliminares del programa nacional de auditoria de calidad en servicios de radioterapia en la Republica de Cuba

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez Hung, Lourdes; Larrinaga Cortina, Eduardo F. [Centro de Control Estatal de Equipos Medicos, La Habana (Cuba); Morales Lopez, Jorge L.; Garcia Yip, Fernando [Instituto Nacional de Oncologia y Radiobiologia, La Habana (Cuba); Campa Menendez, Raudel [Centro de Proteccion y Higiene de las Radiaciones, La Habana (Cuba)

    2001-07-01

    The current state of the radiotherapy in Cuba has allowed to pass to a superior stage, the establishment of a National Quality Audit Program (PNAC). The National Control Center for Medical Devices as national regulator entity for the control and supervision of the medical devices of the National Health System is the responsible for it implementation. This paper presents the preliminary results of the execution of the PNAC in teletherapy services with isotopic units of {sup 60} Co. The audits were carried out according to the methodology settled down in the normalized procedure of operation of the PNAC. The physical aspects related with the treatment were audit, such as: the installation and unit's security, treatment unit's mechanical and dosimetric aspects and organizational aspects of the institution quality assurance program. Also were carried out, in the clinical aspect, verifications of cases type planned by the qualified personnel of the service. The results corresponding to the determination of the reference dose for each institution were compared with those obtained in a postal audit with the International Atomic Energy Agency. These first audits allowed to evaluate the performance of the institution's program of quality assurance and a feedback for the setting about to the PNAC. (author)

  13. Incidence and risk factors of functional upper airway complications of primary esthetic closed rhinoplasty in two residency programs: A 6-month preliminary prospective cohort study

    Directory of Open Access Journals (Sweden)

    Hassan Mohajerani

    2013-01-01

    Conclusions : High complication rates were observed in both residency programs. Failure to follow home care instructions might prevent/delay recovery. Further in-depth studies are needed to assess this.

  14. Preliminary Study on Teachers' Use of the iPad in Bachelor of Education Program at a Private University in Malaysia

    Science.gov (United States)

    Yusup, Yusri

    2014-01-01

    This paper examines the status of iPad (1st generation) use as a learning device among primary school teachers enrolled in an undergraduate bachelor of education program at a private university in Malaysia. A survey was conducted on 93 teachers who were given iPads to assist them in this online distance-learning program in the March 2011 semester.…

  15. Preliminary Study on Teachers' Use of the iPad in Bachelor of Education Program at a Private University in Malaysia

    Science.gov (United States)

    Yusup, Yusri

    2014-01-01

    This paper examines the status of iPad (1st generation) use as a learning device among primary school teachers enrolled in an undergraduate bachelor of education program at a private university in Malaysia. A survey was conducted on 93 teachers who were given iPads to assist them in this online distance-learning program in the March 2011 semester.…

  16. Preliminary Study on Teachers' Use of the iPpad in Bachelor of Education Program at a Private University in Malaysia

    Science.gov (United States)

    Yusup, Yusri

    2014-01-01

    This paper examines the status of iPad (1st generation) use as a learning device among primary school teachers enrolled in an undergraduate bachelor of education program at a private university in Malaysia. A survey was conducted on 93 teachers who were given iPads to assist them in this online distance-learning program in the March 2011 semester.…

  17. The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence Historical vignette

    NARCIS (Netherlands)

    Groen, Rob J. M.; Koehler, Peter J.; Kloet, Alfred

    The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney

  18. The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence Historical vignette

    NARCIS (Netherlands)

    Groen, Rob J. M.; Koehler, Peter J.; Kloet, Alfred

    2013-01-01

    The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney Med

  19. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  20. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

    Science.gov (United States)

    Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

    2017-01-01

    Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency

  1. A Preliminary Study on the C Program Design Course Teaching Reform%C程序设计课程教学改革初探

    Institute of Scientific and Technical Information of China (English)

    肖敏雷; 肖敏连

    2014-01-01

    The C program design is the first programming course in our college computer majors. It has the advantages of high ef-ficiency, powerful, strong portability and simple and flexible characteristics of [1]. According to the features of C program design this course starting, combined with their own teaching experience for many years C program design, from the teaching content, teaching method, practice teaching and assessment methods in four aspects on how to improve the teaching effect of C program design course of study and practice.%C程序设计是我校计算机专业开设的第一门程序设计课程。它具有效率高、功能强大、可移植性强和简洁灵活等特点。该文根据C程序设计这门课程的特点出发,结合自身多年C程序设计教学经验,从教学内容、教学方法、实践教学和考核方式四个方面对如何提高C程序设计课程教学效果进行了探讨与实践。

  2. Pain management using Han's acupoint nerve stimulator combined with patient-controlled analgesia following neurosurgery A randomized case control study

    Institute of Scientific and Technical Information of China (English)

    Junming Ye; Zuyu Zhu; Cheng Huang; Jun Wei

    2008-01-01

    BACKGROUND:Han's acupoint ncwve stimulator(HANS)has been frequently used to relieve pain by promoting the central ncrvve system's release of endogenous opioid peptides through electric stimulation to the body surface.OBJECTIVE:To investigate the pain-relieving effects of HANS,combined with patient-controlled analgesia,following neurosurgery,and to observe adverse reactions and effects.DESIGN,TIME AND SETTING:A randomized centrel observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan MeScal College(Ganzhou,Jiangxi Province,China)from January 2005 to February 2006.PARTICIPANTS:Forty patients,who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Garman Medical College(China),were included in this study.METHODS:Forty patients underwent neurosurgery and were randomly divided into two groups:patient-controlled analgesia plus HANS(+HANS,n=20)and patient-controlled analgesia(-HANS,n=20).Both groups were well matched in baseline data.Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co.,Ltd.(China).Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide.LH-402 HANS instrument was produced in Beijing(China),with a serial number of 402183.The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan,Shenmen penetrating Shen,Waifei,Naogan penetrating Pizhixia ear acupoints on the affected side for one hour,with 2-hour intervals.The disperse-dense wave was alternating,with a 2/100 Hz frequency of dectrical stimulation.MAIN OUTCOME MEASURE:The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery.RESULTS:Compared with the-HANS group,the visual analogue scale scores were remarkably lower in the+HANS group six hours after surgery(P<0.01),and the incidence rate of adverse reactions

  3. Compressed air energy storage: Preliminary design and site development program in an aquifer. Task 1: Establish facility design criteria and utility benefits

    Science.gov (United States)

    1980-10-01

    Compressed air energy storage (CAES) stores mechanical energy in the form of compressed air during off-peak hours, using power supplied by a large, high efficiency baseload power plant. At times of high electrical demand, the compressed air is drawn from storage and is heated in a combustor by the burning of fuel oil, after which the air is expanded in a turbine. Essentially all of the turbine output can be applied to the generation of electricity, unlike a conventional gas turbine which expends approximately two-thirds of the turbine shaft power in driving the air compressor. The separation of the compression and generation modes in the system results in increased net generation and greater premium fuel economy. Work performed in establishing facility design criteria for a CAES system with aquifer storage includes: determination of initial design bases; preliminary analysis of the CAES system; development of data for site-specific analysis of the CAES system; detailed analysis of the CAES system for three selected heat cycles; CAES power plant design; and an economic analysis of CAES.

  4. National spent fuel program preliminary report RCRA characteristics of DOE-owned spent nuclear fuel DOE-SNF-REP-002. Revision 3

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-07-01

    This report presents information on the preliminary process knowledge to be used in characterizing all Department of Energy (DOE)-owned Spent Nuclear Fuel (SNF) types that potentially exhibit a Resource Conservation and Recovery Act (RCRA) characteristic. This report also includes the process knowledge, analyses, and rationale used to preliminarily exclude certain SNF types from RCRA regulation under 40 CFR {section}261.4(a)(4), ``Identification and Listing of Hazardous Waste,`` as special nuclear and byproduct material. The evaluations and analyses detailed herein have been undertaken as a proactive approach. In the event that DOE-owned SNF is determined to be a RCRA solid waste, this report provides general direction for each site regarding further characterization efforts. The intent of this report is also to define the path forward to be taken for further evaluation of specific SNF types and a recommended position to be negotiated and established with regional and state regulators throughout the DOE Complex regarding the RCRA-related policy issues.

  5. Compressed air energy storage: preliminary design and site development program in an aquifer. Final draft, Task 1: establish facility design criteria and utility benefits

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-10-01

    Compressed air energy storage (CAES) has been identified as one of the principal new energy storage technologies worthy of further research and development. The CAES system stores mechanical energy in the form of compressed air during off-peak hours, using power supplied by a large, high-efficiency baseload power plant. At times of high electrical demand, the compressed air is drawn from storage and is heated in a combustor by the burning of fuel oil, after which the air is expanded in a turbine. In this manner, essentially all of the turbine output can be applied to the generation of electricity, unlike a conventional gas turbine which expends approximately two-thirds of the turbine shaft power in driving the air compressor. The separation of the compression and generation modes in the CAES system results in increased net generation and greater premium fuel economy. The use of CAES systems to meet the utilities' high electrical demand requirements is particularly attractive in view of the reduced availability of premium fuels such as oil and natural gas. This volume documents the Task 1 work performed in establishing facility design criteria for a CAES system with aquifer storage. Information is included on: determination of initial design bases; preliminary analysis of the CAES system; development of data for site-specific analysis of the CAES system; detailed analysis of the CAES system for three selected heat cycles; CAES power plant design; and an economic analysis of CAES.

  6. A prospective longitudinal study of neuropsychological and psychosocial factors in asymptomatic individuals at risk for HTLV-III/LAV infection in a methadone program: preliminary findings.

    Science.gov (United States)

    Silberstein, C H; McKegney, F P; O'Dowd, M A; Selwyn, P A; Schoenbaum, E; Drucker, E; Feiner, C; Cox, C P; Friedland, G

    1987-02-01

    To test the hypothesis that cognitive impairment may be present early in the course of HTLV-III/LAV infection, intravenous drug abusers (IDVAs) without overt symptoms of AIDS related illness were tested with standard neuropsychological and psychosocial measures. This study is the baseline for a prospective longitudinal study of the natural history of HTLV-III/LAV infection in this high risk population. Of 211 subjects initially evaluated, 70 (33%) were HTLV-III/LAV seropositive and 141 (67%) were seronegative. At the baseline, by univariate analysis, the seropositive IVDAs were significantly (p less than .05) more impaired than seronegatives on 4 of 8 measures: Finger Tapping--dominant, hand, Digit Span Forward, Trail making A and WAIS-Similarities. However, by multivariate analysis the seropositives were significantly more impaired only on the WAIS-Similarities and Wechsler--Associative Learning tests. Multiple factors such as drug use and psychological stress may have influenced test performance. These preliminary results, however, suggest that seropositive IVDAs may show evidence of impaired neuropsychological function even in the absence of AIDS related symptoms and are consistent with the hypothesis of the early neurotropism of HTLV-III/LAV.

  7. Preliminary report on the ecological assessment of Waste Area Grouping 5 at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Environmental Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Ashwood, T.L.; Suter, G.W. II; Stewart, A.J.

    1992-09-01

    In support of the remedial investigation for Waste Area Grouping (WAG) 5, staff of the Environmental Sciences Division of Oak Ridge National Laboratory have conducted preliminary ecological assessment activities. A screening level ecological risk assessment has been completed, ambient toxicity tests have been conducted on streams and seeps within WAG 5, WAG 5 has been surveyed for rare and endangered species and wetlands, and wild turkeys that may feed on contaminated vegetation and insects in WAG 5 have been screened for beta-emitting isotopes and {sup 137}Cs. The screening-level ecological risk assessment identified some data gaps that were addressed in the ecological assessment plan. These include gaps in data on the toxicity of surface water and soil within WAG 5 and on the status of rare and endangered species. In addition, the screening-level risk assessment identified the need for data on the level of contaminants in wild turkeys that may be consumed by predatory wildlife and humans. Three rounds of ambient toxicity tests on six streams and seeps, using the microcrustacean Ceriodaphnia, have identified potential toxicity in three of the sample sites. Further tests are required to identify the toxicant. No rare or endangered animal species have been identified in the WAG 5 area.

  8. The innovative viscoelastic CP ESP cervical disk prosthesis with six degrees of freedom: biomechanical concepts, development program and preliminary clinical experience.

    Science.gov (United States)

    Lazennec, Jean-Yves; Aaron, Alain; Ricart, Olivier; Rakover, Jean Patrick

    2016-01-01

    The viscoelastic cervical disk prosthesis ESP is an innovative one-piece deformable but cohesive interbody spacer. It is an evolution of the LP ESP lumbar disk implanted since 2006. CP ESP provides six full degrees of freedom about the three axes including shock absorbtion. The prosthesis geometry allows limited rotation and translation with resistance to motion (elastic return property) aimed at avoiding overload of the posterior facets. The rotation center can vary freely during motion. The concept of the ESP prosthesis is fundamentally different from that of the devices currently used in the cervical spine. The originality of the concept of the ESP® prosthesis led to innovative and intense testing to validate the adhesion of the viscoelastic component of the disk on the titanium endplates and to assess the mechanical properties of the PCU cushion. The preliminary clinical and radiological results with 2-year follow-up are encouraging for pain, function and kinematic behavior (range of motion and evolution of the mean centers of rotation). In this series, we did not observe device-related specific complications, misalignment, instability or ossifications. Additional studies and longer patient follow-up are needed to assess long-term reliability of this innovative implant.

  9. The Preliminary Findings of a Study Exploring the Perceptions of a Sample of Young Heterosexual Males regarding HIV Prevention Education Programming in Nova Scotia, Canada

    Science.gov (United States)

    Gahagan, Jacqueline; Rehman, Laurene; Barbour, Laura; McWilliam, Susan

    2007-01-01

    Despite the increasing numbers of young Canadian females becoming infected with HIV through heterosexual transmission with an infected male sexual partner, the majority of current HIV prevention programs and services in Canada continue to ignore the needs of young heterosexual males. This research is derived from 30 in-depth interviews, 9 focus…

  10. Psychotropic and Anticonvulsant Drug Usage in Early Childhood Special Education Programs I. Phase One: A Preliminary Report: Prevalence, Attitude, Training, and Problems.

    Science.gov (United States)

    Gadow, Kenneth D.

    As part of a three phase study designed to survey the teachers and parents of children receiving psychotropic and anticonvulsant drugs, 208 teachers of preschool special education children on medication were mailed questionnaires. The Early Childhood Medication Questionnaire used in the survey included items relating to teacher, program, and…

  11. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    Science.gov (United States)

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  12. Preliminary Evaluation of the FRIENDS for Life Program on Students' and Teachers' Emotional States for a School in a Low Socio-Economic Status Area

    Science.gov (United States)

    Iizuka, Christina A.; Barrett, Paula M.; Gillies, Robyn; Cook, Clayton R.; Marinovic, Welber

    2015-01-01

    The purpose of this study was to examine the impact of the FRIENDS for Life program on students' and teachers' emotional outcomes in a school serving a high-poverty population. The focus of the intervention was to train/coach teachers with strategies to develop social and emotional skills for students. A single group, pre/post-test design was used…

  13. Preliminary Monthly Climatological Summaries

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Preliminary Local Climatological Data, recorded since 1970 on Weather Burean Form 1030 and then National Weather Service Form F-6. The preliminary climate data pages...

  14. Laser Nano-Neurosurgery from gentle manipulation to nano-incision of neuronal cells and scaffolds: an advanced neurotechnology tool.

    Directory of Open Access Journals (Sweden)

    Alessandro eSoloperto

    2016-03-01

    Full Text Available Current optical approaches are progressing far beyond the scope of monitoring the structure and function of living matter, and they are becoming widely recognized as extremely precise, minimally-invasive, contact-free handling tools. Laser manipulation of living tissues, single cells or even single-molecules is becoming a well-established methodology, thus founding the onset of new experimental paradigms and research fields. Indeed, a tightly focused pulsed laser source permits complex tasks such as developing engineered bioscaffolds, applying calibrated forces, transfecting, stimulating or even ablating single cells with subcellular precision, and operating intracellular surgical protocols at the level of single organelles. In the present review, we report the state of the art of laser manipulation in neuroscience, to inspire future applications of light-assisted tools in nano-neurosurgery.

  15. Speaking Secrets: Epilepsy, Neurosurgery, and Patient Testimony in the Age of the Explorable Brain, 1934-1960.

    Science.gov (United States)

    Elder, Rachel

    2015-01-01

    This article examines the role of Wilder Penfield's patients in early neurosurgeries for epilepsy at the Montreal Neurological Institute from the 1930s to 1950s. Shifting the focus from scientific discoveries that emerged as a result of Penfield's unprecedented "exploration" of the brain, this piece considers how patients contributed to the creation of such knowledge through their spoken feedback, both within and beyond the operating room. Correspondingly, it examines the personal and social contexts under which patients elected for surgery. Tracing an underexplored social history of Penfield's patients through more than sixty clinical records, it suggests that making knowledge about the brain was a multidirectional process in which patients meaningfully participated, and in which their experiences of epilepsy and motivations for surgery were significant.

  16. From anesthetic sponge to nonsinking skull perforator, unitary work neurosurgery in the ancient Arabic and Islamic world.

    Science.gov (United States)

    Najjar, Jalal

    2010-05-01

    During the Middle Ages, the work of Middle Eastern physicians such as Avicenna, Albucasis, and Rhazes was of paramount importance in guarding the knowledge that had been accumulated throughout history, particularly the contributions of Greek and Roman scholars, and it is well known that the Arabic versions of all of the works by Hippocrates and Galen by Islamic and Arabic scholars are the only copies that have survived until now. In addition to preserving this wealth of knowledge, these Middle Eastern scholars made significant contributions of their own to both medicine and neurosurgery. Many points regarding ancient Arabic and Islamic science need to be discussed and clarified, such as cadaver dissections, anatomic studies, neurosurgical practice and instruments, Arabic translations of Hippocratic and other works, and the influence of the Islamic civilization on Western civilization, especially the Renaissance.

  17. Target registration and target positioning errors in computer-assisted neurosurgery: proposal for a standardized reporting of error assessment.

    Science.gov (United States)

    Widmann, Gerlig; Stoffner, Rudolf; Sieb, Michael; Bale, Reto

    2009-12-01

    Assessment of errors is essential in development, testing and clinical application of computer-assisted neurosurgery. Our aim was to provide a comprehensive overview of the different methods to assess target registration error (TRE) and target positioning error (TPE) and to develop a proposal for a standardized reporting of error assessment. A PubMed research on phantom, cadaver or clinical studies on TRE and TPE has been performed. Reporting standards have been defined according to (a) study design and evaluation methods and (b) specifications of the navigation technology. The proposed standardized reporting includes (a) study design (controlled, non-controlled), study type (non-anthropomorphic phantom, anthropomorphic phantom, cadaver, patient), target design, error type and subtypes, space of TPE measurement, statistics, and (b) image modality, scan parameters, tracking technology, registration procedure and targeting technique. Adoption of the proposed standardized reporting may help in the understanding and comparability of different accuracy reports. Copyright (c) 2009 John Wiley & Sons, Ltd.

  18. A fantastic voyage: a personal perspective on involvement in the development of modern stereotactic and functional neurosurgery (1974-2004).

    Science.gov (United States)

    Apuzzo, Michael L J

    2005-05-01

    Stressing environments, individuals, ideas, and global events, this historical stereotactic and functional neurosurgical vignette initially presents a review of factors in the genesis of personal interest and the foundations of involvement in the discipline of neurological surgery. The vignette then traces the development of concepts and instrumentation and their ultimate practical utilization in patient care on the neurosurgical services at the Keck School of Medicine at the University of Southern California over the course of a 3-decade period (1974-2004). The article summarizes and elaborates details of contributions to the literature and complex involvement on the national and international levels as the refinements and capabilities of stereotactic and functional neurosurgery have been reinvented over a generation through the emergence of new technology, ideas, individual ingenuity, and active collegial exchange.

  19. Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial.

    Science.gov (United States)

    Bähr, Oliver; Hermisson, Mirjam; Rona, Sabine; Rieger, Johannes; Nussbaum, Susanne; Körtvelyessy, Peter; Franz, Kea; Tatagiba, Marcos; Seifert, Volker; Weller, Michael; Steinbach, Joachim P

    2012-02-01

    Levetiracetam (LEV) is a newer anticonvulsant with a favorable safety profile. There seem to be no relevant drug interactions, and an intravenous formulation is available. Therefore, LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery. In this prospective study (NCT00571155) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure. Thirty patients with brain tumor-related seizures and intended neurosurgery were included. Three patients did not undergo the scheduled surgery after enrollment, and two patients were lost to follow-up. Therefore, 25 patients were fully evaluable. After initiation of therapy with LEV, 100% of the patients were seizure-free in the pre-surgery phase (3 days up to 4 weeks before surgery), 88% in the 48 h post-surgery phase and 84% in the early follow-up phase (48 h to 4 weeks post surgery). Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients. No serious adverse events related to the treatment with LEV occurred. Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures. Although this was a single arm study, the efficacy of LEV appears promising. Considering the side effects and interactions of other anticonvulsants, LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures.

  20. Preliminary Audit Report on "Management Controls over the Commonwealth of Virginia's Efforts to Implement the American Recovery and Reinvestment Act Weatherization Assistance Program"

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-05-01

    The Department of Energy's (Department) Weatherization Assistance Program received $5 billion under the American Recovery and Reinvestment Act of 2009 (Recovery Act) to improve the energy efficiency of homes, multi-family rental units and mobile homes owned or occupied by low-income persons. Subsequently, the Department awarded a three-year Weatherization Assistance Program grant for $94 million to the Commonwealth of Virginia (Virginia). This grant provided more than a ten-fold increase in funds available to Virginia for weatherization over that authorized in Fiscal Year (FY) 2009. Corresponding to the increase in funding, the Recovery Act increased the limit on the average amount spent to weatherize a home (unit) from $2,500 to $6,500. Virginia's Department of Housing and Community Development (DHCD) administers the Recovery Act grant through 22 local community action agencies. These agencies (sub-grantees) are responsible for determining applicant eligibility, weatherizing homes, and conducting home assessments and inspections. Typical weatherization services include installing insulation; sealing ducts; tuning and repairing furnaces; and, mitigating heat loss through windows, doors and other infiltration points. Virginia plans to use its Recovery Act Weatherization funding to weatherize about 9,193 units over the life of the grant - a significant increase over the 1,475 housing units that were planned to be completed in FY 2009. Given the significant increase in funding and the demands associated with weatherizing thousands of homes, we initiated this audit to determine if Virginia had adequate safeguards in place to ensure that the Weatherization Program was managed efficiently and effectively. The State of Virginia's DHCD had not implemented financial and reporting controls needed to ensure Weatherization Program funds are spent effectively and efficiently. Specifically, DHCD had not: (1) Performed on-site financial monitoring of any of its sub

  1. Ocean Thermal Energy Conversion power system development. Phase I: preliminary design. Final report. [OSAP-1 code; OTEC Steady-State Analysis Program

    Energy Technology Data Exchange (ETDEWEB)

    Westerberg, Arthur

    1978-12-04

    The following appendices are included: highlights of direction and correspondence; user manual for OTEC Steady-State Analysis Program (OSAP-1); sample results of OSAP-1; surface condenser installations; double-clad systems; aluminum alloy seawater piping; references searched for ammonia evaluation; references on stress-corrosion for ammonia; references on anhydrous ammonia storage; references on miscellaneous ammonia items; OTEC materials testing; test reports; OTEC technical specification chlorination system; OTEC technical specification AMERTAP system; OTEC optimization program users guide; concrete hull construction; weight and stability estimates; packing factor data; machinery and equipment list; letter from HPTI on titanium tubes; tables on Wolverine Korodense tubes; evaporator and condenser enhancement tables; code weld titanium tube price, weight tables Alcoa tubing tables; Union Carbide tubing pricing tables; turbotec tubing pricing tables; Wolverine tubing pricing tables; Union Carbide tubing characteristics and pricing; working fluids and turbines for OTEC power system; and hydrodynamic design of prototype OTEC cold and warm seawater pumps. (WHK)

  2. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.

    Science.gov (United States)

    Kabat-Zinn, J

    1982-04-01

    The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.

  3. Resident designed intern orientation to address the new ACGME Common Program Requirements for resident supervision.

    Science.gov (United States)

    Rialon, Kristy L; Barfield, Michael E; Elfenbein, Dawn M; Lunsford, Keri E; Tracy, Elisabeth T; Migaly, John

    2013-01-01

    To design an orientation for surgical interns to meet the new Accreditation Council for Graduate Medical Education Common Program Requirements regarding supervision, to test patient-management competencies, and to assess confidence on skills and tasks pre-orientation and post-orientation. Twenty-seven incoming surgical interns participated in a two-day orientation to clinical duties. Activities included a pre-test, lectures, simulation, oral examination, intern shadowing, and a post-test. Incoming interns were surveyed before and after orientation and two months later for confidence in patient-management and surgical intern skills. Paired t-tests were used to determine if confidence improved pre-orientation and post-orientation, and two months following orientation. The study took place at an academic training hospital. All (n = 27) postgraduate year-1 (PGY-1) surgical residents at our institution, which included the categorical and nondesignated preliminary general surgery, urology, orthopedic surgery, otolaryngology, and neurosurgery programs. All interns passed the oral and written examinations, and were deemed able to be indirectly supervised, with direct supervision immediately available. They reported increased confidence in all areas of patient management addressed during orientation, and this confidence was retained after two months. In surgical and floor-related tasks and skills, interns reported no increase in confidence directly following orientation. However, after two months, they reported a significant increase in confidence, particularly in those tasks that are performed often. New requirements for resident supervision require creative ways of verifying resident competency in basic skills. This type of orientation is an effective way to address the new requirements of supervision and teach interns the tasks and skills that are necessary for internship. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All

  4. A preliminary study for the development of indices and the current state of surgical site infections (SSIs) in Korea: the Korean Surgical Site Infection Surveillance (KOSSIS) program.

    Science.gov (United States)

    Park, Sun Jin; Lee, Kil Yeon; Park, Ji Won; Lee, Jae Gil; Choi, Hee Jung; Chun, Hee Kyung; Kang, Jung Gu

    2015-03-01

    We aimed to develop an effective system for surgical site infection (SSI) surveillance and examine the current domestic state of SSIs for common abdominal surgeries in Korea. The Korean Surgical Site Infection Surveillance (KOSSIS) program was developed as an SSI surveillance system. A prospective multicenter study in nine university-affiliated or general hospitals was conducted for patients who underwent gastrectomy, cholecystectomy, appendectomy, colectomy, or proctectomy between August 16 and September 30 in 2012. Patients were monitored for up to 30 days by combining direct observation and a postdischarge surgeon survey. Data on SSIs were prospectively collected with KOSSIS secretarial support according to a common protocol. Operation-specific SSI rates were stratified according to risk factors and compared with data from the Korean Nosocomial Infections Surveillance System (KONIS) and National Healthcare Safety Network. A focus group interview was conducted with participating hospitals for feedback. A total of 1,088 operations were monitored: 207 gastrectomies, 318 cholecystectomies, 270 appendectomies, 197 colectomies, and 96 proctectomies. Operation-specific SSI rates determined by the KOSSIS program were substantially higher than those found in KONIS (7.73% [95% confidence interval, 4.5%-12.3%] vs. 3.4% for gastrectomies, 10.15% [95% confidence interval, 6.1%-15.2%] vs. 4.0% for colectomy, and 13.5% [95% confidence interval, 7.4%-22.0%] vs. 4.2% for proctectomy). Despite a short surveillance period and heterogenous group of hospitals, our results suggest that KOSSIS could be a useful program to enhance SSI surveillance in Korea.

  5. 75 FR 39091 - Airport Privatization Pilot Program

    Science.gov (United States)

    2010-07-07

    ... Program (62 FR 48693). A request for participation in the Pilot Program must be initiated by the filing of... Federal Aviation Administration Airport Privatization Pilot Program AGENCY: Federal Aviation... (SJU) preliminary application for participation in the airport privatization pilot program...

  6. Communicating alcohol and drug prevention strategies and models across cultural boundaries: preliminary report on an ILO/WHO/UNDCP [International Labour Office/World Health Organization/United Nations International Drug Control Program] Interagency Program.

    Science.gov (United States)

    Fauske, S; Wilkinson, D A; Shain, M

    1996-01-01

    The joint ILO/WHO/UNDCP collaborative program "Prevention of Drug and Alcohol Problems among Workers and their Families" represents transfer of an innovative model to a culturally diverse group of nations: Egypt, Mexico, Namibia, Poland, and Sri Lanka. The concept is to move from reactive programs-led by alcohol and drug experts, reactive to problem employees-to proactive prevention led by management. Nontechnical language and metaphors have been developed to secure the commitment of managers in the private and public sectors. Participating countries and enterprises adapt the program to local conditions, fostering "local ownership" with the objective of creating self-sustaining activities. The objective is to describe elements of the program which may be readily transferable worldwide across the cultural borders that characterize nations, enterprises, and public sector workplaces.

  7. Preliminary validation of an exercise program suitable for pregnant women with abnormal glucose metabolism: inhibitory effects of Tai Chi Yuttari-exercise on plasma glucose elevation

    Science.gov (United States)

    Yamamoto, Sachina; Kagawa, Kyoko; Hori, Naohi; Akezaki, Yoshiteru; Mori, Kohei; Nomura, Takuo

    2016-01-01

    [Purpose] There is insufficient evidence related to exercise programs that are safe and efficacious for pregnant women with abnormal glucose metabolism. Tai Chi Yuttari-exercise is an exercise program with validated safety and efficacy in improving physical function in the elderly. In this study, we investigated this program’s inhibitory effects on plasma glucose elevation when it was adapted to a pregnancy model. [Subjects and Methods] Twelve 18- to 19-year-old females without a history of pregnancy were randomly assorted into two groups: an intervention group, for which six subjects were outfitted with mock-pregnancy suits and asked to perform Tai Chi Yuttari-exercise, and a control group who did not perform exercise. The intervention group had a mean Borg Scale score of 11.1 ± 0.9 during the exercise. [Results] No significant intragroup differences were observed in fasting, baseline, or post-intervention/observation plasma glucose levels. On the other hand, the intergroup change in plasma glucose levels after intervention/observation was significant when comparing the intervention and control groups: −1.66 ± 7.0 and 9.42 ± 6.57 mg/dl, respectively. [Conclusion] Tai Chi Yuttari-exercise appears to effectively inhibit plasma glucose elevation at intensity and movement levels that can be safely applied to pregnant women with abnormal glucose metabolism. PMID:28174463

  8. Effectiveness of a balance-training program provided by qualified care workers for community-based older adults: A preliminary study.

    Science.gov (United States)

    Hirase, Tatsuya; Inokuchi, Shigeru; Matsusaka, Nobuou; Okita, Minoru

    2015-01-01

    The purpose of this study was to determine the effectiveness of a balance-training program provided by qualified care workers (QCWs) to community-based older adults attending day centers. Weekly balance training was conducted by QCWs working at day centers over a 6-month period. Fall risk factors, fear of falling, and physical function were compared between balance-training (n = 22) and control (n = 23) groups at baseline and after 6 months of intervention. Physical function assessments included the following: one-leg standing test, chair-standing test (CST), timed up-and-go test (TUGT), and a lower-extremity muscle strength test (LEST). Participants who underwent balance training significantly improved in the CST and LEST, and had reduced fear and risk of falling compared with the control group (p balance-training group, the TUGT was significantly better at 6 months than at baseline (p balance-training program for community-dwelling older adults can be effectively implemented by QCWs.

  9. Development of an assessment tool to measure students′ perceptions of respiratory care education programs: Item generation, item reduction, and preliminary validation

    Directory of Open Access Journals (Sweden)

    Ghazi Alotaibi

    2013-01-01

    Full Text Available Objectives: Students who perceived their learning environment positively are more likely to develop effective learning strategies, and adopt a deep learning approach. Currently, there is no validated instrument for measuring the educational environment of educational programs on respiratory care (RC. The aim of this study was to develop an instrument to measure students′ perception of the RC educational environment. Materials and Methods: Based on the literature review and an assessment of content validity by multiple focus groups of RC educationalists, potential items of the instrument relevant to RC educational environment construct were generated by the research group. The initial 71 item questionnaire was then field-tested on all students from the 3 RC programs in Saudi Arabia and was subjected to multi-trait scaling analysis. Cronbach′s alpha was used to assess internal consistency reliabilities. Results: Two hundred and twelve students (100% completed the survey. The initial instrument of 71 items was reduced to 65 across 5 scales. Convergent and discriminant validity assessment demonstrated that the majority of items correlated more highly with their intended scale than a competing one. Cronbach′s alpha exceeded the standard criterion of >0.70 in all scales except one. There was no floor or ceiling effect for scale or overall score. Conclusions: This instrument is the first assessment tool developed to measure the RC educational environment. There was evidence of its good feasibility, validity, and reliability. This first validation of the instrument supports its use by RC students to evaluate educational environment.

  10. Self-efficacy in Prosthetics & Orthotics students who did and did not participate in short term study abroad programs - preliminary results.

    Science.gov (United States)

    Fiedler, Goeran; Kremer, Uta

    2017-04-01

    It is conventional knowledge that travel is educational and that a study stay in a foreign country contributes to a student's personality formation and well-roundedness. The benefit of such experiences on attitudes that shape professional aptitude and career success may, however, be debated. It could be argued that exposure to experiences that are irrelevant to a student's chosen profession may have no sizeable impact - thus not justifying the invested time and money - or, in an extreme case, may even be detrimental to career success if the wrong conclusions are drawn. Examples for such occurrences may include the adoption of inappropriate belief systems, educational priorities, or work habits. In this study, it was investigated how a short-term study stay abroad was reflected in the self-efficacy of students and graduates of a professional Master of Science program. A cohort of U.S. American students of Prosthetics and Orthotics who had participated in non-compulsory study excursions to Germany and a comparable cohort of their peers who had not participated in such trips were asked to state their confidence in mastering specific hypothetical situations of daily work life. About one half of the subjects of each group had already graduated and were in residence at the time of the survey, whereas the remaining half was still in their first year of the study program. Answers were compared using descriptive statistics and qualitative analysis to investigate main and interaction effects of professional experience and short-term stay abroad. The results seem to support the hypothesis that the experience was beneficial, making the inclusion of respective course offerings recommendable. Copyright © 2017. Published by Elsevier GmbH.

  11. Management of Subarachnoid Hemorrhage in Two Important Italian Political Leaders: A Paradigm of Ethical and Technological Evolution of Neurosurgery During the Past Half-Century.

    Science.gov (United States)

    Longatti, Pierluigi; Giombelli, Ermanno; Pavesi, Giacomo; Carteri, Alessandro; Feletti, Alberto

    2016-08-01

    For a curious and extraordinary coincidence, 5 of the 7 most relevant leaders of the Italian Communist Party (Partito Comunista Italiano, which was established in 1921, has been the biggest Communist Party in Western Countries) suffered a cerebral stroke. Cerebrovascular diseases afflicted also Stalin and Lenin, and a number of Presidents of the United States. We present the stories of 2 important Italian political leaders who shared both the leadership role of the major left Italian Party and the dramatic experience of a subarachnoid hemorrhage. Retracing their medical incidents, separated by 50 years of history, we show how a fatal medical disease has become neurosurgical and successfully cured thanks to the advances of neurosurgery, neuroradiology, and hospital organization. A neurologic disease that was disgraceful 50 years ago has lost any disquieting and embarrassing significance in the present time to the light of evolution of vascular neurosurgery.

  12. Preliminary results of a program of quality assurance applied to the image service of a public hospital; Resultados preliminares de um programa de garantia de qualidade aplicado ao servico de imagem de um hospital publico

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Claudio Domingues de; Ferreira, Rubemar de Souza; Marechal, Maria Helena H. [Instituto de Radioprotecao e Dosimetria (IRD), Rio de Janeiro, RJ (Brazil); Milano, Nelly Ester [Hospital Municipal Cardoso Fontes, Rio de Janeiro, RJ (Brazil). Setor de Imagem

    2001-07-01

    Overall quality in radiological protection and medical image depend largely on keeping certain safety standards and technical procedures in good levels. In this way, in June 1998, the Ministry of Health published the document 453 - Guidelines of Radiological Protection to Medical and Dental Practices, defining different levels of actions and responsibility for radiological installation where the critical starting point was the necessity of a previous quality assurance program (QAP) into the radiological service. Preliminary results of a QAP realized in the Department of Radiology of a high complexity Hospital in Rio de Janeiro has showed that, although the importance of 453 Regulation be recognized, there is a few motivation for implementing it. Besides, during 1999 it was possible to identify film losses of 14,9 % related only to the repetition of exposures in the patients, reflecting in terms of cost about U$ 100,000 a year. Results suggest that losses of 64% of total film are due to under or over exposures and 15% are due to inadequate positioning of either film or patient, evidencing the need for training the technical and medical staff . (author)

  13. Animation program used to encourage patients or family members to take an active role for eliminating wrong-site, wrong-person, wrong-procedure surgeries: preliminary evaluation.

    Science.gov (United States)

    See, Lai-Chu; Chang, Yi-Hua; Chuang, Kai-Lan; Lai, Hui-Ru; Peng, Pei-I; Jean, Wen-Chyi; Wang, Chao-Hui

    2011-01-01

    Wrong-site surgeries (including wrong-site, wrong-person and wrong-procedure errors) remain the number one problem among adverse events of health care delivery. Patients and/or family members should be involved when possible to help prevent such errors. 1) Design an educational animation program about patient safety for patients and/or family members to help eliminate wrong-site surgery errors. 2) Evaluate its educational effect. The animation developed for this study includes an introduction, hypothetical story, and guided information, and was presented at a tertiary medical center in northern Taiwan. A single-group pretest and posttest design was used. Forty-six patients and 48 family members participated in the study. The pre-training score was 3.6 (on a scale of 1-4). After watching the animation, there was no significant increase (0.08 ± 0.5) for the patient group, but the family member group showed significant improvement (0.21 ± 0.6, P = .0309). Most participants (98.9%) were satisfied with the animation. The majority of participants reported good practices for avoiding wrong-site surgery mistakes before an operation. A significant improvement of post-training scores in the family member group was seen. The high satisfaction rating given by the participants after seeing the animation indicates that it was generally acceptable. Copyright © 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.

    Science.gov (United States)

    Weinstock, Peter; Rehder, Roberta; Prabhu, Sanjay P; Forbes, Peter W; Roussin, Christopher J; Cohen, Alan R

    2017-07-01

    OBJECTIVE Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus. METHODS A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV. RESULTS A

  15. The North Carolina Field Test: Field performance of the preliminary version of an advanced weatherization audit for the Department of Energy`s Weatherization Assistance Program

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, T.R.

    1994-06-01

    The field performance of weatherizations based on a newly-developed advanced technique for selecting residential energy conservation measures was tested alongside current Retro-Tech-based weatherizations in North Carolina. The new technique is computer-based and determines measures based on the needs of an individual house. In addition, it recommends only those measures that it determines will have a benefit-to-cost ratio greater than 1 for the house being evaluated. The new technique also considers the interaction of measures in computing the benefit-to-cost ratio of each measure. The two weatherization approaches were compared based on implementation ease, measures installed, labor and cost requirements, and both heating and cooling energy savings achieved. One-hundred and twenty houses with the following characteristics participated: the occupants were low-income, eligible for North Carolina`s current weatherization program, and responsible for their own fuel and electric bills. Houses were detached single-family dwellings, not mobile homes; were heated by kerosene, fuel oil, natural gas, or propane; and had one or two operating window air conditioners. Houses were divided equally into one control group and two weatherization groups. Weekly space heating and cooling energy use, and hourly indoor and outdoor temperatures were monitored between November 1989 and September 1990 (pre-period) and between December 1990 and August 1991 (post-period). House consumption models were used to normalize for annual weather differences and a 68{degrees}F indoor temperature. Control group savings were used to adjust the savings determined for the weatherization groups. The two weatherization approaches involved installing attic and floor insulations in near equivalent quantities, and installing storm windows and wall insulation in drastically different quantities. Substantial differences also were found in average air leakage reductions for the two weatherization groups.

  16. Advantages and limitations of intraoperative 3D ultrasound in neurosurgery. Technical note.

    Science.gov (United States)

    Bozinov, Oliver; Burkhardt, Jan-Karl; Fischer, Claudia Miranda; Kockro, Ralf Alfons; Bernays, René-Ludwig; Bertalanffy, Helmut

    2011-01-01

    Three-dimensional ultrasound (US) technology is supposed to help combat some of the orientation difficulties inherent to two-dimensional US. Contemporary navigation solutions combine reconstructed 3D US images with common navigation images and support orientation. New real-time 3D US (without neuronavigation) is more time effective, but whether it further assists in orientation remains to be determined. An integrated US system (IGSonic, VectorVision, BrainLAB, Munich Germany) and a non-integrated system with real-time 3D US (iU22, Philips, Bothell, USA) were recently compared in neurosurgical procedures in our group. The reconstructed navigation view was time-consuming, but images were displayed in familiar planes (e.g., axial, sagittal, coronal). Further potential applications of US angiography and pure US navigation are possible. Real-time 3D images were displayed without the need for an additional acquisition and reconstruction process, but spatial orientation remained challenging in this preliminary testing phase. Reconstructed 3D US navigation appears to be superior with respect to spatial orientation, and the technique can be combined with other imaging data. However, the potential of real-time 3D US imaging is promising.

  17. Photodynamic therapy in neurosurgery: a proof of concept of treatment planning system

    Science.gov (United States)

    Dupont, C.; Reyns, N.; Mordon, S.; Vermandel, M.

    2017-02-01

    Glioblastoma (GBM) is the most common primary brain tumor. PhotoDynamic Therapy (PDT) appears as an interesting research field to improve GBM treatment. Nevertheless, PDT cannot fit into the current therapeutic modalities according to several reasons: the lack of reliable and reproducible therapy schemes (devices, light delivery system), the lack of consensus on a photosensitizer and the absence of randomized and controlled multicenter clinical trial. The main objective of this study is to bring a common support for PDT planning. Here, we describe a proof of concept of Treatment Planning System (TPS) dedicated to interstitial PDT for GBM treatment. The TPS was developed with the integrated development environment C++ Builder XE8 and the environment ArtiMED, developed in our laboratory. This software enables stereotactic registration of DICOM images, light sources insertion and an accelerated CUDA GPU dosimetry modeling. Although, Monte-Carlo is more robust to describe light diffusion in biological tissue, analytical model accelerated by GPU remains relevant for dose preview or fast reverse planning processes. Finally, this preliminary work proposes a new tool to plan interstitial or intraoperative PDT treatment and might be included in the design of future clinical trials in order to deliver PDT straightforwardly and homogenously in investigator centers.

  18. Preliminary aspects of a qualitative research projection

    Directory of Open Access Journals (Sweden)

    Simona Haidau

    2012-12-01

    Full Text Available In this paper are presented preliminary aspects on the design of of qualitative research achieved by nongovernmental organizations in the North-East of Romȃnia. The research aims to identify attitudes, opinions and behaviors to nongovernmental organizations to implement public relations programs and campaigns.

  19. The North Carolina Field Test: Field Performance of the Preliminary Version of an Advanced Weatherization Audit for the Department of Energy's Weatherization Assistance Program

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, T.R.

    1994-01-01

    The field performance of weatherizations based on a newly-developed advanced technique for selecting residential energy conservation measures was tested alongside current Retro-Tech-based weatherizations in North Carolina. The new technique is computer-based and determines measures based on the needs of an individual house. In addition, it recommends only those measures that it determines will have a benefit-to-cost ratio greater than 1 for the house being evaluated. The new technique also considers the interaction of measures in computing the benefit-to-cost ratio of each measure. The two weatherization approaches were compared based on implementation ease, measures installed, labor and cost requirements, and both heating and cooling energy savings achieved. One-hundred and twenty houses with the following characteristics participated: the occupants were low-income, eligible for North Carolina's current weatherization program, and responsible for their own fuel and electric bills. Houses were detached single-family dwellings, not mobile homes; were heated by kerosene, fuel oil, natural gas, or propane; and had one or two operating window air conditioners. Houses were divided equally into one control group and two weatherization groups. Weekly space heating and cooling energy use, and hourly indoor and outdoor temperatures were monitored between November 1989 and September 1990 (pre-period) and between December 1990 and August 1991 (post-period). House consumption models were used to normalize for annual weather differences and a 68 F indoor temperature. Control group savings were used to adjust the savings determined for the weatherization groups. The two weatherization approaches involved installing attic and floor insulations in near equivalent quantities, and installing storm windows and wall insulation in drastically different quantities. Substantial differences also were found in average air leakage reductions for the two weatherization groups. Average

  20. FY2012 Office of Child Support Preliminary Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Office of Child Support Preliminary Report highlights financial and statistical program achievements based on quarterly and annual data. In fiscal year (FY)...

  1. [A new human machine interface in neurosurgery: The Leap Motion(®). Technical note regarding a new touchless interface].

    Science.gov (United States)

    Di Tommaso, L; Aubry, S; Godard, J; Katranji, H; Pauchot, J

    2016-06-01

    Currently, cross-sectional imaging viewing is used in routine practice whereas the surgical procedure requires physical contact with an interface (mouse or touch-sensitive screen). This type of contact results in a risk of lack of aseptic control and causes loss of time. The recent appearance of devices such as the Leap Motion(®) (Leap Motion society, San Francisco, USA) a sensor which enables to interact with the computer without any physical contact is of major interest in the field of surgery. However, its configuration and ergonomics produce key challenges in order to adapt to the practitioner's requirements, the imaging software as well as the surgical environment. This article aims to suggest an easy configuration of the Leap Motion(®) in neurosurgery on a PC for an optimized utilization with Carestream(®) Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, USA) using a plug-in (to download at: https://drive.google.com/?usp=chrome_app#folders/0B_F4eBeBQc3ybElEeEhqME5DQkU) and a video tutorial (https://www.youtube.com/watch?v=yVPTgxg-SIk).

  2. Preliminary concept Post-Piledriver Exploratory Program

    Energy Technology Data Exchange (ETDEWEB)

    Nordyke, M. D.

    1966-10-13

    This is the concept for a series of post-shot investigations at the Piledriver site, Area 15, Nevada Test Site (NTS), to gain information on: Chimney geometry and associated wall rock conditions resulting from a deeply buried (1500 ft) nuclear explosion in granite; The characteristics and distribution of rubble and radioactivity in the chimney; and Data pertinent to in-situ leaching.

  3. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery.

    Science.gov (United States)

    Morineau, T; Morandi, X; Le Moëllic, N; Jannin, P

    2013-03-01

    This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.

  4. National healthcare spending in the U.S. and Japan: national economic policy and implications for neurosurgery.

    Science.gov (United States)

    Bean, James R

    2005-01-01

    Growth of national healthcare spending is a problem confronting national governments of all industrially advanced countries. Healthcare spending in the U.S. reached 13.9% of the Gross Domestic Product (GDP) in 2003, compared to only 8% in Japan. In the U.S., health insurance is voluntary, with 15% of the population uninsured. In Japan, health insurance is mandatory and virtually universal, with growth in national health costs about half the rate of growth in the U.S. U.S. healthcare costs are projected to reach 18.4% of GDP 2013. The predicted growth in health care costs is expected to cause strain on the federal budget and a growing inability of employers and employees to pay for private insurance. Different national policies are the reason for different national health care costs in the U.S. and Japan. The U.S. has higher healthcare prices for salaries, equipment, supplies, and pharmaceuticals as compared to Japan. Higher prices, higher service intensity and volume during hospitalization create higher total cost in the U.S. Price controls in Japan kept medical inflation low at 0.46%/yr from 1980-2000. Market-pricing mechanisms in the U.S. have proven ineffective in controlling national healthcare costs, while Japan's national fee and price control policies have kept national costs among the lowest within the Organization for Economic Cooperation and Development. To guide insurance coverage policy, neurosurgery and other highly technical specialties should better define the comparative health benefit of high price technical services by prospective outcome studies.

  5. Neurosurgery in Nigeria II - Evaluation of the perceptions of health personnel after the commencement of services in a new centre

    Directory of Open Access Journals (Sweden)

    Jude Kennedy C Emejulu

    2010-01-01

    Full Text Available Background: Prior to the commencement of neurosurgical services in our new centre, in 2006, the awareness of and perceptions about this specialty amongst the health workers were studied. One year after, having experienced first-hand the activities of the unit, these perceptions were again re-evaluated amongst the same workers to determine the impact of the unit on the opinions about the specialty. Methods and Materials: This study was carried out with a questionnaire designed with the 5-point Likert scale, and the respondents comprised of doctors, nurses, students, paramedics and administrators, randomly selected. The same questionnaire was used in the first study but was slightly modified for the present study. Results: Out of 400 questionnaires distributed randomly, 342 were completed and returned. Most of the respondents 282 (82.5% were aged 20 - 30years, mostly students 220 (64.3%, and majority 318 (93% have heard of neurosurgery prior to the establishment of our unit. The service need was rated very necessary by most 286(83.6%, availability of services in Nigeria rated inadequate by 177 (51.8%, and the quality of services rated fair 155(45.3%. The services in our centre were rated fair 138 (40.4% and lack of equipment/facilities was adjudged the greatest hindrance to practice 216 (63.2%, and majority 289 (84.5% strongly recommended that services continue. Conclusion: Neurosurgical services are still significantly inadequate in Nigeria, and though the establishment of new units has positively changed the perception of health workers about the specialty, provision of more manpower and modern facilities remains the major challenge.

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

    Science.gov (United States)

    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.

  7. 2016 TRI Preliminary Dataset

    Science.gov (United States)

    The TRI preliminary dataset includes the most current TRI data available and reflects toxic chemical releases and pollution prevention activities that occurred at TRI facilities during the 2016 calendar year.

  8. Neurosurgery Specialist Nurse Training and Discussion%神经外科专科护士的培训与探讨

    Institute of Scientific and Technical Information of China (English)

    德琳; 江晓锦

    2011-01-01

    目的:探讨神经外科专科护士培训培养专科护理人才,提高神经外科护理质量.方法:根据神经外科护理特点,对5年内护士培训临床实践能力,5年以上护士培训专科观察、分析、判断能力及临床带教能力,高年资护士培训解决护理专业难度能力.结果:护士的专科知识和技能得到拓展和加深,护士的专科护理水平、护理质量和危重病人抢救成功率显著提高.结论:通过专科培训,护士的责任心增强了,护理缺陷降低了,工作效率明显提高,对专科护理发展起到了积极推动作用.%Objective: To discuss how to train neurosurgery nurse, culture professional murse, and improve nursing quality in neurosurgery. Methods: By the characteristic of the neurosurgery nurse, train the nurses working below 5 years for clincal practice abilities, those above 5 years for observe, analyze, judge and teach abilities, senior nurses for the abilities of solving professional difficult problems. Results : The nurses' professional knowledge and skill were developped. The professional mursing level, nursing quality and the success ratio of rescuing the dying patients was improved evidently. Conclusion: Through the professional nursing, the nurse sense of responsibility was enhanced and nursing defects was reduced, work efficiency was improved obviously. The professional nursing has played a positive role to improve the development of specialized nursing.

  9. The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence.

    Science.gov (United States)

    Groen, Rob J M; Koehler, Peter J; Kloet, Alfred

    2013-03-01

    The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney Medical Library in New Haven and the Alan Mason Chesney Medical Archives in Baltimore) of Cushing and Dandy with their Dutch disciples. The correspondence provides a unique inside view into the minds of both neurosurgical giants. After the neurologist Bernard Brouwer had paved the way for sending the Dutch surgeon Ignaz Oljenick overseas, Cushing personally took the responsibility to train him (1927-1929). On his return to Amsterdam, Oljenick and Brouwer established the first neurosurgical department in the country. Encouraged by Oljenick's favorable results, a number of Dutch general surgeons started asking Cushing for support. Cushing strategically managed and deflected these requests, probably aiming to increase the advantage of Oljenick and Brouwer. However, the University Hospital in Groningen persisted in the plans to establish its own neurosurgical unit and sent Ferdinand Verbeek to the US in 1932. Although staying at Cushing's department initially, Verbeek ultimately applied to Walter Dandy for a position of visiting voluntary assistant, staying until the end of 1934. Verbeek and Dandy became lifelong friends. On his return to Groningen, Verbeek started practicing neurosurgery, isolated in the northern part of the country. He relied on the support of Dandy, with whom he kept up a regular correspondence, discussing cases and seeking advice. Dandy, on his part, used Verbeek as the ambassador in Europe for his operative innovations. At the beginning of World War II, Oljenick had to flee the country, which concluded the direct line with the Cushing school in the Netherlands. After Dandy's death (1946), Verbeek continued practicing neurosurgery following his style and

  10. Stripe-like increase of rCBV beyond the visible border of glioblastomas: site of tumor infiltration growing after neurosurgery.

    Science.gov (United States)

    Blasel, Stella; Franz, Kea; Ackermann, Hanns; Weidauer, Stefan; Zanella, Friedhelm; Hattingen, Elke

    2011-07-01

    We observed a stripe-like pattern of regional cerebral blood volume (rCBV) increase in a defined region adjacent to the contrast enhancement (CE) on MRI of glioblastomas (GBM) that we defined as the "striate sign" (SS). We hypothesized that the SS marks infiltration of GBM outside the CE volume transforming into future CE tumor in the follow-up. T2*-weighted dynamic susceptibility-weighted CE (DSC)-MRI, and T1 and T2-weighted images (WI) of 16 patients with GBM were retrospectively evaluated in a baseline MRI performed before neurosurgery. In seven of these patients we also performed a (1)H MR spectroscopic imaging ((1)H MRSI). The regions of interest (ROI) delineating the SS were defined on rCBV maps for each patient. ROIs were overlaid on follow-up T1-WI and T2-WI MRI performed 3, 6, and 9 months after neurosurgery. Size and maximum signal intensity (max SI) of de novo CE within the area of the SS were analyzed. Statistical analysis was performed with the Friedman test (P max SI of de-novo CE of the 3, 6, and 9-months follow-up MR examinations were significantly higher than in the baseline MRI (P < 0.001). Normalized choline was increased within the SS in all patients with de novo CE (n = 6). De-novo CE appeared within the SS in all patients (96% of all slices). This implies that the SS might indicate the site of future CE tumor, which represents the area of tumor growth after neurosurgery.

  11. E-WIN Project 2016: Evaluating the Current Gender Situation in Neurosurgery Across Europe-An Interactive, Multiple-Level Survey.

    Science.gov (United States)

    Steklacova, Anna; Bradac, Ondrej; de Lacy, Patricia; Benes, Vladimir

    2017-08-01

    The proportion of women among neurosurgeons appears to be growing worldwide with time. Official data concerning the current situation across Europe have not yet been published. Thus, there are still concerns about gender inequality. The European Women in Neurosurgery Project 2016 was designed to recognize the current situation across Europe. The office holders of the national neurosurgical societies of 39 countries forming the European Association of Neurosurgical Societies were contacted to provide data stating the proportion of women in neurosurgery. Obtained data were supplied with the results of an online survey. The response rate of national office holders was 90%. The number of reported neurosurgeons was 12,985, and overall proportion of women represented was 12%. Two hundred thirty-seven responses to online questionnaire were taken into account. The overall proportion of female respondents was 30%. There was no intergender variability in responses regarding amount of working time per week, exposure to surgeries, or administrative work. Male respondents reported dedicating significantly more time to scientific work and feeling more confident dictating own career direction. Female respondents reported being less often married, having fewer children, a stronger perception of gender significance level, and a higher appreciation of personal qualities. Neurosurgery is a challenging field of medicine. The results of our survey did not imply an overall feeling of gender inequality among European respondents, although women believe that the gender issue to be more important than men do and that they have to sacrifice more of their personal lives. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. THE TOMSK SCIENTIFIC SCHOOL OF NEUROLOGISTS. TO THE 120TH ANNIVERSARY OF THE DEPARTMENT OF NEUROLOGY AND NEUROSURGERY OF SIBERIAN STATE MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    V. M. Alifirova

    2013-01-01

    Full Text Available The history of the development of the Tomsk Scientific School Neurologists and the past and current events in the Department of Neurology and Neurosurgery of Siberian State Medical University are described. The Department of Neurology was established in 1881–1882. At a different times the department was headed by many great Russian physicians such as Michail G. Kurlov, Leonid I. Omorokov, Nikolay V. Schubin, Nikolay I. Komandenko. In addition to the academic work the department leads research in many fields of neurology, including movement disorders, cerebrovascular diseases, demyelinating and paroxysmal diseases. 

  13. Use of Google Glass to Enhance Surgical Education of Neurosurgery Residents: "Proof-of-Concept" Study.

    Science.gov (United States)

    Nakhla, Jonathan; Kobets, Andrew; De la Garza Ramos, Rafeal; Haranhalli, Neil; Gelfand, Yaroslav; Ammar, Adam; Echt, Murray; Scoco, Aleka; Kinon, Merritt; Yassari, Reza

    2017-02-01

    The relatively decreased time spent in the operating room and overall reduction in cases performed by neurosurgical trainees as a result of duty-hour restrictions demands that the pedagogical content within each surgical encounter be maximized and crafted toward the specific talents and shortcomings of the individual. It is imperative to future generations that the quality of training adapts to the changing administrative infrastructures and compensates for anything that may compromise the technical abilities of trainees. Neurosurgeons in teaching hospitals continue to experiment with various emerging technologies-such as simulators and virtual presence-to supplement and improve surgical training. The authors participated in the Google Glass Explorer Program in order to assess the applicability of Google Glass as a tool to enhance the operative education of neurosurgical residents. Google Glass is a type of wearable technology in the form of eyeglasses that employs a high-definition camera and allows the user to interact using voice commands. Google Glass was able to effectively capture video segments of various lengths for residents to review in a variety of clinical settings within a large, tertiary care university hospital, as well as during a surgical mission to a developing country. The resolution and quality of the video were adequate to review and use as a teaching tool. While Google Glass harbors the potential to dramatically improve both neurosurgical education and practice in a variety of ways, certain technical drawbacks of the current model limit its effectiveness as a teaching tool. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Topaz II preliminary safety assessment

    Science.gov (United States)

    Marshall, Albert C.; Standley, Vaughn; Voss, Susan S.; Haskin, Eric

    1993-01-01

    The Strategic Defense Initiative Organization (SDIO) decided to investigate the possibility of launching a Russian Topaz II space nuclear power system. A preliminary safety assessment was conducted to determine whether or not a space mission could be conducted safely and within budget constraints. As part of this assessment, a safety policy and safety functional requirements were developed to guide both the safety assessment and future Topaz II activities. A review of the Russian flight safety program was conducted and documented. Our preliminary safety assessment included a top level event tree, neutronic analysis of normal and accident configurations, an evaluation of temperature coefficients of reactivity, a reentry and disposal analysis, and analysis of postulated launch abort impact accidents, and an analysis of postulated propellant fire and explosion accidents. Based on the assessment, it appears that it will be possible to safely launch the Topaz II system in the U.S. with some possible system modifications. The principal system modifications will probably include design changes to preclude water flooded criticality and to assure intact reentry.

  15. Accounting and comparing of expenditure on the medical services given at neuro-surgery department of Imam Khomeyni Hospital in the year of 1994 (1373

    Directory of Open Access Journals (Sweden)

    Abasi Moghadam M

    1998-09-01

    Full Text Available This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373. In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

  16. Legal and Ethical Issues on Neurosurgery for Drug Addiction%颅脑手术戒毒相关法律问题与伦理思考

    Institute of Scientific and Technical Information of China (English)

    车京辉; 张金钟

    2011-01-01

    In recent years, neurosurgery for drug addiction, a newly emerging clinical method for treating drug addiction, has attracted extensive attention from the whole society. Opportunity comes, and challenge also arises, when exerting its advantages, this novel technology also brings potential threats to the recipients'normal physiological functions. Therefore, under the current circumstances when corresponding legislations are not established, it is necessary to explore the related ethical issues on recipients'life rights, health rights, informed consent, operational cost, and other legal issues before the massive clinical application of neurosurgery for drug addiction.%颅脑手术戒毒作为一项新兴的临床医学戒毒技术,受到了社会的广泛关注.这种临床戒毒方法 在发挥其优势的同时,也给接受治疗者的正常生理功能带来一定的潜在威胁,在相关立法尚不完善的情况下,有必要在颅脑手术戒毒正式应用于临床之前,对其涉及的生命权、健康权、知情同意权、手术费用等伦理问题进行讨论.

  17. Comparison of Continuous Noninvasive Blood Pressure Monitoring by TL-300 With Standard Invasive Blood Pressure Measurement in Patients Undergoing Elective Neurosurgery.

    Science.gov (United States)

    Lin, Wen-Qian; Wu, Huang-Hui; Su, Chang-Sheng; Yang, Jian-Teng; Xiao, Jin-Rong; Cai, Yu-Ping; Wu, Xiao-Zhi; Chen, Guo-Zhong

    2017-01-01

    Intraoperative blood pressure (BP) is one of the basic vital signs monitoring. Compared with standard invasive BP measurement, TL-300 allows for a continuous and beat-to-beat noninvasive intraoperative BP monitoring. The current retrospective study compared the accuracy and precision of this noninvasive technique for continuous BP monitoring with that of standard invasive BP measurement in patients undergoing elective neurosurgery. BP records of 23 patients undergoing elective neurosurgery, measured by both noninvasive TL-300 and invasive radial arterial catheter method, were retrospectively analyzed. Variability in BP data was analyzed by using linear regressions and Bland-Altman analysis. Four thousand three hundred eighty-one pairs of BP measurements from a total of 23 patients were included. The coefficient of determination of systolic, diastolic, and mean BP were 0.908, 0.803, and 0.922, respectively. And their bias was found to be 1.3±5.87 mm Hg (95% limits of agreement: -10.2 to +12.8 mm Hg), 2.8±6.40 mm Hg (95% limits of agreement: -9.8 to +15.3 mm Hg), and 1.8±4.20 mm Hg (95% limits of agreement: -6.4 to +10.1 mm Hg), respectively. TL-300 system is a promising noninvasive alternative to the invasive arterial catheter method for intraoperative BP monitoring, with a high accuracy and precision. With the limitation of the current retrospective study, further prospective method comparison studies are needed.

  18. Phantom study and accuracy evaluation of an image-to-world registration approach used with electro-magnetic tracking system for neurosurgery

    Science.gov (United States)

    Li, Senhu; Sarment, David

    2015-12-01

    Minimally invasive neurosurgery needs intraoperative imaging updates and high efficient image guide system to facilitate the procedure. An automatic image guided system utilized with a compact and mobile intraoperative CT imager was introduced in this work. A tracking frame that can be easily attached onto the commercially available skull clamp was designed. With known geometry of fiducial and tracking sensor arranged on this rigid frame that was fabricated through high precision 3D printing, not only was an accurate, fully automatic registration method developed in a simple and less-costly approach, but also it helped in estimating the errors from fiducial localization in image space through image processing, and in patient space through the calibration of tracking frame. Our phantom study shows the fiducial registration error as 0.348+/-0.028mm, comparing the manual registration error as 1.976+/-0.778mm. The system in this study provided a robust and accurate image-to-patient registration without interruption of routine surgical workflow and any user interactions involved through the neurosurgery.

  19. Harvey Cushing and pituitary Case Number 3 (Mary D.): the origin of this most baffling problem in neurosurgery.

    Science.gov (United States)

    Pascual, José María; Prieto, Ruth

    2016-07-01

    neurosurgery. In this paper the authors analyze the case of Mary D. and the great influence it had on Cushing's conceptions of the pituitary gland and its afflictions, and on the history of pituitary surgery.

  20. 优质护理在神经外科中的应用%Application of Quality Care in Neurosurgery

    Institute of Scientific and Technical Information of China (English)

    曾惠莉

    2014-01-01

    Objective To investigate the quality care in neurosurgery application effect. Methods 100 patients were divided into two groups (each 50), control group with general care, observation group of high quality care. Care for some time, for the care effect and satisfaction of patients and their families to investigate, through the investigation contrast, draw two care effect differences. Results The results of the two groups of nursing and family satisfaction surveys, the implementation of quality care in all aspects of the observation group satisfaction has been greatly improved, reaching 98.00%, no case of medical malpractice, the patient's family is also the case for the patient more satisfied, compared to the difference was statistically significant. Conclusion In the spirit of the application of surgical care quality care with good results, it is worth widely used.%目的:探究优质护理在神经外科的应用效果。方法把100例患者分为两组(各50例),对照组采用一般护理,观察组采用优质护理。护理一段时间后,对于护理效果和患者及家属的满意度进行调查,通过调查对比,得出两组护理效果的差异。结果对两组的护理效果及家属满意度进行调查,实行优质护理的观察组患者各方面的满意度有了很大的提高,达到了98.00%,没有出现1例医疗纠纷,患者家属也对于患者情况更加满意,对比差异有统计学意义。结论在精神外科的护理中应用优质护理有良好的效果,值得广泛应用。

  1. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description.

    Science.gov (United States)

    McGirt, Matthew J; Speroff, Theodore; Dittus, Robert S; Harrell, Frank E; Asher, Anthony L

    2013-01-01

    Given the unsustainable costs of US health care, universal agreement exists among payers, regulatory agencies, and other health care stakeholders that reform must include substantial improvements in the quality, effectiveness, and value of health care delivery. The Institute of Medicine and the American Recovery and Reinvestment Act of 2009 have called for the establishment of prospective registries to capture patient-centered data from real-world practice as a high priority to guide evidence-based reform. As a result, the American Association of Neurological Surgeons launched the National Neurosurgery Quality and Outcomes Database (N(2)QOD) and began enrolling patients in March 2012 into its initial pilot project: a web-based lumbar spine module. As a nationwide, prospective longitudinal registry utilizing patient reported outcome instruments, the N(2)QOD lumbar spine surgery pilot aims to systematically measure and aggregate surgical safety and 1-year postoperative outcome data from approximately 30 neurosurgical practices across the US with the primary aim of demonstrating the feasibility and validity of standardized 1-year outcome measurement from everyday real-world practice. At the end of the pilot year, 1) risk-adjusted modeling will be developed for the safety, quality, and effectiveness of lumbar surgical care (morbidity, readmission, improvements in pain, disability, quality of life, and return to work); 2) data integrity and validation will be demonstrated via internal quality control analyses and auditing, and 3) the feasibility of obtaining a high level of follow-up (~80%) of nationwide 1-year outcome measurement will be established. N(2)QOD will use only prospective clinical data, will avoid the use of administrative data proxies, and will rely on neurosurgically relevant risk factors for risk adjustment. Once national benchmarks of quality and effectiveness are accurately established and validated utilizing practice-based data extractors in the pilot

  2. UVISS preliminary visibility analysis

    DEFF Research Database (Denmark)

    Betto, Maurizio

    1998-01-01

    The goal of this work is to obtain a preliminary assessment of the sky visibility for anastronomical telescope located on the express pallet of the International SpaceStation (ISS)} taking into account the major constraints imposed on the instrument by the ISSattitude and structure. Part of the w......The goal of this work is to obtain a preliminary assessment of the sky visibility for anastronomical telescope located on the express pallet of the International SpaceStation (ISS)} taking into account the major constraints imposed on the instrument by the ISSattitude and structure. Part...

  3. Preliminary design package for prototype solar heating system

    Science.gov (United States)

    1978-01-01

    A summary is given of the preliminary analysis and design activity on solar heating systems. The analysis was made without site specific data other than weather; therefore, the results indicate performance expected under these special conditions. Major items include system candidates, design approaches, trade studies and other special data required to evaluate the preliminary analysis and design. The program calls for the development and delivery of eight prototype solar heating and cooling systems for installation and operational test.

  4. UVISS preliminary visibility analysis

    DEFF Research Database (Denmark)

    Betto, Maurizio

    1998-01-01

    The goal of this work is to obtain a preliminary assessment of the sky visibility for anastronomical telescope located on the express pallet of the International SpaceStation (ISS)} taking into account the major constraints imposed on the instrument by the ISSattitude and structure. Part...

  5. Bradycardia in neurosurgery.

    Science.gov (United States)

    Agrawal, Amit; Timothy, Jake; Cincu, Rafael; Agarwal, Trisha; Waghmare, Lalit B

    2008-04-01

    Cushing reflex' is characterized by the occurrence of hypertension, bradycardia and apnoea secondary to raised increased intracranial pressure (ICP), leading to pressure on and or stretch, or both, of the brainstem. With the wide availability of monitoring facilities and advancements in investigation techniques, observation of increased intracranial pressure resulting in haemodynamic instability and bradycardia has been increasingly recognized in relation to many neurosurgical conditions and procedures. The causes of bradycardia include space occupying lesion involving or compressing the brain parenchyma (subdural haematoma, tumours, hydrocephalus), neurosurgical procedures (neuroendoscopy, placement of extradural drains), epileptic and non-epileptic seizures, trigemino-cardiac reflex, cerebellar lesions, spinal lesions (neurogenic shock, autonomic dysreflexia) and many other rare causes (Ventricular catheter obstruction in cases of hydrocephalus, colloid cysts related acute neurogenic cardiac dysfunction, Ondine's curse syndrome, etc.). This highlights that bradycardia can be a warning sign in many neurosurgical conditions and Cushing's reflex is a protective and effective action of the brain for preserving an adequate cerebral perfusion pressure despite an increased intracranial pressure. Management of these patients include identification and treatment of the underlying cause of bradycardia, anti-cholinergics and if necessary cardiac pacing, nevertheless, other causes of haemodynamic changes (i.e. anesthetic drugs, tumor manipulation) should also be considered and managed accordingly. We believe that this knowledge and understanding will help to identify the patients' at risk and will also help in the management of neurosurgical patients with bradycardia.

  6. Industrial cogeneration optimization program. Volume II. Appendix A. Conceptual designs and preliminary equipment specifications. Appendix B. Characterization of cogeneration systems (near-term technology). Appendix C. Optimized cogeneration systems

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    This appendix to a report which evaluates the technical, economic, and institutional aspects of industrial cogeneration for conserving energy in the food, chemical, textile, paper, and petroleum industries contains data, descriptions, and diagrams on conceptual designs and preliminary equipment specifications for cogeneration facilities; characterization of cogeneration systems in terms of fuel utilization, performance, air pollution control, thermal energy storage systems, and capital equipment costs; and optimized cogeneration systems for specific industrial plants. (LCL)

  7. Uso de dexmedetomidina em neurocirurgia Uso de dexmedetomidina en neurocirugía The use of dexmedetomidine in neurosurgery

    Directory of Open Access Journals (Sweden)

    Bernardo Aloisio Grings Herbert

    2007-04-01

    aneurisma y la retirada de tumores va en aumento. Además, su uso en intervenciones quirúrgicas funcionales es promisorio.BACKGROUND AND OBJECTIVES: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery. CONTENTS: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described. CONCLUSIONS: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

  8. 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.

  9. Air-guided photonic-crystal-fiber pulse-compression delivery of multimegawatt femtosecond laser output for nonlinear-optical imaging and neurosurgery

    Science.gov (United States)

    Lanin, Aleksandr A.; Fedotov, Il'ya V.; Sidorov-Biryukov, Dmitrii A.; Doronina-Amitonova, Lyubov V.; Ivashkina, Olga I.; Zots, Marina A.; Sun, Chi-Kuang; Ömer Ilday, F.; Fedotov, Andrei B.; Anokhin, Konstantin V.; Zheltikov, Aleksei M.

    2012-03-01

    Large-core hollow photonic-crystal fibers (PCFs) are shown to enable a fiber-format air-guided delivery of ultrashort infrared laser pulses for neurosurgery and nonlinear-optical imaging. With an appropriate dispersion precompensation, an anomalously dispersive 15-μm-core hollow PCF compresses 510-fs, 1070-nm light pulses to a pulse width of about 110 fs, providing a peak power in excess of 5 MW. The compressed PCF output is employed to induce a local photodisruption of corpus callosum tissues in mouse brain and is used to generate the third harmonic in brain tissues, which is captured by the PCF and delivered to a detector through the PCF cladding.

  10. On Preliminary Breakdown

    Science.gov (United States)

    Beasley, W. H.; Petersen, D.

    2013-12-01

    The preliminary breakdown phase of a negative cloud-to-ground lightning flash was observed in detail. Observations were made with a Photron SA1.1 high-speed video camera operating at 9,000 frames per second, fast optical sensors, a flat-plate electric field antenna covering the SLF to MF band, and VHF and UHF radio receivers with bandwidths of 20 MHz. Bright stepwise extensions of a negative leader were observed at an altitude of 8 km during the first few milliseconds of the flash, and were coincident with bipolar electric field pulses called 'characteristic pulses'. The 2-D step lengths of the preliminary processes were in excess of 100 meters, with some 2-D step lengths in excess of 200 meters. Smaller and shorter unipolar electric field pulses were superposed onto the bipolar electric field pulses, and were coincident with VHF and UHF radio pulses. After a few milliseconds, the emerging negative stepped leader system showed a marked decrease in luminosity, step length, and propagation velocity. Details of these events will be discussed, including the possibility that the preliminary breakdown phase consists not of a single developing lightning leader system, but of multiple smaller lightning leader systems that eventually join together into a single system.

  11. 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

  12. Feasibility of diffusion tractography for the reconstruction of intra-thalamic and cerebello-thalamic targets for functional neurosurgery: a multi-vendor pilot study in four subjects

    Directory of Open Access Journals (Sweden)

    Andras Jakab

    2016-07-01

    Full Text Available Functional stereotactic neurosurgery by means of deep brain stimulation or ablation provides an effective treatment for movement disorders, but the outcome of surgical interventions depends on the accuracy by which the target structures are reached. The purpose of this pilot study was to evaluate the feasibility of diffusion tensor imaging (DTI based probabilistic tractography of deep brain structures that are commonly used for pre- and perioperative targeting for functional neurosurgery. Three targets were reconstructed based on their significance as intervention sites or as a no-go area to avoid adverse side effects: the connections propagating from the thalamus to (1 primary and supplementary motor areas, (2 to somatosensory areas and the cerebello-thalamic tract. We evaluated the overlap of the reconstructed connectivity based targets with corresponding atlas based data, and tested the inter-subject and inter-scanner variability by acquiring repeated DTI from four volunteers, and on three MRI scanners with similar sequence parameters.Compared to a 3D histological atlas of the human thalamus, moderate overlaps of 35-50% were measured between connectivity- and atlas based volumes, while the minimal distance between the centerpoints of atlas and connectivity targets was 2.5 mm. The variability caused by the MRI scanner was similar to the inter-subject variability, except for connections with the postcentral gyrus where it was higher. While cerebello-thalamic tractography resolved the anatomically correct trajectory of the tract individually, high volumetric variability was found across subjects and between scanners. DTI can be applied in the clinical, preoperative setting to reconstruct the cerebello-thalamic tract and to localize subdivisions within the lateral thalamus. In our pilot study, such subdivisions moderately matched the borders of the ventrolateral-posteroventral (VLpv nucleus and the ventral-posterolateral (VPL nucleus. Limitations

  13. 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.

  14. Environmental Survey preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    1988-04-01

    This report presents the preliminary findings from the first phase of the Environmental Survey of the United States Department of Energy (DOE) Sandia National Laboratories conducted August 17 through September 4, 1987. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with Sandia National Laboratories-Albuquerque (SNLA). The Survey covers all environmental media and all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at SNLA, and interviews with site personnel. 85 refs., 49 figs., 48 tabs.

  15. Ruiz Volcano: Preliminary report

    Science.gov (United States)

    Ruiz Volcano, Colombia (4.88°N, 75.32°W). All times are local (= GMT -5 hours).An explosive eruption on November 13, 1985, melted ice and snow in the summit area, generating lahars that flowed tens of kilometers down flank river valleys, killing more than 20,000 people. This is history's fourth largest single-eruption death toll, behind only Tambora in 1815 (92,000), Krakatau in 1883 (36,000), and Mount Pelée in May 1902 (28,000). The following briefly summarizes the very preliminary and inevitably conflicting information that had been received by press time.

  16. Butterfly and Moth Preliminary Checklist: Overton Bottoms North Unit, Big Muddy National Fish and Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This preliminary checklist was prepared by refuge staff with assistance from members of the Boone's Lick Chapter of the Missouri Master Naturalist Program and the...

  17. Definition study for an extended manned test of a regenerative life support system, preliminary test plan

    Science.gov (United States)

    1971-01-01

    A preliminary plan and procedure are presented for conducting an extended manned test program for a regenerative life support system. Emphasis will be placed on elements associated with long-term system operation and long-term uninterrupted crew confinement.

  18. A Preliminary Jupiter Model

    CERN Document Server

    Hubbard, W B

    2016-01-01

    In anticipation of new observational results for Jupiter's axial moment of inertia and gravitational zonal harmonic coefficients from the forthcoming Juno orbiter, we present a number of preliminary Jupiter interior models. We combine results from ab initio computer simulations of hydrogen-helium mixtures, including immiscibility calculations, with a new nonperturbative calculation of Jupiter's zonal harmonic coefficients, to derive a self-consistent model for the planet's external gravity and moment of inertia. We assume helium rain modified the interior temperature and composition profiles. Our calculation predicts zonal harmonic values to which measurements can be compared. Although some models fit the observed (pre-Juno) second- and fourth-order zonal harmonics to within their error bars, our preferred reference model predicts a fourth-order zonal harmonic whose absolute value lies above the pre-Juno error bars. This model has a dense core of about 12 Earth masses, and a hydrogen-helium-rich envelope with...

  19. A Preliminary Jupiter Model

    Science.gov (United States)

    Hubbard, W. B.; Militzer, B.

    2016-03-01

    In anticipation of new observational results for Jupiter's axial moment of inertia and gravitational zonal harmonic coefficients from the forthcoming Juno orbiter, we present a number of preliminary Jupiter interior models. We combine results from ab initio computer simulations of hydrogen-helium mixtures, including immiscibility calculations, with a new nonperturbative calculation of Jupiter's zonal harmonic coefficients, to derive a self-consistent model for the planet's external gravity and moment of inertia. We assume helium rain modified the interior temperature and composition profiles. Our calculation predicts zonal harmonic values to which measurements can be compared. Although some models fit the observed (pre-Juno) second- and fourth-order zonal harmonics to within their error bars, our preferred reference model predicts a fourth-order zonal harmonic whose absolute value lies above the pre-Juno error bars. This model has a dense core of about 12 Earth masses and a hydrogen-helium-rich envelope with approximately three times solar metallicity.

  20. NeuRobot: telecontrolled micromanipulator system for minimally invasive microneurosurgery-preliminary results.

    Science.gov (United States)

    Hongo, Kazuhiro; Kobayashi, Shigeaki; Kakizawa, Yukinari; Koyama, Jun-Ichi; Goto, Tetsuya; Okudera, Hiroshi; Kan, Kazutoshi; Fujie, Masakatsu G; Iseki, Hiroshi; Takakura, Kintomo

    2002-10-01

    Microneurosurgery can be performed less invasively with the recent advances in neuronavigation and neuroendoscopy. For even less invasive microneurosurgery, we have developed a telecontrolled micromanipulator system. The NeuRobot telecontrolled micromanipulator system was developed. With the use of this system, surgical simulations were performed with a human cadaveric head. The system consists of four main parts, i.e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a three-dimensional display monitor. Three 1-mm forceps and a three-dimensional endoscope, which could be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. All surgical procedures were accurately performed with this system. The use of telecontrolled manipulator systems in neurosurgery is very promising, and we are convinced that this system will facilitate more accurate, less invasive microneurosurgery. The details of the NeuRobot system and preliminary results are presented.