Science.gov

Sample records for aid surgical planning

  1. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence.

    PubMed

    Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Chen, K-C; Li, J; Zhang, X; Tang, Z; Alfi, D M

    2015-12-01

    The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.

  2. Three-dimensional visualization system as an aid for facial surgical planning

    NASA Astrophysics Data System (ADS)

    Barre, Sebastien; Fernandez-Maloigne, Christine; Paume, Patricia; Subrenat, Gilles

    2001-05-01

    We present an aid for facial deformities treatment. We designed a system for surgical planning and prediction of human facial aspect after maxillo-facial surgery. We study the 3D reconstruction process of the tissues involved in the simulation, starting from CT acquisitions. 3D iso-surfaces meshes of soft tissues and bone structures are built. A sparse set of still photographs is used to reconstruct a 360 degree(s) texture of the facial surface and increase its visual realism. Reconstructed objects are inserted into an object-oriented, portable and scriptable visualization software allowing the practitioner to manipulate and visualize them interactively. Several LODs (Level-Of- Details) techniques are used to ensure usability. Bone structures are separated and moved by means of cut planes matching orthognatic surgery procedures. We simulate soft tissue deformations by creating a physically-based springs model between both tissues. The new static state of the facial model is computed by minimizing the energy of the springs system to achieve equilibrium. This process is optimized by transferring informations like participation hints at vertex-level between a warped generic model and the facial mesh.

  3. Mandibular Reconstruction Using a Custom-Made Titanium Prosthesis: A Case Report on the Use of Virtual Surgical Planning and Computer-Aided Design/Computer-Aided Manufacturing.

    PubMed

    Ow, Andrew; Tan, Winston; Pienkowski, Lukasz

    2016-09-01

    The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore a segmental mandibular defect. The design specifications and sequence of the custom-made titanium prosthesis are discussed. Although successful in this case, there are limitations in its application and case selection is of vital importance. PMID:27516841

  4. Mandibular Reconstruction Using a Custom-Made Titanium Prosthesis: A Case Report on the Use of Virtual Surgical Planning and Computer-Aided Design/Computer-Aided Manufacturing.

    PubMed

    Ow, Andrew; Tan, Winston; Pienkowski, Lukasz

    2016-09-01

    The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore a segmental mandibular defect. The design specifications and sequence of the custom-made titanium prosthesis are discussed. Although successful in this case, there are limitations in its application and case selection is of vital importance.

  5. AIDS and family planning.

    PubMed

    1992-01-01

    In 1991, an HIV prevention program advisor and a research/evaluation specialist for family planning programs discussed problems that affected HIV prevention and family planning services in Haiti before and after the coup of the Aristide government. Population activities began aimlessly in 1974 and HIV prevention efforts only began in 1988. After the coup, Haitians lost their newly found hope for meaningful development. All foreign assistance ended and they did not trust the army. In fact, other than essential child survival activities, no health and family planning services operated for several weeks. The situation grew worse after the economic embargo. 3 months after the coup, the US considered adding family planning assistance. Still little movement of condom, family planning, and health supplies left Port-au-Prince for the provinces which adversely affected all health related efforts. Condoms could no longer be distributed easily either in the socially marketed or US supplied condom distribution programs. Before the coup, HIV prevention and family planning programs depended on peer educators to educate the public (this approach made these programs quite successful), but the 2 experts feared that they would not return to those roles and that these programs would need to completely rebuild. Another concern was the large scale urban-rural migration making it difficult for them to continue care. Early in the AIDS epidemic, the Haitian government was on the defensive because the US considered Haitians as a high risk group so it did little to prevent HIV transmission. After 1988, HIV prevention activities in Haiti centered on raising awareness and personalizing the epidemic. The AIDS specialist noted, however, that a major obstacle to increasing knowledge is that AIDS is just 1 of many fatal diseases in Haiti. Moreover few health professionals in Haiti have ever had public health training. PMID:12159262

  6. Lesson plans in surgical training.

    PubMed

    Lester, S E; Robson, A K R

    2007-06-01

    Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments. Lesson plans are individualised to the trainee and encourage ownership of learning. They are based on SMART criteria and therefore have a sound educational footing. Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min. Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees.

  7. Lesson plans in surgical training.

    PubMed

    Lester, S E; Robson, A K R

    2007-06-01

    Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments. Lesson plans are individualised to the trainee and encourage ownership of learning. They are based on SMART criteria and therefore have a sound educational footing. Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min. Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees. PMID:17550516

  8. [12 years of Computer-Aided Surgery around the Head : Developments in surgical planning and simulation from a Bern perspective].

    PubMed

    Wimmer, W; Gerber, N; Weber, S; Nolte, L-P; Caversaccio, M

    2016-09-01

    Over the past years, the multidisciplinary character of the international Computer-Aided Surgery around the Head (CAS-H) symposium has advanced many medical technologies, which were often adopted by industry. In Bern, the synergetic effects of the CAS-H symposium have enabled many experiences and developments in the area of computer-aided surgery. Planning and simulation methods in the areas of craniomaxillofacial surgery and otorhinolaryngology were developed and tested in clinical settings. In the future, further CAS-H symposia should follow, in order to promote the possibilities and applications of computer-assisted surgery around the head.

  9. Planning Resource Aid, 1989.

    ERIC Educational Resources Information Center

    Broadbent, William A.

    Designed to assist persons charged with the preparation of planning proposals that meet the requirements of the program of federal assistance to vocational education, this booklet reviews several types of planning strategies. After introductory comments, the booklet lists several steps that all planners should incorporate into their strategy: (1)…

  10. Three dimensional model for surgical planning in resection of thoracic tumors

    PubMed Central

    Kim, Min P.; Ta, Anderson H.; Ellsworth, Warren A.; Marco, Rex A.; Gaur, Puja; Miller​, Jordan S.

    2015-01-01

    Introduction The computed tomography scan provides vital information about the relationship of thoracic malignancies to the surrounding structures and aids in surgical planning. However, it can be difficult to visualize the images in a two-dimensional screen to interpret the full extent of the relationship between important structures in the surgical field. Presentation of case We report two cases where we used a three-dimensional printed model to aid in the surgical resection of thoracic malignancies. Discussion Careful planning is necessary to resect thoracic malignancies. Although two-dimensional images of the thoracic malignancies provide vital information about the tumor and its surrounding structures, the three-dimensional printed model can provide more accurate information about the tumor and assist in surgical planning. Conclusion Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy. PMID:26453940

  11. Three-Dimensional Planning in Maxillofacial Fracture Surgery: Computer-Aided Design/Computer-Aided Manufacture Surgical Splints by Integrating Cone Beam Computerized Tomography Images Into Multislice Computerized Tomography Images.

    PubMed

    Ren, Jiayin; Zhou, Zhongwei; Li, Peng; Tang, Wei; Guo, Jixiang; Wang, Hu; Tian, Weidong

    2016-09-01

    This study aimed to evaluate an innovative workflow for maxillofacial fracture surgery planning and surgical splint designing. The maxillofacial multislice computerized tomography (MSCT) data and dental cone beam computerized tomography (CBCT) data both were obtained from 40 normal adults and 58 adults who suffered fractures. The each part of the CBCT dentition image was registered into MSCT image by the use of the iterative closest point algorithm. Volume evaluation of the virtual splints that were designed by the registered MSCT images and MSCT images of the same object was performed. Eighteen patients (group 1) were operated without any splint. Twenty-one (group 2) and 19 patients (group 3) used the splints designed according to the MSCT images and registered MSCT images, respectively. The authors' results showed that the mean errors between the 2 models ranged from 0.53 to 0.92 mm and the RMS errors ranged from 0.38 to 0.69 mm in fracture patients. The mean errors between the 2 models ranged from 0.47 to 0.85 mm and the RMS errors ranged from 0.33 to 0.71 mm in normal adults. 72.22% patients in group 1 recovered occlusion. 85.71% patients in group 2, and 94.73% patients in group 3 reconstructed occlusion. There was a statistically significant difference between the MSCT images based splints' volume and the registered MSCT splints' volume in patients (P <0.05). The MSCT images based splints' volume was statistically significantly distinct from the registered MSCT splints' volume in normal adults (P <0.05). There was a statistically significant difference between the MSCT images based splints' volume and the registered MSCT splints' volume in patients and normal adults (P <0.05). The occlusion recovery rate of group 3 was better than that of group 1 and group 2. The way of integrating CBCT images into MSCT images for splints designing was feasible. The volume of the splints designed by MSCT images tended to be smaller than the splints designed by

  12. Three-Dimensional Planning in Maxillofacial Fracture Surgery: Computer-Aided Design/Computer-Aided Manufacture Surgical Splints by Integrating Cone Beam Computerized Tomography Images Into Multislice Computerized Tomography Images.

    PubMed

    Ren, Jiayin; Zhou, Zhongwei; Li, Peng; Tang, Wei; Guo, Jixiang; Wang, Hu; Tian, Weidong

    2016-09-01

    This study aimed to evaluate an innovative workflow for maxillofacial fracture surgery planning and surgical splint designing. The maxillofacial multislice computerized tomography (MSCT) data and dental cone beam computerized tomography (CBCT) data both were obtained from 40 normal adults and 58 adults who suffered fractures. The each part of the CBCT dentition image was registered into MSCT image by the use of the iterative closest point algorithm. Volume evaluation of the virtual splints that were designed by the registered MSCT images and MSCT images of the same object was performed. Eighteen patients (group 1) were operated without any splint. Twenty-one (group 2) and 19 patients (group 3) used the splints designed according to the MSCT images and registered MSCT images, respectively. The authors' results showed that the mean errors between the 2 models ranged from 0.53 to 0.92 mm and the RMS errors ranged from 0.38 to 0.69 mm in fracture patients. The mean errors between the 2 models ranged from 0.47 to 0.85 mm and the RMS errors ranged from 0.33 to 0.71 mm in normal adults. 72.22% patients in group 1 recovered occlusion. 85.71% patients in group 2, and 94.73% patients in group 3 reconstructed occlusion. There was a statistically significant difference between the MSCT images based splints' volume and the registered MSCT splints' volume in patients (P <0.05). The MSCT images based splints' volume was statistically significantly distinct from the registered MSCT splints' volume in normal adults (P <0.05). There was a statistically significant difference between the MSCT images based splints' volume and the registered MSCT splints' volume in patients and normal adults (P <0.05). The occlusion recovery rate of group 3 was better than that of group 1 and group 2. The way of integrating CBCT images into MSCT images for splints designing was feasible. The volume of the splints designed by MSCT images tended to be smaller than the splints designed by

  13. Virtual Surgical Planning for Orbital Reconstruction

    PubMed Central

    Susarla, Srinivas M.; Duncan, Katherine; Mahoney, Nicholas R.; Merbs, Shannath L.; Grant, Michael P.

    2015-01-01

    The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction. Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability. In this article, we review the use of virtual surgical planning for orbital decompression, posttraumatic midface reconstruction, reconstruction of a two-wall orbital defect, and reconstruction of a large orbital floor defect with a custom implant. The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology. PMID:26692714

  14. New Methods to Evaluate Craniofacial Deformity and to Plan Surgical Correction

    PubMed Central

    Gateno, Jaime; Xia, James J.; Teichgraeber, John F.

    2011-01-01

    The success of cranio-maxillofacial (CMF) surgery depends not only on surgical techniques, but also upon an accurate surgical plan. Unfortunately, traditional planning methods are often inadequate for planning complex cranio-maxillofacial deformities. To this end, we developed 3D computer-aided surgical simulation (CASS) technique. Using our CASS method, we are able to treat patients with significant asymmetries in a single operation which in the past was usually completed in two stages. The purpose of this article is to introduce our CASS method in evaluating craniofacial deformities and planning surgical correction. In addition, we discuss the problems associated with the traditional surgical planning methods. Finally, we discuss the strength and pitfalls of using three-dimensional measurements to evaluate craniofacial deformity. PMID:21927548

  15. Does computer-aided surgical simulation improve efficiency in bimaxillary orthognathic surgery?

    PubMed

    Schwartz, H C

    2014-05-01

    The purpose of this study was to compare the efficiency of bimaxillary orthognathic surgery using computer-aided surgical simulation (CASS), with cases planned using traditional methods. Total doctor time was used to measure efficiency. While costs vary widely in different localities and in different health schemes, time is a valuable and limited resource everywhere. For this reason, total doctor time is a more useful measure of efficiency than is cost. Even though we use CASS primarily for planning more complex cases at the present time, this study showed an average saving of 60min for each case. In the context of a department that performs 200 bimaxillary cases each year, this would represent a saving of 25 days of doctor time, if applied to every case. It is concluded that CASS offers great potential for improving efficiency when used in the planning of bimaxillary orthognathic surgery. It saves significant doctor time that can be applied to additional surgical work.

  16. Treatment planning complications and surgical miscues.

    PubMed

    Binon, Paul P

    2007-07-01

    It is critical to have an accurate understanding of the educational limitations of dentists because of a lack of formal training with implants. It is not a unilateral problem, as it can be easily discerned from the cases illustrated in this article. The team must pay attention to specific direction as to the number, location, depth, angulation, spacing, and distribution of implants in their patients. More and more experienced restorative dentists are incorporating implant treatment in their practice. There is more awareness and concern at having simple restorative cases turn into very complex undertakings that require extra chair time and additional laboratory expenses. To avoid treatment planning complications and surgical miscues the following is recommended: 1) always complete a detailed restorative and surgical examination; 2) do not place implants without a restorative prosthodontic workup; 3) refer the patient to an experienced dentist for the workup; 4) insist on a diagnostic wax-up; 5) insist on a radiographic and a surgical stent and use it during placement; 6) determine that the entire treatment team has the knowledge and experience to complete the case; 7) as a surgeon, be sure you understand the exigencies of fixed and removable restorative care; 8) make sure that team members have the same treatment vision; and 9) communicate. Never take anything for granted. Communicate.

  17. Single-tooth dento-osseous osteotomy with a computer-aided design/computer-aided manufacturing surgical guide

    PubMed Central

    2016-01-01

    This clinical note introduces a method to assist surgeons in performing single-tooth dento-osseous osteotomy. For use in this method, a surgical guide was manufactured using computer-aided design/computer-aided manufacturing technology and was based on preoperative surgical simulation data. This method was highly conducive to successful single-tooth dento-osseous segmental osteotomy. PMID:27162756

  18. Surgical treatment of distal anterior cerebral artery aneurysms aided by electromagnetic navigation CT angiography.

    PubMed

    Hermann, Elvis J; Petrakakis, Ioannis; Götz, Friedrich; Lütjens, Götz; Lang, Josef; Nakamura, Makoto; Krauss, Joachim K

    2015-07-01

    The surgical treatment of distal anterior cerebral artery (DACA) aneurysms still presents a challenge for neurosurgeons because of their small size and their location in the depth of the narrow frontal interhemispheric fissure. This study aimed to investigate feasibility, safety, accuracy, and usefulness of electromagnetic (EM) navigation to aid clipping of DACA aneurysms. Eight patients (age between 2 and 68 years, mean age 49.8 years) with a DACA aneurysm underwent EM-guided neuronavigated microsurgery for clipping of the aneurysm. All patients underwent craniocervical 3D-CT angiography preoperatively. After planning the optimal approach and surgical trajectory avoiding opening of the frontal sinus, the head was fixed. Intraoperative screenshots were correlated with the microscopical view of the DACA aneurysms before clipping. EM-guided neuronavigation using CT angiography for DACA aneurysms enabled fast and accurate referencing of the patient and planning of a tailored craniotomy without opening of the frontal sinus. Intraoperative accuracy was highly reliable except in one instance due to dislocation of the dynamic reference frame (DRF). There was a good correlation between the 3D-CT angiography-based navigation data sets and the intraoperative vascular anatomy. In all patients, bridging veins were spared. The aid of EM neuronavigation was considered useful in all instances. EM-guided neuronavigation using CT angiography for surgery of DACA aneurysms is a useful tool optimizing the surgical approach directly to the aneurysm minimizing additional damage to the surrounding tissue during preparation of the aneurysm and the parent vessel. PMID:25666391

  19. Accuracy of different types of computer-aided design/computer-aided manufacturing surgical guides for dental implant placement

    PubMed Central

    Geng, Wei; Liu, Changying; Su, Yucheng; Li, Jun; Zhou, Yanmin

    2015-01-01

    Purpose: To evaluate the clinical outcomes of implants placed using different types of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, including partially guided and totally guided templates, and determine the accuracy of these guides Materials and methods: In total, 111 implants were placed in 24 patients using CAD/CAM surgical guides. After implant insertion, the positions and angulations of the placed implants relative to those of the planned ones were determined using special software that matched pre- and postoperative computed tomography (CT) images, and deviations were calculated and compared between the different guides and templates. Results: The mean angular deviations were 1.72 ± 1.67 and 2.71 ± 2.58, the mean deviations in position at the neck were 0.27 ± 0.24 and 0.69 ± 0.66 mm, the mean deviations in position at the apex were 0.37 ± 0.35 and 0.94 ± 0.75 mm, and the mean depth deviations were 0.32 ± 0.32 and 0.51 ± 0.48 mm with tooth- and mucosa-supported stereolithographic guides, respectively (P < .05 for all). The mean distance deviations when partially guided (29 implants) and totally guided templates (30 implants) were used were 0.54 ± 0.50 mm and 0.89 ± 0.78 mm, respectively, at the neck and 1.10 ± 0.85 mm and 0.81 ± 0.64 mm, respectively, at the apex, with corresponding mean angular deviations of 2.56 ± 2.23° and 2.90 ± 3.0° (P > .05 for all). Conclusions: Tooth-supported surgical guides may be more accurate than mucosa-supported guides, while both partially and totally guided templates can simplify surgery and aid in optimal implant placement. PMID:26309497

  20. Computer-Designed Splints for Surgical Transfer of 3D Orthognathic Planning.

    PubMed

    Zinser, Max; Zoeller, Joachim

    2015-10-01

    Advances in computers and imaging have permitted the adoption of three-dimensional (3D) planning protocols in orthognathic surgery, which may allow a paradigm shift when the computer-assisted planning can be transferred properly. The purpose of this investigation was to introduce an innovative clinical protocol using computer-aided designed and computer-aided manufactured (CAD/CAM) surgical splints for surgical transfer of 3D orthognathic planning compared with the classic technique using arbitrary occlusal splints. The clinical protocols consisted of computed tomography (CT) or cone-beam CT (CBCT) maxillofacial imaging, bone segmentation, 3D diagnosis, computer-assisted surgical treatment planning, and CAD/CAM surgical splints (group A) and manufacture of arbitrary occlusal splints (group B) for intraoperative surgical planning transfer. The observed patients underwent bimaxillary osteotomies and, if necessary, an additional genioplasty. Both techniques were evaluated by applying 13 hard tissue parameters to compare the 3D orthognathic planning (T0) with the postoperative result (T1) using 3D cephalometry. The CAD/CAM splints showed significant better precision for the maxilla (ΔT < 0.23 mm) and mandible (ΔT < 0.33 mm) compared with a maxillary deviation of 1.3 mm and a mandibular deviation of 1.8 mm when using the arbitrary splints. Computer-assisted diagnosis and preoperative surgical planning provide clinicians with valuable tools and allow 3D imagination. CAD/CAM splints provide a reliable, innovative, and precise approach for the transfer of 3D orthognathic planning, which is more precise compared with the conventional arbitrary occlusal splints.

  1. Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

    PubMed Central

    Hammoudeh, Jeffrey A.; Howell, Lori K.; Boutros, Shadi; Scott, Michelle A.

    2015-01-01

    Background: Orthognathic surgery has traditionally been performed using stone model surgery. This involves translating desired clinical movements of the maxilla and mandible into stone models that are then cut and repositioned into class I occlusion from which a splint is generated. Model surgery is an accurate and reproducible method of surgical correction of the dentofacial skeleton in cleft and noncleft patients, albeit considerably time-consuming. With the advent of computed tomography scanning, 3D imaging and virtual surgical planning (VSP) have gained a foothold in orthognathic surgery with VSP rapidly replacing traditional model surgery in many parts of the country and the world. What has yet to be determined is whether the application and feasibility of virtual model surgery is at a point where it will eliminate the need for traditional model surgery in both the private and academic setting. Methods: Traditional model surgery was compared with VSP splint fabrication to determine the feasibility of use and accuracy of application in orthognathic surgery within our institution. Results: VSP was found to generate acrylic splints of equal quality to model surgery splints in a fraction of the time. Drawbacks of VSP splint fabrication are the increased cost of production and certain limitations as it relates to complex craniofacial patients. Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients. PMID:25750846

  2. Family planning and AIDS on Yokohama agenda.

    PubMed

    1994-10-01

    The 10th International Conference on AIDS/International Conference on STD in Yokohama August 7-12, 1994, attracted 12,000 people from 130 countries to consider the expanding AIDS pandemic. A satellite symposium was held the day before the opening of the conference, August 6, also in Yokohama, to bring participants together to focus upon the importance of providing access to oral contraceptives and the necessity of condoms. This symposium was organized by the Japan Family Planning Association. Speakers called for the authorization of the low-dose oral contraceptive pill for Japanese women; greater condom use against HIV and other STDs; expanding the concept of reproductive health to include maternal and child health, the prevention of STDs, and infertility; clinical approaches and care for HIV-infected individuals during pregnancy and labor; and counseling to pregnant HIV-infected women. PMID:12318906

  3. Computer aided detection of surgical retained foreign object for prevention

    SciTech Connect

    Hadjiiski, Lubomir Marentis, Theodore C.; Rondon, Lucas; Chan, Heang-Ping; Chaudhury, Amrita R.; Chronis, Nikolaos

    2015-03-15

    Purpose: Surgical retained foreign objects (RFOs) have significant morbidity and mortality. They are associated with approximately $1.5 × 10{sup 9} annually in preventable medical costs. The detection accuracy of radiographs for RFOs is a mediocre 59%. The authors address the RFO problem with two complementary technologies: a three-dimensional (3D) gossypiboma micro tag, the μTag that improves the visibility of RFOs on radiographs, and a computer aided detection (CAD) system that detects the μTag. It is desirable for the CAD system to operate in a high specificity mode in the operating room (OR) and function as a first reader for the surgeon. This allows for fast point of care results and seamless workflow integration. The CAD system can also operate in a high sensitivity mode as a second reader for the radiologist to ensure the highest possible detection accuracy. Methods: The 3D geometry of the μTag produces a similar two dimensional (2D) depiction on radiographs regardless of its orientation in the human body and ensures accurate detection by a radiologist and the CAD. The authors created a data set of 1800 cadaver images with the 3D μTag and other common man-made surgical objects positioned randomly. A total of 1061 cadaver images contained a single μTag and the remaining 739 were without μTag. A radiologist marked the location of the μTag using an in-house developed graphical user interface. The data set was partitioned into three independent subsets: a training set, a validation set, and a test set, consisting of 540, 560, and 700 images, respectively. A CAD system with modules that included preprocessing μTag enhancement, labeling, segmentation, feature analysis, classification, and detection was developed. The CAD system was developed using the training and the validation sets. Results: On the training set, the CAD achieved 81.5% sensitivity with 0.014 false positives (FPs) per image in a high specificity mode for the surgeons in the OR and 96

  4. Surgical mission planning in the developing world.

    PubMed

    McClenaghan, F; Fell, M; Martin, D; Smith, G; McGurk, M

    2013-12-01

    Surgical missions to the developing world have been criticized for their lack of outcome analysis. Reported studies indicate a high rate of postoperative complications. An integrated pathway developed for surgical missions and a report of its performance in action is presented herein. Patients were optimized for surgery by a medical team from the UK for a minimum of 14 days preoperatively. They were then transferred to hospital for surgery and returned when stable. At the completion of the mission a junior doctor remained behind for 3 weeks to chart the patients' progress. Thirty case patients were treated over a 2-week period. The complication rate at 3 weeks postoperatively was 7/30. Twenty-two operations were classified as complex (over 1h with more than one flap) and eight as simple (under 1h with minimal flaps). Of those undergoing the simple operations, 2/8 encountered complications at an average of 5 days postoperatively (range 3-7 days). Many medical teams depart in an elevated atmosphere of accomplishment, which without an outcome analysis gives a false impression of their positive impact. Outcome analysis is essential to honestly appraise the effect of surgical missions.

  5. Virtual occlusion in planning orthognathic surgical procedures.

    PubMed

    Nadjmi, N; Mollemans, W; Daelemans, A; Van Hemelen, G; Schutyser, F; Bergé, S

    2010-05-01

    Accurate preoperative planning is mandatory for orthognathic surgery. One of the most important aims of this planning process is obtaining good postoperative dental occlusion. Recently, 3D image-based planning systems have been introduced that enable a surgeon to define different osteotomy planes preoperatively and to assess the result of moving different bone fragments in a 3D virtual environment, even for soft tissue simulation of the face. Although the use of these systems is becoming more accepted in orthognathic surgery, few solutions have been proposed for determining optimal occlusion in the 3D planning process. In this study, a 3D virtual occlusion tool is presented that calculates a realistic interaction between upper and lower dentitions. It enables the surgeon to obtain an optimal and physically possible occlusion easily. A validation study, including 11 patient data sets, demonstrates that the differences between manually and virtually defined occlusions are small, therefore the presented system can be used in clinical practice.

  6. Guide to Planning Health Promotion for AIDS Prevention and Control. WHO AIDS Series 5.

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    This guide is intended to provide planners, managers, and technical staff with guidelines for planning, implementing, monitoring, and evaluating an Acquired Immune Deficiency Syndrome (AIDS) health promotion program. As such, it can be used in the development of a detailed AIDS health promotion action plan. The guide reviews the steps, processes,…

  7. Utilization of a multimedia PACS workstation for surgical planning of epilepsy

    NASA Astrophysics Data System (ADS)

    Hoo, Kent S., Jr.; Wong, Stephen T. C.; Hawkins, Randall A.; Knowlton, Robert C.; Laxer, Kenneth D.; Rowley, Howard A.

    1997-05-01

    Surgical treatment of temporal lobe epilepsy requires the localization of the epileptogenic zone for surgical resection. Currently, clinicians utilize electroencephalography, various neuroimaging modalities, and psychological tests together to determine the location of this zone. We investigate how a multimedia neuroimaging workstation built on top of the UCSF Picture Archiving and Communication System can be used to aid surgical planning of epilepsy and related brain diseases. This usage demonstrates the ability of the workstation to retrieve image and textural data from PACS and other image sources, register multimodality images, visualize and render 3D data sets, analyze images, generate new image and text data from the analysis, and organize all data in a relational database management system.

  8. Virtual cystoscopy--a surgical planning and guidance tool.

    PubMed

    Braticevici, Bogdan; Onu, Mihaela; Bengus, Florentin

    2006-03-01

    Image guided-surgery systems facilitates surgical planning phases of endoscopic procedures. In this paper, we used a software package for 3D surface model generation and vizualization of the urinary bladder, based on magnetic resonance (MR) cross sectional images of the pelvis. The patients group consisted in 6 patients diagnosed with urinary bladder tumour. They were submitted to MRI exam. Twelve consecutive cross sectional images of the pelvis were aquired (TR (repetition time) = 600 msec, TE (echo time) = 19 msec, slice thickness = 6 divided by 7 mm, FOV (field of view) = 36 cm. All these images were transferred to a personal computer running the 3DSlicer software. We obtained, for each patient, a 3D model of the pelvis including the urinary bladder. In This way, the surgical enviroment was simulated and we are able to investigate the bladder by virtual cystoscopy. The virtual endoscopy may be used as a tool in the preoperative training and in surgical planning.

  9. Enhanced segmentation and skeletonization for endovascular surgical planning

    NASA Astrophysics Data System (ADS)

    Cheng, Irene; Firouzmanesh, Amirhossein; Leleve, Arnaud; Shen, Rui; Moreau, Richard; Brizzi, Vicenzo; Pham, Minh-Tu; Redarce, Tanneguy; Lermusiaux, Patrick; Basu, Anup

    2012-02-01

    Endovascular surgery is becoming widely deployed for many critical procedures, replacing invasive medical operations with long recovery times. However, there are still many challenges in improving the efficiency and safety of its usage, and reducing surgery time; namely, regular exposure to radiation, manual navigation of surgical tools, lack of 3D visualization, and lack of intelligent planning and automatic tracking of a surgical end-effector. Thus, our goal is to develop hardware and software components of a tele-operation system to alleviate the abovementioned problems. There are three specific objectives in this project: (i) to reduce the need for a surgeon to be physically next to a patient during endovascular surgery; (ii) to overcome the difficulties encountered in manual navigation; and, (iii) to improve the speed and experience of performing such surgeries. To achieve (i) we will develop an electro-mechanical interface to accurately guide mechanically controlled surgical tools from a close distance, along with a 3D visualization interface; for (ii) we will replace the current surgical tools with an "intelligent wire" controlled by the electro-mechanical system; for (iii) we will segment 3D medical images to extract precise shapes of blood vessels, following which we will perform automatic path planning for a surgical end-effector.

  10. 34 CFR 300.113 - Routine checking of hearing aids and external components of surgically implanted medical devices.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Routine checking of hearing aids and external... Eligibility Other Fape Requirements § 300.113 Routine checking of hearing aids and external components of surgically implanted medical devices. (a) Hearing aids. Each public agency must ensure that hearing aids...

  11. 34 CFR 300.113 - Routine checking of hearing aids and external components of surgically implanted medical devices.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Routine checking of hearing aids and external... Eligibility Other Fape Requirements § 300.113 Routine checking of hearing aids and external components of surgically implanted medical devices. (a) Hearing aids. Each public agency must ensure that hearing aids...

  12. 34 CFR 300.113 - Routine checking of hearing aids and external components of surgically implanted medical devices.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true Routine checking of hearing aids and external components... Eligibility Other Fape Requirements § 300.113 Routine checking of hearing aids and external components of surgically implanted medical devices. (a) Hearing aids. Each public agency must ensure that hearing aids...

  13. 34 CFR 300.113 - Routine checking of hearing aids and external components of surgically implanted medical devices.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Routine checking of hearing aids and external... Eligibility Other Fape Requirements § 300.113 Routine checking of hearing aids and external components of surgically implanted medical devices. (a) Hearing aids. Each public agency must ensure that hearing aids...

  14. 34 CFR 300.113 - Routine checking of hearing aids and external components of surgically implanted medical devices.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Routine checking of hearing aids and external components... Eligibility Other Fape Requirements § 300.113 Routine checking of hearing aids and external components of surgically implanted medical devices. (a) Hearing aids. Each public agency must ensure that hearing aids...

  15. Surgical planning of the total cavopulmonary connection: robustness analysis.

    PubMed

    Restrepo, Maria; Luffel, Mark; Sebring, Jake; Kanter, Kirk; Del Nido, Pedro; Veneziani, Alessandro; Rossignac, Jarek; Yoganathan, Ajit

    2015-06-01

    In surgical planning of the Fontan connection for single ventricle physiologies, there can be differences between the proposed and implemented options. Here, we developed a surgical planning framework that help determine the best performing option and ensures that the results will be comparable if there are slight geometrical variations. Eight patients with different underlying anatomies were evaluated in this study; surgical variations were created for each connection by changing either angle, offset or baffle diameter. Computational fluid dynamics were performed and the energy efficiency (indexed power loss-iPL) and hepatic flow distribution (HFD) computed. Differences with the original connection were evaluated: iPL was not considerably affected by the changes in geometry. For HFD, the single superior vena cava (SVC) connections presented less variability compared to the other anatomies. The Y-graft connection was the most robust overall, while the extra-cardiac connections showed dependency to offset. Bilateral SVC and interrupted inferior vena cava with azygous continuation showed high variability in HFD. We have developed a framework to assess the robustness of a surgical option for the TCPC; this will be useful to assess the most complex cases where pre-surgery planning could be most beneficial to ensure an efficient and robust hemodynamic performance.

  16. OrthoGraphics. A two-dimensional surgical planning system.

    PubMed

    Lotwin, R S; Baerg, R H

    1993-07-01

    Presurgical planning is a useful means of attaining consistent and predictable surgical results. The range of intraoperative errors is narrowed, and surgical time and materials are minimized. Computer-assisted presurgical planning is an extremely valuable tool for reconstructive foot surgery. A versatile, self-taught software program that permits longitudinal tracking of deformities and visualization of multiple surgical options, i.e., base wedge versus neck osteotomy, is effective in terms of cost, speed, accessibility, documentation, research, and education. The concept of CAD in presurgical planning is not new to other surgical specialties, but as of this date, it has not been implemented fully by podiatric surgeons. The cost factor for office computer use has decreased significantly over the years, and it is highly unusual to locate an office today that does not employ a computer in some aspect of office operation. The additional hardware and OrthoGraphics software at this date may represent between a $6000 and $20,000 investment, depending on how sophisticated an office operation is desired. It is of particular interest that one optical disk in the ICS can hold up to 1000 patient records with nearly 4000 radiographs. In addition, a 35-mm slide-creating interface is available along with the opportunity to modify existing programs to create custom software to meet special needs. It would appear that the teaching applications of this type of system are most compatible with the podiatric medical college clinical curriculum as a component of instructional programs in both biomechanics and surgery.

  17. [Computer-aided reconstruction of the facial skeleton : Planning and implementation in clinical routine].

    PubMed

    Wilde, F; Schramm, A

    2016-09-01

    In computer-aided reconstruction of the facial skeleton, a workflow has been established involving the following steps: > diagnosis → planning and simulation → surgical procedure → validation and quality control <. In addition to clinical findings, the focus of diagnosis is on three-dimensional (3D) imaging, particularly computed tomography. Planning and simulation involves creation of a virtual model of the desired surgical outcome using special planning software. The accuracy of implant fit can be virtually verified before surgery. 3D models and virtual reconstructions can be used for manufacturing patient-specific implants. During the surgical procedure, planning must be transferred to the surgical site as accurately as possible. A number of techniques are available for this purpose, e. g., closed reduction, open reduction with the placement of anatomically preformed or patient-specific implants in combination with surgical guides, and the additional use of navigation. Validation and quality control require postprocedural 3D imaging. After reconstructions of the midface, 3D imaging should be performed even before surgery is completed. Malpositions can thus be directly corrected and unnecessary open reconstructions avoided. Mobile 3D c-arms are particularly useful for intraoperative 3D imaging. Whereas intraoperative imaging makes postoperative imaging after midface reconstruction unnecessary in many cases, postoperative 3D imaging in addition to intraoperative imaging may still be recommended after complex reconstructions of the facial skeleton. PMID:27525666

  18. [Computer-aided reconstruction of the facial skeleton : Planning and implementation in clinical routine].

    PubMed

    Wilde, F; Schramm, A

    2016-09-01

    In computer-aided reconstruction of the facial skeleton, a workflow has been established involving the following steps: > diagnosis → planning and simulation → surgical procedure → validation and quality control <. In addition to clinical findings, the focus of diagnosis is on three-dimensional (3D) imaging, particularly computed tomography. Planning and simulation involves creation of a virtual model of the desired surgical outcome using special planning software. The accuracy of implant fit can be virtually verified before surgery. 3D models and virtual reconstructions can be used for manufacturing patient-specific implants. During the surgical procedure, planning must be transferred to the surgical site as accurately as possible. A number of techniques are available for this purpose, e. g., closed reduction, open reduction with the placement of anatomically preformed or patient-specific implants in combination with surgical guides, and the additional use of navigation. Validation and quality control require postprocedural 3D imaging. After reconstructions of the midface, 3D imaging should be performed even before surgery is completed. Malpositions can thus be directly corrected and unnecessary open reconstructions avoided. Mobile 3D c-arms are particularly useful for intraoperative 3D imaging. Whereas intraoperative imaging makes postoperative imaging after midface reconstruction unnecessary in many cases, postoperative 3D imaging in addition to intraoperative imaging may still be recommended after complex reconstructions of the facial skeleton.

  19. Anesthesia, surgical aid and resuscitation in manned space missions

    NASA Astrophysics Data System (ADS)

    Stazhadze, L. L.; Goncharov, I. B.; Neumyvakin, I. P.; Bogomolov, V. V.; Vladimirov, I. V.

    When discussing problems related to medical service in space flight, particular attention should be given to the specific living conditions and changes associated with space flight. In disease and injury, surgery can be provided only after conservative therapy has failed. In this context gnotobiological chambers allowing surgery in aseptic conditions seem promising. A portable set of interchangeable surgical tools should be made of light-weight alloys that can be readily sterilized. Electroanalgesia in combination with auriculoacupuncture as well as peridureal anesthesia may be used as they allow normal operations in autonomous space flight conditions. Changes in the sympatho-adrenal and kallikrein-kinin systems, as well as water-electrolyte balance, should be taken into account in developing methods and means of medical service in critical situations. Special attention should be given to the prevention and treatment of brain edema in view of weightlessness-induced cephalad fluid shifts.

  20. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids

    PubMed Central

    Donnelly, Kyla Z; Thompson, Rachel

    2015-01-01

    Introduction Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). Methods and analysis For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. Ethics and dissemination As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. Trial registration number This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717). PMID:26173718

  1. 11. BEACH TOILET BUILDING, OFFICE AND FIRST AID BUILDING, PLANS, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. BEACH TOILET BUILDING, OFFICE AND FIRST AID BUILDING, PLANS, ELEVATIONS AND SECTIONS Drawing No. 103-07 - Glen Echo Park, Crystal Swimming Pool, 7300 McArthur Boulevard, Glen Echo, Montgomery County, MD

  2. AIDS and family planning: Thailand conference breaks new ground.

    PubMed

    Finger, W R

    1990-12-01

    The July 1990 2-day meeting in Pattaya, Thailand, attended by over 220 family planning practitioners was the first nationwide conference in the developing world to address integration of acquired immunodeficiency syndrome (AIDS) prevention and education into the family planning service delivery system. The conference was co-sponsored by the Thailand Ministry of Public Health, the Thailand Fertility Research Association, and Family Health International, with funding from the US Agency for International Development and the Hewlett Foundation. As of September 1990, 22,075 cases of human immunodeficiency virus (HIV) infection--including 53 AIDS cases--has been documented in Thailand. There is general consensus that the actual number of HIV-infected persons is 50,000-100,000, with commercial sex workers, their clients, the clients' spouses, and newborns at highest risk. Conference organizers hope to boost AIDS prevention and control effectiveness by building on the already established cooperation between governmental and nongovernmental organizations in a nationwide network for family planning service delivery. A priority need is the development of counseling materials aimed at various target populations. A Women and AIDS Week is planned to involve women's groups. Another projected program centers on counseling men who visit commercial sex workers. In addition to AIDS education to family planning clients, family planning centers plan to provide counseling to contacts of HIV-infected persons and condoms to infected couples. At present, condoms are available at 18,000 family planning clinics and 10,000 pharmacies in Thailand. PMID:12283719

  3. Echocardiography in congenital heart disease. An aid to surgical diagnosis.

    PubMed

    Meyer, R A

    1977-05-01

    Echocardiography is an important noninvasive method for accurately diagnosing many congenital cardiac defects. This method provides significant information so that cardiac surgery, when necessary, can be planned with greater facility. The value of the sonar method rests not only on its ability to diagnose specific cardiac defects but also to exclude heart disease, especially in infants with shock or cyanosis from noncardiac causes. Development of two-dimensional real-time scanning systems should provide greater understanding of anatomic spatial relationships and ease of diagnosis.

  4. Clinton plans conference to discuss AIDS epidemic.

    PubMed

    1995-10-20

    President Bill Clinton scheduled the White House Conference on HIV and AIDS in December 1995. The one-day meeting was organized to assemble experts from around the nation to discuss the status of the epidemic and consider strategies to deal with it. The meeting is also intended to raise public awareness to increase prevention. Participants will be divided into working groups to address the status of research, prevention, and care programs; discrimination and legal issues; benefit programs; and coping strategies for those living with HIV and AIDS.

  5. An Aid for Planning Programs in Career Education.

    ERIC Educational Resources Information Center

    Illinois State Board of Vocational Education and Rehabilitation, Springfield. Div. of Vocational and Technical Education.

    Offered as an aid for developing sequential occupational education programs, the publication presents a concept in career education planning beginning with kindergarten and continuing through adult years. Career education goals are defined, and steps in planning sequential programs are outlined as follows: (1) organization of the occupational…

  6. Indiana AIDS Prevention Plan, 1986. Version 1.0.

    ERIC Educational Resources Information Center

    Indiana State Board of Health, Indianapolis.

    The Indiana statewide Acquired Immune Deficiency Syndrome (AIDS) prevention plan focuses on community education efforts targeted for specific high risk groups as well as health care and other professionals. Plans are summarized for dissemination of information to the following groups: risk groups, physicians, dental health, nursing, ancillary…

  7. Mathematical modelling in the computer-aided process planning

    NASA Astrophysics Data System (ADS)

    Mitin, S.; Bochkarev, P.

    2016-04-01

    This paper presents new approaches to organization of manufacturing preparation and mathematical models related to development of the computer-aided multi product process planning (CAMPP) system. CAMPP system has some peculiarities compared to the existing computer-aided process planning (CAPP) systems: fully formalized developing of the machining operations; a capacity to create and to formalize the interrelationships among design, process planning and process implementation; procedures for consideration of the real manufacturing conditions. The paper describes the structure of the CAMPP system and shows the mathematical models and methods to formalize the design procedures.

  8. The Approval Plan: Selection Aid, Selection Substitute

    ERIC Educational Resources Information Center

    Fenner, Audrey

    2004-01-01

    Approval plans are used by many libraries as an adjunct to title-by-title selection, and sometimes as a substitute for it. The author examines this approach to purchasing library materials, considering positive and negative effects approval plans may have on collection balance as well as on acquisitions budgets and workflow. The article also…

  9. Surgical planning and prosthesis construction using computer technology and medical imaging for immediate loading of implants in the pterygomaxillary region.

    PubMed

    Balshi, Stephen F; Wolfinger, Glenn J; Balshi, Thomas J

    2006-06-01

    This report describes a protocol that uses computerized tomography (CT), computer-aided design/computer-assisted manufacture (CAD/CAM) technology, and the Internet to plan placement of anterior and posterior dental implants and construct a precise surgical template and definitive prosthesis, which is connected at the time of implant placement. This procedure drastically reduces surgical treatment time and the recovery period. Patients with an edentulous arch had a denture with radiopaque markers constructed for CT scans of the appropriate jaw. The CT images, with acquisition slices of 0.5 mm, were transferred into a three-dimensional image-based program for planning and strategic placement of dental implants. After implants were virtually placed on the computer, the surgical treatment plan was sent to a manufacturing facility for construction of a surgical template and the prosthesis, Special surgical guide components were also manufactured for placement of implants in the pterygomaxillary region. The manufactured surgical components, surgical template, and definitive prosthesis were then delivered to the clinical site. Implant placement surgery was performed using the surgical template, without a flap, and the prosthesis was delivered, achieving immediate functional loading. Minor occlusal adjustments were made. The total surgical treatment time required was less than 60 minutes. Postoperative symptoms, such as pain, swelling, and inflammation, were minimal. Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows precise placement of implants. CAD/CAM technology using the three-dimensional images allows for fabrication of the surgical guide and final prosthesis. This is a significant advancement in implant dentistry and prosthodontics.

  10. [Computer-aided surgery planning for implantation of artificial ear].

    PubMed

    Huang, Yufeng; Huang, Yuanliang; Niu, Mao; Wang, Lisheng; Chang, Shixin

    2009-08-01

    In conventional ear implantation surgery, clinical physicians usually make a surgery planning based on their observation on series of 2D X-ray images or CT images. Such a planning method requires the physicians to have a high level of clinical experience. Besides, the whole operation is unintuitive, and might have certain risk. Considering these facts, we have developed a computer-aided system for the surgery planning of the implantation of artificial ear based on CT imaging and 3D reconstruction techniques. The system effectively overcomes the main drawbacks in conventional surgery planning techniques, and it makes the surgery planning procedure more precise, safe, and intuitive. PMID:19813593

  11. Generating patient-specific pulmonary vascular models for surgical planning

    NASA Astrophysics Data System (ADS)

    Murff, Daniel; Co-Vu, Jennifer; O'Dell, Walter G.

    2015-03-01

    Each year in the U.S., 7.4 million surgical procedures involving the major vessels are performed. Many of our patients require multiple surgeries, and many of the procedures include "surgical exploration". Procedures of this kind come with a significant amount of risk, carrying up to a 17.4% predicted mortality rate. This is especially concerning for our target population of pediatric patients with congenital abnormalities of the heart and major pulmonary vessels. This paper offers a novel approach to surgical planning which includes studying virtual and physical models of pulmonary vasculature of an individual patient before operation obtained from conventional 3D X-ray computed tomography (CT) scans of the chest. These models would provide clinicians with a non-invasive, intricately detailed representation of patient anatomy, and could reduce the need for invasive planning procedures such as exploratory surgery. Researchers involved in the AirPROM project have already demonstrated the utility of virtual and physical models in treatment planning of the airways of the chest. Clinicians have acknowledged the potential benefit from such a technology. A method for creating patient-derived physical models is demonstrated on pulmonary vasculature extracted from a CT scan with contrast of an adult human. Using a modified version of the NIH ImageJ program, a series of image processing functions are used to extract and mathematically reconstruct the vasculature tree structures of interest. An auto-generated STL file is sent to a 3D printer to create a physical model of the major pulmonary vasculature generated from 3D CT scans of patients.

  12. Discharge planning for the elderly ambulatory surgical patient.

    PubMed

    Burden, Nancy

    2004-12-01

    Discharge planning for the elderly ambulatory surgery patient should begin as soon as the patient's procedure is booked. Successful discharge planning relies on 1) comprehensive preoperative assessment; 2) effective communication among the surgical facility's caregivers, the physician's office, the patient, and the family; 3) consideration of the patient's preoperative status; and 4) a strong patient and family education plan. The challenges of planning the aftercare are compounded by the physical, social, financial, cognitive, and sensory changes related to the normal aging process as well as to systemic diseases, which are more prevalent in the older population than in younger patients. The elderly patient's discharge plan should identify and address age-related barriers to communication, incorporate the patient's existing physical and medical condition, diminish the negative effects of social support challenges, and address environmental issues that can be improved to support recovery. The elderly population often deals with the imperfect: isolation from family or friends, aging bodies, hearing and visual loss, financial limitations, and emotional challenges. Although the nurse cannot reverse these challenges of old age, he or she can still make a difference by providing guidance and resources to blunt the potential complications of surgery and anesthesia. PMID:15801349

  13. [From "acute AIDS" to "chronic AIDS": body perception and surgical interventions in people living with HIV and AIDS].

    PubMed

    de Alencar, Tatianna Meireles Dantas; Nemes, Maria Ines Battistella; Velloso, Marco Aurélio

    2008-01-01

    The Brazilian government has been providing free and universal access to the HAART therapy for people living with HIV and AIDS for ten years. Since then, many epidemiological characteristics have changed, and AIDS passed scientifically and medically to be classified as a chronic condition. This qualitative study aims to comprehend the challenges posed by self-perception of body changes experienced by people living with AIDS during recent years, as a result of prolonged use of antiretroviral medication.With this purpose, in 1999 and 2005, 32 semi-structured interviews with HIV positive individuals were held in the State of Sao Paulo to capture the challenges occurred during this period, in particular with regard to the lipodystrophy syndrome. The analysis of the data indicates that even with the availability and use of new technologies that allowed for AIDS to transform into a chronic, clinically treatable disease, there are still important aspects lived by patients that reedit fears and difficulties similar to those of the initial periods of the epidemic, among others appearance-impairing physical stigma.

  14. 3D surgical planning in patients affected by lipodystrophy.

    PubMed

    Pérez-Carrasco, J A; Acha, B; Gómez-Cia, T; Lopez-Garcia, R A; Delgado, Carlos; Serrano, C

    2015-03-01

    Lipodystrophy is a pathological condition characterized by the focal or general absence of adipose tissue. Surgeons reset the patient's surface contours using injectable materials to recreate a normal physical appearance. However, due to difficulties in preoperative planning and intraoperative assessment, about 15% of the surgical procedures involved are reinterventions to improve volume or symmetry. This increases the need for an available, efficient tool capable of providing the surgeon with a good estimation of the volumes to be injected before the intervention proper begins. This work describes a virtual reality-based application for the surgical planning of facial lipodystrophy correction (FLIC). The tool uses points selected interactively by the surgeon to compute a curve that delimits the surface area to be operated on. It then automatically computes an estimated natural reconstructed surface and the quantity of volume that needs to be implanted during the intervention. Experiments have been carried out in which the filling volumes estimated using FLIC and ZBrush software were compared with the real volumes injected by the surgeon. ICCs higher than 0.97 indicate that there were no significant differences between the respective measurements, thus validating the tool proposed in this paper.

  15. Web-based system for surgical planning and simulation

    NASA Astrophysics Data System (ADS)

    Eldeib, Ayman M.; Ahmed, Mohamed N.; Farag, Aly A.; Sites, C. B.

    1998-10-01

    The growing scientific knowledge and rapid progress in medical imaging techniques has led to an increasing demand for better and more efficient methods of remote access to high-performance computer facilities. This paper introduces a web-based telemedicine project that provides interactive tools for surgical simulation and planning. The presented approach makes use of client-server architecture based on new internet technology where clients use an ordinary web browser to view, send, receive and manipulate patients' medical records while the server uses the supercomputer facility to generate online semi-automatic segmentation, 3D visualization, surgical simulation/planning and neuroendoscopic procedures navigation. The supercomputer (SGI ONYX 1000) is located at the Computer Vision and Image Processing Lab, University of Louisville, Kentucky. This system is under development in cooperation with the Department of Neurological Surgery, Alliant Health Systems, Louisville, Kentucky. The server is connected via a network to the Picture Archiving and Communication System at Alliant Health Systems through a DICOM standard interface that enables authorized clients to access patients' images from different medical modalities.

  16. Application of Particle Swarm Optimization in Computer Aided Setup Planning

    NASA Astrophysics Data System (ADS)

    Kafashi, Sajad; Shakeri, Mohsen; Abedini, Vahid

    2011-01-01

    New researches are trying to integrate computer aided design (CAD) and computer aided manufacturing (CAM) environments. The role of process planning is to convert the design specification into manufacturing instructions. Setup planning has a basic role in computer aided process planning (CAPP) and significantly affects the overall cost and quality of machined part. This research focuses on the development for automatic generation of setups and finding the best setup plan in feasible condition. In order to computerize the setup planning process, three major steps are performed in the proposed system: a) Extraction of machining data of the part. b) Analyzing and generation of all possible setups c) Optimization to reach the best setup plan based on cost functions. Considering workshop resources such as machine tool, cutter and fixture, all feasible setups could be generated. Then the problem is adopted with technological constraints such as TAD (tool approach direction), tolerance relationship and feature precedence relationship to have a completely real and practical approach. The optimal setup plan is the result of applying the PSO (particle swarm optimization) algorithm into the system using cost functions. A real sample part is illustrated to demonstrate the performance and productivity of the system.

  17. Solid models for CT/MR image display: accuracy and utility in surgical planning

    NASA Astrophysics Data System (ADS)

    Mankovich, Nicholas J.; Yue, Alvin; Ammirati, Mario; Kioumehr, Farhad; Turner, Scott

    1991-05-01

    Medical imaging can now take wider advantage of Computer-Aided-Manufacturing through rapid prototyping technologies (RPT) such as stereolithography, laser sintering, and laminated object manufacturing to directly produce solid models of patient anatomy from processed CT and MR images. While conventional surgical planning relies on consultation with the radiologist combined with direct reading and measurement of CT and MR studies, 3-D surface and volumetric display workstations are providing a more easily interpretable view of patient anatomy. RPT can provide the surgeon with a life size model of patient anatomy constructed layer by layer with full internal detail. Although this life-size anatomic model is more easily understandable by the surgeon, its accuracy and true surgical utility remain untested. We have developed a prototype image processing and model fabrication system based on stereolithography, which provides the neurosurgeon with models of the skull base. Parallel comparison of the model with the original thresholded CT data and with a CRT displayed surface rendering showed that both have an accuracy of 99.6 percent. Because of the ease of exact voxel localization on the model, its precision was high with the standard deviation of measurement of 0.71 percent. The measurements on the surface rendered display proved more difficult to exactly locate and yielded a standard deviation of 2.37 percent. This paper presents our accuracy study and discussed ways of assessing the quality of neurosurgical plans when 3-D models a made available as planning tools.

  18. Simulation based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison L.

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  19. Simulation based planning of surgical interventions in pediatric cardiology

    PubMed Central

    Marsden, Alison L.

    2013-01-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting. PMID:24255590

  20. Software components for medical image visualization and surgical planning

    NASA Astrophysics Data System (ADS)

    Starreveld, Yves P.; Gobbi, David G.; Finnis, Kirk; Peters, Terence M.

    2001-05-01

    Purpose: The development of new applications in medical image visualization and surgical planning requires the completion of many common tasks such as image reading and re-sampling, segmentation, volume rendering, and surface display. Intra-operative use requires an interface to a tracking system and image registration, and the application requires basic, easy to understand user interface components. Rapid changes in computer and end-application hardware, as well as in operating systems and network environments make it desirable to have a hardware and operating system as an independent collection of reusable software components that can be assembled rapidly to prototype new applications. Methods: Using the OpenGL based Visualization Toolkit as a base, we have developed a set of components that implement the above mentioned tasks. The components are written in both C++ and Python, but all are accessible from Python, a byte compiled scripting language. The components have been used on the Red Hat Linux, Silicon Graphics Iris, Microsoft Windows, and Apple OS X platforms. Rigorous object-oriented software design methods have been applied to ensure hardware independence and a standard application programming interface (API). There are components to acquire, display, and register images from MRI, MRA, CT, Computed Rotational Angiography (CRA), Digital Subtraction Angiography (DSA), 2D and 3D ultrasound, video and physiological recordings. Interfaces to various tracking systems for intra-operative use have also been implemented. Results: The described components have been implemented and tested. To date they have been used to create image manipulation and viewing tools, a deep brain functional atlas, a 3D ultrasound acquisition and display platform, a prototype minimally invasive robotic coronary artery bypass graft planning system, a tracked neuro-endoscope guidance system and a frame-based stereotaxy neurosurgery planning tool. The frame-based stereotaxy module has been

  1. Computer Aided Setup Planning Using Tolerance Analysis for Prismatic Components

    NASA Astrophysics Data System (ADS)

    Vahid, Abedini; Mohsen, Shakeri; Sajad, Kafashi

    2011-01-01

    Computer aided process planning (CAPP) is the bridge between CAD and CAM. Setup planning is the major key to transform design concept into manufacturing domain, which is mainly experience based activity in modern manufacturing industry. Setup planning is a complicated non-linear task constrained by many factors such as tool approach direction, geometric feature relationship, fixturing constrain, tolerance requirement and manufacturing practice. The objective of setup planning is to determine the number of setup needed, the orientation of the workpiece and the machining surfaces in each setup. This paper focuses on the development of a formalized procedure for automatic generation of setup plan. Tolerance relations are used as critical constraints for setup planning. The tasks that are performed are: (a) identifying groups of features that can be machined in a single setup, (b) determining a suitable work piece orientation, i.e. the suitable datum planes for each setup, (c) determining all the feasible setup plans to machine the given set of features of prismatic parts, and (d) evaluating the feasible setup plans on the basis of technological conditions. Trial runs with industrial parts indicate that the system is applicable for industrial use.

  2. Accuracy of a Computer-Aided Surgical Simulation (CASS) Protocol for Orthognathic Surgery: A Prospective Multicenter Study

    PubMed Central

    Hsu, Sam Sheng-Pin; Gateno, Jaime; Bell, R. Bryan; Hirsch, David L.; Markiewicz, Michael R.; Teichgraeber, John F.; Zhou, Xiaobo; Xia, James J.

    2012-01-01

    Purpose The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. Materials and Methods The accuracy of the CASS protocol was assessed by comparing planned and postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, one center utilized computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were utilized without the chin templates for the remaining patients. The primary outcome measurements were linear and angular differences for the maxilla, mandible and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were: maxillary dental midline difference between the planned and postoperative positions; and linear and angular differences of the chin segment between the groups with and without the use of the template. The latter was measured when the planned and postoperative models were registered at mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and Bland and Altman's method for assessing measurement agreement. Results In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSD was 1.0mm and 1.5° for the maxilla, and 1.1mm and 1.8° for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy with largest positional RMSD of 1.0mm and the largest orientational RSMD of 2.2°. However, larger variances were observed in the group not using the chin template. This was significant in anteroposterior and superoinferior directions, as in

  3. Computer‐assisted surgical planning and intraoperative guidance in fetal surgery: a systematic review†

    PubMed Central

    Deprest, Jan; Vercauteren, Tom; Ourselin, Sebastien; David, Anna L.

    2015-01-01

    Abstract Fetal surgery has become a clinical reality, with interventions for twin‐to‐twin transfusion syndrome (TTTS) and spina bifida demonstrated to improve outcome. Fetal imaging is evolving, with the use of 3D ultrasound and fetal MRI becoming more common in clinical practise. Medical imaging analysis is also changing, with technology being developed to assist surgeons by creating 3D virtual models that improve understanding of complex anatomy, and prove powerful tools in surgical planning and intraoperative guidance. We introduce the concept of computer‐assisted surgical planning, and present the results of a systematic review of image reconstruction for fetal surgical planning that identified six articles using such technology. Indications from other specialities suggest a benefit of surgical planning and guidance to improve outcomes. There is therefore an urgent need to develop fetal‐specific technology in order to improve fetal surgical outcome. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd. PMID:26235960

  4. Individualized Surgical Templates and Titanium Microplates for Le Fort I Osteotomy by Computer-Aided Design and Computer-Aided Manufacturing.

    PubMed

    He, Wei; Tian, Kaiyue; Xie, Xiaoyan; Wang, Xiaoxia; Li, Yang; Wang, Xing; Li, Zili

    2015-09-01

    The authors report the use of novel individualized surgical templates and titanium miniplates for Le Fort I osteotomy and evaluate the accuracy of this technique in vitro. Nine three-dimensional stereolithographic skull models were used to design the templates and titanium microplates and to simulate the operation. Cone beam computed tomography (CBCT) scans of the skulls were acquired preoperatively and were used to generate virtual models. The surgical plans were made based on three-dimensional cephalometric analyses, and osteotomies were then performed virtually. Cylinder-shaped markers were placed to permit the correct location of titanium screws, and individualized surgical templates were designed. The bony segments were then repositioned virtually according to the surgical plans to correct the skeletal deformities. Resin surgical templates were produced by stereolithography rapid prototyping and the titanium miniplates by three-dimensional cutting. Le Fort I osteotomy was performed under the guide of the surgical templates and fixed with the titanium miniplates. Postoperatively, CBCT scans of each skull model were taken, and the differences between the actual and planned surgical outcomes were measured by superimposing the planned and postoperative virtual models generated from CBCT images. The authors demonstrated that the average linear difference between the planned and actual outcomes was <1 mm and the average orientation difference was <1°. The individualized surgical templates and titanium microplates designed in this experimental study permitted the repositioning of the maxillary segment to the correct planned positions during Le Fort I osteotomy, making this technique a promising alternative to the conventional split method.

  5. Educational Planning: A Critical Review and Recommendations for A.I.D.

    ERIC Educational Resources Information Center

    Daniere, A.

    Directed toward personnel in the Agency for International Development (AID), this document reviews the planning of AID educational assistance programs in developing nations. The report recommends that AID personnel should be in a position (a) to assign, organize, and monitor the planning of their own activities in the field of education; (b) to…

  6. Promoting perioperative advance care planning: a systematic review of advance care planning decision aids.

    PubMed

    Aslakson, Rebecca A; Schuster, Anne L R; Reardon, Jessica; Lynch, Thomas; Suarez-Cuervo, Catalina; Miller, Judith A; Moldovan, Rita; Johnston, Fabian; Anton, Blair; Weiss, Matthew; Bridges, John F P

    2015-11-01

    This systematic review identifies possible decision aids that promote perioperative advance care planning (ACP) and synthesizes the available evidence regarding their use. Using PubMed, EMBASE, Cochrane, SCOPUS, Web of Science, CINAHL, PsycINFO and Sociological Abstracts, researchers identified and screened articles for eligibility. Data were abstracted and risk of bias assessed for included articles. Thirty-nine of 5327 articles satisfied the eligibility criteria. Primarily completed in outpatient ambulatory populations, studies evaluated a variety of ACP decision aids. None were evaluated in a perioperative population. Fifty unique outcomes were reported with no head-to-head comparisons conducted. Findings are likely generalizable to a perioperative population and can inform development of a perioperative ACP decision aid. Future studies should compare the effectiveness of ACP decision aids.

  7. STD / AIDS prevention: new challenges for family planning programs.

    PubMed

    Williamson, N; Townsend, S

    1991-12-01

    Family planning (FP) professionals and programs are increasingly called upon to respond to increasing rates of sexually transmitted diseases (STD) and AIDS. While structural and ideological readjustment to meet these demands may seem problematic for some programs, the AIDS epidemic allows the opportunity for programs to expand into preventive health activities. Dr. Nancy Williamson, Director of Family Health International's Division of Program Evaluation and 1 of the authors of the World Health Organization's guidelines on family planning and AIDS, responds to questions most frequently posed by FP providers considering the need for and process of FP program restructuring. She holds that programmatic expansion for the prevention of HIV infection enhances the capability to provide good contraceptive services. FP programs are not expected to abandon their central missions of preventing unwanted pregnancies, but to engage in both the prevention of STD infection and unwanted pregnancies where possible. Sharing responsible sex behavior and the condom as common means of prevention, these 2 missions are far from mutually exclusive. The AIDS epidemic has impacted upon FP programs in a number of ways. Increased demand for condoms has been observed in countries with high levels of HIV seropositivity, greater concern has been placed upon counseling and sterile procedures, view have been altered to accept this dual role of contraception, and universal precautions for the protection of both client and workers from infection are of greater importance. Promoting the consistent use of condoms for the prevention of STDs has proved more challenging than promoting for contraceptive uses. Gaining the legitimacy of condoms among married couples while they are also promoted among high-risk groups also remains difficult. On other issues, promoting the routine use of 2 temporary methods is not recommended, questions must be posed to determine clients' risk status for infection, counseling

  8. Strategic planning ensures surgical success in cases of proliferative vitreoretinopathy.

    PubMed

    Lakhanpal, R Ross; Hariprasad, Seenu M

    2015-02-01

    For this Practical Retina column, Dr. Ross Lakhanpal from Baltimore was asked to comment on the current state of thinking and management options for proliferative vitreoretinopathy (PVR) after retinal detachment (RD) surgery.We are all aware that PVR continues to be an important cause of recurrent RD after successful repair. This feared complication has been reported to occur in up to 8% of patients after undergoing RD repair. Despite the historic progress made in managing various vitreoretinal diseases over the past decade, most retina specialists will agree that an unmet need remains in this landscape. Fortunately, advances in various surgical technologies such as instrumentation, lighting, and visualization have improved the outcomes after PVR management.Dr. Lakhanpal discusses causes of PVR, management goals, surgical techniques, and pearls to avoid complications after managing PVR. His experience working in an urban tertiary surgical retina practice enables him to offer insights that will be highly valued by our community.

  9. The Planning and Execution of Surgical Hand Mission Trips in Developing Countries.

    PubMed

    Nugent, Ajani G; Panthaki, Zubin; Thaller, Seth

    2015-06-01

    An important teaching tool and overall humanitarian good, medical mission trips are a common theme among health care professionals. These trips encompass large potential for education, global health progress, and cultural exposure, but the logistics of planning and execution are just as great and if not given serious consideration can limit success. This article sets out to explain the importance of planning and to provide specifics that are unique to surgical hand mission trips. Establishing trustworthy relationships, adapting to the host nation's limited resources, and preparing the proper surgical procedures for the particular areas' most common surgical needs are all discussed in this article.

  10. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases.

    PubMed

    Aboul-Hosn Centenero, Samir; Hernández-Alfaro, Federico

    2012-02-01

    The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise(®), Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre's standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs

  11. Recent advances in surgical planning & navigation for tumor biopsy and resection.

    PubMed

    Wang, Defeng; Ma, Diya; Wong, Matthew Lun; Wáng, Yì Xiáng J

    2015-10-01

    This paper highlights recent advancements in imaging technologies for surgical planning and navigation in tumor biopsy and resection which need high-precision in detection and characterization of lesion margin in preoperative planning and intraoperative navigation. Multimodality image-guided surgery platforms brought great benefits in surgical planning and operation accuracy via registration of various data sets with information on morphology [X-ray, magnetic resonance (MR), computed tomography (CT)], function connectivity [functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), rest-status fMRI], or molecular activity [positron emission tomography (PET)]. These image-guided platforms provide a correspondence between the pre-operative surgical planning and intra-operative procedure. We envisage that the combination of advanced multimodal imaging, three-dimensional (3D) printing, and cloud computing will play increasingly important roles in planning and navigation of surgery for tumor biopsy and resection in the coming years. PMID:26682133

  12. Recent advances in surgical planning & navigation for tumor biopsy and resection

    PubMed Central

    Ma, Diya; Wong, Matthew Lun; Wáng, Yì Xiáng J.

    2015-01-01

    This paper highlights recent advancements in imaging technologies for surgical planning and navigation in tumor biopsy and resection which need high-precision in detection and characterization of lesion margin in preoperative planning and intraoperative navigation. Multimodality image-guided surgery platforms brought great benefits in surgical planning and operation accuracy via registration of various data sets with information on morphology [X-ray, magnetic resonance (MR), computed tomography (CT)], function connectivity [functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), rest-status fMRI], or molecular activity [positron emission tomography (PET)]. These image-guided platforms provide a correspondence between the pre-operative surgical planning and intra-operative procedure. We envisage that the combination of advanced multimodal imaging, three-dimensional (3D) printing, and cloud computing will play increasingly important roles in planning and navigation of surgery for tumor biopsy and resection in the coming years. PMID:26682133

  13. Surgical retained foreign object (RFO) prevention by computer aided detection (CAD)

    NASA Astrophysics Data System (ADS)

    Marentis, Theodore C.; Hadjiiyski, Lubomir; Chaudhury, Amrita R.; Rondon, Lucas; Chronis, Nikolaos; Chan, Heang-Ping

    2014-03-01

    Surgical Retained Foreign Objects (RFOs) cause significant morbidity and mortality. They are associated with $1.5 billion annually in preventable medical costs. The detection accuracy of radiographs for RFOs is a mediocre 59%. We address the RFO problem with two complementary technologies: a three dimensional (3D) Gossypiboma Micro Tag (μTa) that improves the visibility of RFOs on radiographs, and a Computer Aided Detection (CAD) system that detects the μTag. The 3D geometry of the μTag produces a similar 2D depiction on radiographs regardless of its orientation in the human body and ensures accurate detection by a radiologist and the CAD. We create a database of cadaveric radiographs with the μTag and other common man-made objects positioned randomly. We develop the CAD modules that include preprocessing, μTag enhancement, labeling, segmentation, feature analysis, classification and detection. The CAD can operate in a high specificity mode for the surgeon to allow for seamless workflow integration and function as a first reader. The CAD can also operate in a high sensitivity mode for the radiologist to ensure accurate detection. On a data set of 346 cadaveric radiographs, the CAD system performed at a high specificity (85.5% sensitivity, 0.02 FPs/image) for the OR and a high sensitivity (96% sensitivity, 0.73 FPs/image) for the radiologists.

  14. Computer-aided liver surgery planning: an augmented reality approach

    NASA Astrophysics Data System (ADS)

    Bornik, Alexander; Beichel, Reinhard; Reitinger, Bernhard; Gotschuli, Georg; Sorantin, Erich; Leberl, Franz W.; Sonka, Milan

    2003-05-01

    Surgical resection of liver tumors requires a detailed three-dimensional understanding of a complex arrangement of vasculature, liver segments and tumors inside the liver. In most cases, surgeons need to develop this understanding by looking at sequences of axial images from modalities like X-ray computed tomography. A system for liver surgery planning is reported that enables physicians to visualize and refine segmented input liver data sets, as well as to simulate and evaluate different resections plans. The system supports surgeons in finding the optimal treatment strategy for each patient and eases the data preparation process. The use of augmented reality contributes to a user-friendly design and simplifies complex interaction with 3D objects. The main function blocks developed so far are: basic augmented reality environment, user interface, rendering, surface reconstruction from segmented volume data sets, surface manipulation and quantitative measurement toolkit. The flexible design allows to add functionality via plug-ins. First practical evaluation steps have shown a good acceptance. Evaluation of the system is ongoing and future feedback from surgeons will be collected and used for design refinements.

  15. A semi-automatic computer-aided method for surgical template design

    NASA Astrophysics Data System (ADS)

    Chen, Xiaojun; Xu, Lu; Yang, Yue; Egger, Jan

    2016-02-01

    This paper presents a generalized integrated framework of semi-automatic surgical template design. Several algorithms were implemented including the mesh segmentation, offset surface generation, collision detection, ruled surface generation, etc., and a special software named TemDesigner was developed. With a simple user interface, a customized template can be semi- automatically designed according to the preoperative plan. Firstly, mesh segmentation with signed scalar of vertex is utilized to partition the inner surface from the input surface mesh based on the indicated point loop. Then, the offset surface of the inner surface is obtained through contouring the distance field of the inner surface, and segmented to generate the outer surface. Ruled surface is employed to connect inner and outer surfaces. Finally, drilling tubes are generated according to the preoperative plan through collision detection and merging. It has been applied to the template design for various kinds of surgeries, including oral implantology, cervical pedicle screw insertion, iliosacral screw insertion and osteotomy, demonstrating the efficiency, functionality and generality of our method.

  16. A semi-automatic computer-aided method for surgical template design

    PubMed Central

    Chen, Xiaojun; Xu, Lu; Yang, Yue; Egger, Jan

    2016-01-01

    This paper presents a generalized integrated framework of semi-automatic surgical template design. Several algorithms were implemented including the mesh segmentation, offset surface generation, collision detection, ruled surface generation, etc., and a special software named TemDesigner was developed. With a simple user interface, a customized template can be semi- automatically designed according to the preoperative plan. Firstly, mesh segmentation with signed scalar of vertex is utilized to partition the inner surface from the input surface mesh based on the indicated point loop. Then, the offset surface of the inner surface is obtained through contouring the distance field of the inner surface, and segmented to generate the outer surface. Ruled surface is employed to connect inner and outer surfaces. Finally, drilling tubes are generated according to the preoperative plan through collision detection and merging. It has been applied to the template design for various kinds of surgeries, including oral implantology, cervical pedicle screw insertion, iliosacral screw insertion and osteotomy, demonstrating the efficiency, functionality and generality of our method. PMID:26843434

  17. Intelligent Pilot Aids for Flight Re-Planning in Emergencies

    NASA Technical Reports Server (NTRS)

    Pritchett, Amy R.

    2002-01-01

    Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions

  18. Virtual surgical modification for planning tetralogy of Fallot repair

    NASA Astrophysics Data System (ADS)

    Plasencia, Jonathan; Babiker, Haithem; Richardson, Randy; Rhee, Edward; Willis, Brigham; Nigro, John; Cleveland, David; Frakes, David H.

    2010-01-01

    Goals for treating congenital heart defects are becoming increasingly focused on the long-term, targeting solutions that last into adulthood. Although this shift has motivated the modification of many current surgical procedures, there remains a great deal of room for improvement. We present a new methodological component for tetralogy of Fallot (TOF) repair that aims to improve long-term outcomes. The current gold standard for TOF repair involves the use of echocardiography (ECHO) for measuring the pulmonary valve (PV) diameter. This is then used, along with other factors, to formulate a Z-score that drives surgical preparation. Unfortunately this process can be inaccurate and requires a mid-operative confirmation that the pressure gradient across the PV is not excessive. Ideally, surgeons prefer not to manipulate the PV as this can lead to valve insufficiency. However, an excessive pressure gradient across the valve necessitates surgical action. We propose the use of computational fluid dynamics (CFD) to improve preparation for TOF repair. In our study, pre-operative CT data were segmented and reconstructed, and a virtual surgical operation was then performed to simulate post-operative conditions. The modified anatomy was used to drive CFD simulation. The pressure gradient across the pulmonary valve was calculated to be 9.24mmHg, which is within the normal range. This finding indicates that CFD may be a viable tool for predicting post-operative pressure gradients for TOF repair. Our proposed methodology would remove the need for mid-operative measurements that can be both unreliable and detrimental to the patient.

  19. Physics-based simulation of surgical fields for preoperative strategic planning.

    PubMed

    Nakao, Megumi; Kuroda, Tomohiro; Oyama, Hiroshi; Sakaguchi, Genichi; Komeda, Masashi

    2006-10-01

    Although careful planning of surgical approach is a key for success of surgery, conventional planning and simulation tools cannot support detailed discussion. This issue is derived from the difficulty of estimating complex physical behavior of soft tissues provided by a series of surgical procedures like cutting and deformation. This paper proposes an adaptive physics-based framework that simulates both interactive cutting and accurate deformation on virtual bodies, and performs preoperative planning for supporting strategic discussion. We focus on limited use of the two models: A particle-based model and an FEM-based model considering required quality and performance in different situations. FEM-based deformation of incision accurately produces estimated surgical fields. Based on the framework, a strategic planning system was developed for supporting decision of surgical approach using 3D representation of the surgical fields. We applied clinical CT dataset of an aortic aneurysm case to the system. Some experiments and usability tests confirmed that the system contributes to grasping 3D shape and location of the target organs and performs detailed discussion on patient-specific surgical approaches.

  20. Intelligent Pilot Aids for Flight Re-Planning in Emergencies

    NASA Technical Reports Server (NTRS)

    Pritchett, Amy R.; Ockerman, Jennifer

    2005-01-01

    Effective and safe control of an aircraft may be difficult or nearly impossible for a pilot following an unexpected system failure. Without prior training, the pilot must ascertain on the fly those changes in both manual control technique and procedures that will lead to a safe landing of the aircraft. Sophisticated techniques for determining the required control techniques are now available. Likewise, a body of literature on pilot decision making provides formalisms for examining how pilots approach discrete decisions framed as the selection between options. However, other aspects of behavior, such as the task of route planning and guidance, are not as well studied. Not only is the pilot faced with possible performance changes to the aircraft dynamics, but he or she is also tasked to create a plan of actions that will effectively take the aircraft down to a safe landing. In this plan, the many actions that the pilot can perform are closely intertwined with the trajectory of the aircraft, making it difficult to accurately predict the final outcome. Coupled with the vast number of potential actions to be taken, this problem may seem intractable. This is reflected in the lack of a pre-specified procedure capable of giving pilots the ability to find a resolution for this task. This report summarizes a multi-year effort to examine methods to aid pilots in planning an approach and arrival to an airport following an aircraft systems failure. Ultimately, we hypothesize that automatic assistance to pilots can be provided in real-time in the form of improving pilot control of a damaged aircraft and providing pilots with procedural directives suitable for critical flight conditions; such systems may also benefit pilot training and procedure design. To achieve this result, a systematic, comprehensive research program was followed, building on prior research. This approach included a pencil-and-paper study with airline pilots examining methods of representing a flight route in

  1. Stereolithography: a method for planning the surgical correction of the hypertelorism.

    PubMed

    Hidalgo, Hector Malagon; Romo, Gabriela Wong; Estolano, Roberto Takeo Rivera

    2009-09-01

    Hypertelorism is a deformity characterized by an increase in interorbital distance. The treatment can be orbital mobilization, or if the malformation goes along with occlusal alterations, the indicated treatment is a facial bipartition with hemifacial rotation.The intention of the present study was to describe a surgical planning technique in locating the anatomic points and planes on a stereolithographic model of a patient with 0-14 fissure and its surgical application.

  2. A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques.

    PubMed

    Mohamad, Shwan; Khan, Imran; Hey, S Y; Hussain, S S Musheer

    2016-03-01

    A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.

  3. 3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report

    PubMed Central

    Vale, Francisco; Scherzberg, Jessica; Cavaleiro, João; Sanz, David; Caramelo, Francisco; Maló, Luísa; Marcelino, João Pedro

    2016-01-01

    Objective: In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints. Methods: The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually. Results: It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables. Conclusions: The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are required. PMID:27007767

  4. Three-dimensional surgical simulation.

    PubMed

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

    2010-09-01

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

  5. Three-dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery.

    PubMed

    Xia, J; Samman, N; Yeung, R W; Shen, S G; Wang, D; Ip, H H; Tideman, H

    2000-01-01

    A new integrated computer system, the 3-dimensional (3D) virtual reality surgical planning and simulation workbench for orthognathic surgery (VRSP), is presented. Five major functions are implemented in this system: post-processing and reconstruction of computed tomographic (CT) data, transformation of 3D unique coordinate system geometry, generation of 3D color facial soft tissue models, virtual surgical planning and simulation, and presurgical prediction of soft tissue changes. The basic mensuration functions, such as linear and spatial measurements, are also included. The surgical planning and simulation are based on 3D CT reconstructions, whereas soft tissue prediction is based on an individualized, texture-mapped, color facial soft tissue model. The surgeon "enters" the virtual operatory with virtual reality equipment, "holds" a virtual scalpel, and "operates" on a virtual patient to accomplish actual surgical planning, simulation of the surgical procedure, and prediction of soft tissue changes before surgery. As a final result, a quantitative osteotomy-simulated bone model and predicted color facial model with photorealistic quality can be visualized from any arbitrary viewing point in a personal computer system. This system can be installed in any hospital for daily use.

  6. Late treatment of orbital fractures: a new analysis for surgical planning.

    PubMed

    Pagnoni, M; Marenco, M; Ramieri, V; Terenzi, V; Bartoli, D; Amodeo, G; Mazzoli, A; Iannetti, G

    2014-12-01

    Surgical treatment of orbital fractures should be performed without delay; in some cases acute management is not possible due to general conditions and might be delayed for weeks or months. In the latter case, the fractured fragments can consolidate improperly, causing secondary deformities of the orbital region with aesthetic and functional alteration. Surgical planning of secondary deformities is critical for adequate pre-operative planning. In the last decade an increasing number of dedicated software applications for surgical planning have been developed. Standard computed tomography (CT) or the relatively new cone beam CT can be used for diagnostic purposes, pre-surgical visual treatment outcome and virtual surgery. In this report, the authors propose their pre-operative planning analysis for surgical correction of secondary deformities of orbital fractures. The treatment of orbital fracture must, in fact, analyse not only the bone structures but the soft tissue and surrounding periorbital region. The position of the orbit in the space should be determined in relation to the surrounding structures compared to the contralateral side, if this is not affected by the trauma or pre-existing malformations.

  7. Pre-surgical planning and MR-tractography utility in brain tumour resection.

    PubMed

    Romano, A; D'Andrea, G; Minniti, G; Mastronardi, L; Ferrante, L; Fantozzi, L M; Bozzao, A

    2009-12-01

    The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for presurgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and postsurgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64%(18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. PMID:19533147

  8. Orthodontics: computer-aided diagnosis and treatment planning

    NASA Astrophysics Data System (ADS)

    Yi, Yaxing; Li, Zhongke; Wei, Suyuan; Deng, Fanglin; Yao, Sen

    2000-10-01

    The purpose of this article is to introduce the outline of our newly developed computer-aided 3D dental cast analyzing system with laser scanning, and its preliminary clinical applications. The system is composed of a scanning device and a personal computer as a scanning controller and post processor. The scanning device is composed of a laser beam emitter, two sets of linear CCD cameras and a table which is rotatable by two-degree-of-freedom. The rotating is controlled precisely by a personal computer. The dental cast is projected and scanned with a laser beam. Triangulation is applied to determine the location of each point. Generation of 3D graphics of the dental cast takes approximately 40 minutes. About 170,000 sets of X,Y,Z coordinates are store for one dental cast. Besides the conventional linear and angular measurements of the dental cast, we are also able to demonstrate the size of the top surface area of each molar. The advantage of this system is that it facilitates the otherwise complicated and time- consuming mock surgery necessary for treatment planning in orthognathic surgery.

  9. Correction of pulmonary arteriovenous malformation using image-based surgical planning.

    PubMed

    Sundareswaran, Kartik S; de Zélicourt, Diane; Sharma, Shiva; Kanter, Kirk R; Spray, Thomas L; Rossignac, Jarek; Sotiropoulos, Fotis; Fogel, Mark A; Yoganathan, Ajit P

    2009-08-01

    The objectives of this study were to develop an image-based surgical planning framework that 1) allows for in-depth analysis of pre-operative hemodynamics by the use of cardiac magnetic resonance and 2) enables surgeons to determine the optimum surgical scenarios before the operation. This framework is tailored for applications in which post-operative hemodynamics are important. In particular, it is exemplified here for a Fontan patient with severe left pulmonary arteriovenous malformations due to abnormal hepatic flow distribution to the lungs. Patients first undergo cardiac magnetic resonance for 3-dimensional anatomy and flow reconstruction. After analysis of the pre-operative flow fields, the 3-dimensional anatomy is imported into an interactive surgical planning interface for the surgeon to virtually perform multiple surgical scenarios. Associated hemodynamics are predicted by the use of a fully validated computational fluid dynamic solver. Finally, efficiency metrics (e.g., pressure decrease and hepatic flow distribution) are weighted against surgical feasibility to determine the optimal surgical option. PMID:19679291

  10. Simulation-based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison

    2012-11-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  11. The Role of Virtual Surgical Planning in the Era of Robotic Surgery.

    PubMed

    Kim, Jae Young; Kim, Won Shik; Choi, Eun Chang; Nam, Woong

    2016-01-01

    Among various surgical methods introduced to optimize esthetic results, robotic surgery has gradually expanded in scope. As incision, approach, and operation view in robotic surgery differ from existing surgical methods, we should consider reconstruction from a different perspective. We recently experienced two mandibular reconstruction cases after tumor ablative surgery with robotic neck dissection using the conventional reconstruction method and virtual surgical planning (VSP), respectively. We found that the conventional reconstruction method is inappropriate in modified facelift incision in robotic neck dissection because it provides limited surgical scope, restricts access to the defect area, and therefore, consumes considerable time before anastomosis. For these reasons, the authors consider VSP far more viable in the era of robotic surgery.

  12. Multiscale modeling and surgical planning for single ventricle heart patients

    NASA Astrophysics Data System (ADS)

    Marsden, Alison

    2011-11-01

    Single ventricle heart patients are among the most challenging for pediatric cardiologists to treat, and typically undergo a palliative course of three open-heart surgeries starting immediately after birth. We will present recent tools for modeling blood flow in single ventricle heart patients using a multiscale approach that couples a 3D Navier-Stokes domain to a 0D closed loop lumped parameter network comprised of circuit elements. This coupling allows us to capture the effect of changes in local geometry, such as shunt sizes, on global circulatory dynamics, such as cardiac output. A semi-implicit numerical method is formulated to solve the coupled system in which flow and pressure information is passed between the two domains at the inlets and outlets of the model. A finite element method with outflow stabilization is applied in the 3D Navier-Stokes domain, and the LPN system of ordinary differential equations is solved numerically using a Runge-Kutta method. These tools are coupled via automated scripts to a derivative-free optimization method. Optimization is used to systematically explore surgical designs using clinically relevant cost functions for two stages of single ventricle repair. First, we will present results from optimization of the first stage Blalock Taussig Shunt. Second, we will present results from optimization of a new Y-graft design for the third stage of single ventricle repair called the Fontan surgery. The Y-graft is shown, in simulations, to successfully improve hepatic flow distribution, a known clinical problem. Preliminary clinical experience with the Y-graft will be discussed.

  13. Crouzon syndrome: Virtual planning of surgical treatment by application of internal distractors.

    PubMed

    Rahimov, Chingiz; Asadov, Ruslan; Hajiyeva, Gunel; Verdiyev, Nazim; Novruzov, Zaur; Farzaliyev, Ismayil

    2016-01-01

    Crouzon syndrome is one of the frequent pathologies within craniosynostosis syndrome. Current progress in computers and biotechnologies allows improving surgical approach and forecasting final result of reconstruction as well. We present a case of successful surgical treatment of Crouzon syndrome, done by application of virtual planning allowing determining "monobloc" features, type of reconstruction and distraction protocol as well. A 20-year-old female had presented with craniofacial deformity. Clinical and radiological investigation revealed Crouzon syndrome. The "monobloc" creation, cranioplasty and internal distractors positioning, direction and schedule of advancement were done according to preoperative virtual planning data achieved by Materialise Mimics Research software. Nine months postoperative functional and esthetic result and radiological findings showed to be reasonable. That application of virtual simulation significantly allows to determine best direction of distraction and improves postoperative outcomes of surgical treatment of Crouzon syndrome. PMID:27563623

  14. Crouzon syndrome: Virtual planning of surgical treatment by application of internal distractors

    PubMed Central

    Rahimov, Chingiz; Asadov, Ruslan; Hajiyeva, Gunel; Verdiyev, Nazim; Novruzov, Zaur; Farzaliyev, Ismayil

    2016-01-01

    Crouzon syndrome is one of the frequent pathologies within craniosynostosis syndrome. Current progress in computers and biotechnologies allows improving surgical approach and forecasting final result of reconstruction as well. We present a case of successful surgical treatment of Crouzon syndrome, done by application of virtual planning allowing determining “monobloc” features, type of reconstruction and distraction protocol as well. A 20-year-old female had presented with craniofacial deformity. Clinical and radiological investigation revealed Crouzon syndrome. The “monobloc” creation, cranioplasty and internal distractors positioning, direction and schedule of advancement were done according to preoperative virtual planning data achieved by Materialise Mimics Research software. Nine months postoperative functional and esthetic result and radiological findings showed to be reasonable. That application of virtual simulation significantly allows to determine best direction of distraction and improves postoperative outcomes of surgical treatment of Crouzon syndrome. PMID:27563623

  15. Flow Simulation to Enable Patient Specific Virtual Surgical Planning

    NASA Astrophysics Data System (ADS)

    Jansen, Kenneth; Taylor, Charles; Mueller, Jens

    2003-11-01

    The current paradigm for interventional and surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We have proposed a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict differential changes in blood flow for alternative treatment plans for an individual patient. Ideally, these systems would provide an integrated set of image segmentation, geometric solid modeling, automatic finite element mesh generation, computational mechanics and scientific visualization tools accessible through an intuitive human-computer interface. In this talk we focus on the flow simulation aspects of this project. Error estimators for transient flow analyses have been developed and implemented to focus computational resources on the areas where they may have provide the greatest improvement. We will describe these error estimators and apply them to adaptive as well as uniform refinement simulations and compare the accuracy and performance to available experimental data in porcine bypass models that have been carried out specifically for this purpose.

  16. AIDS and family planning counseling of psychiatrically ill women in community mental health clinics.

    PubMed

    Coverdale, J H; Aruffo, J F

    1992-02-01

    Eighty-two of 83 mental health professionals, including psychiatrists, were surveyed to determine their attitudes and behaviors toward AIDS prevention and family planning counseling with psychiatrically ill female outpatients. Nearly all reported that information should be provided on AIDS and family planning. However, they reported that they had raised topics of AIDS with only 19% of patients and family planning with only 25% of patients. This lack of communication was confirmed by patients' own reports. Factors which might relate to this lack of communication are explored.

  17. "An Instrument of Accountability." ILO/AIDS: A Global Plan and a New Code of Practice.

    ERIC Educational Resources Information Center

    World of Work, 2001

    2001-01-01

    Describes the International Labor Organization's plan of action to fight the global epidemic of Acquired Immune Deficiency Syndrome (AIDS). Describes the code of practice that provides workers, employers, and governments with guidelines for addressing AIDS and its impact on the workplace. Includes key principles of the code. (JOW)

  18. Enhancing School HIV and AIDS Strategic Plan through Expanded Stakeholder Involvement

    ERIC Educational Resources Information Center

    Mgomezulu, V. Y.; Kruger, A. G.

    2011-01-01

    This article focuses on the need for expanded stakeholder involvement as a means of enhancing the Botswana Department of Secondary Education (DSE) HIV and AIDS strategic plan. Research has indicated that the effects of HIV and AIDS on the supply of and demand for education are considerable. Using a questionnaire and interviews, the research has…

  19. HIV / AIDS: not just a matter of statistics. The International Conference on AIDS - Law and Humanity culminates into "New Delhi Declaration and Action Plan on AIDS".

    PubMed

    1996-01-01

    The Indian Ministry of Health and Family Welfare and the Indian Law Institute with the cooperation of UNDP, the World Health Organization (WHO), and other national and international groups organized the International Conference on AIDS--Law and Humanity, held during December 6-10, 1995, in New Delhi, India. The leading speakers focused on the need for a united approach to the HIV/AIDS-related legal issues, which would protect society against the spread of HIV infection and respect the dignity and fundamental human rights of HIV infected persons or those suspected of being HIV infected and their families and friends. All conference participants adopted the New Delhi Declaration and Action Plan on AIDS. The Plan has six principles designed to guide policy makers in developing laws and strategies to help fight against HIV/AIDS. The first principle is that sound and scientific data (not presupposition, prejudice, and stereotypes) should form the basis for all laws and policies on HIV/AIDS. It lays out eight objectives that vary from protection of rights and empowerment of individuals, so that by their cooperation the spread of HIV infection is contained, to allocation of adequate resources for prevention, care, and anti-discrimination efforts. The participants recognized actions that have been or need to be implemented to control HIV/AIDS at the international, national/legislative, executive, and judicial levels. For example, an international action at the international level is expansion of strategies by the High Commissioner for Human Rights for promoting the co-existence of human rights of persons with HIV/AIDS and for containment of the epidemic. The participants resolved to establish both national and international committees to address the national and international implications of HIV/AIDS from the point of view of law and humanity. The international committee should work with UNAIDS, the High Commissioner for Human Rights, WHO, and UNDP.

  20. Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy.

    PubMed

    Xia, J; Ip, H H; Samman, N; Wang, D; Kot, C S; Yeung, R W; Tideman, H

    2000-02-01

    A computer-assisted three-dimensional virtual osteotomy system for orthognathic surgery (CAVOS) is presented. The virtual reality workbench is used for surgical planning. The surgeon immerses in a virtual reality environment with stereo eyewear, holds a virtual "scalpel" (3D Mouse) and operates on a "real" patient (3D visualization) to obtain pre-surgical prediction (3D bony segment movements). Virtual surgery on a computer-generated 3D head model is simulated and can be visualized from any arbitrary viewing point in a personal computer system.

  1. Toward the development of virtual surgical tools to aid orthopaedic FE analyses.

    PubMed

    Tadepalli, Srinivas C; Shivanna, Kiran H; Magnotta, Vincent A; Kallemeyn, Nicole A; Grosland, Nicole M

    2010-01-01

    Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides) which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions.

  2. Toward the Development of Virtual Surgical Tools to Aid Orthopaedic FE Analyses

    NASA Astrophysics Data System (ADS)

    Tadepalli, Srinivas C.; Shivanna, Kiran H.; Magnotta, Vincent A.; Kallemeyn, Nicole A.; Grosland, Nicole M.

    2009-12-01

    Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides) which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions.

  3. Pre-surgical treatment planning of maxillary canine impactions using panoramic vs cone beam CT imaging

    PubMed Central

    Alqerban, A; Hedesiu, M; Baciut, M; Nackaerts, O; Jacobs, R; Fieuws, S; Willems, G

    2013-01-01

    Objectives: The aim of this prospective study was to compare the impact of using two-dimensional (2D) panoramic radiographs and three-dimensional (3D) cone beam CT for the surgical treatment planning of impacted maxillary canines. Methods: This study consisted of 32 subjects (19 females, 13 males) with a mean age of 25 years, referred for surgical intervention of 39 maxillary impacted canines. Initial 2D panoramic radiography was available, and 3D cone beam CT imaging was obtained upon clinical indication. Both 2D and 3D pre-operative radiographic diagnostic sets were subsequently analysed by six observers. Perioperative evaluations were conducted by the treating surgeon. McNemar tests, hierarchical logistic regression and linear mixed models were used to explore the differences in evaluations between imaging modalities. Results: Significantly higher confidence levels were observed for 3D image-based treatment plans than for 2D image-based plans (p < 0.001). The evaluations of canine crown position, contact relationship and lateral incisor root resorption were significantly different between the 2D and 3D images. By contrast, pre- and perioperative evaluations were not significantly different between the two image modalities. Conclusions: Surgical treatment planning of impacted maxillary canines was not significantly different between panoramic and cone beam CT images. PMID:23906975

  4. Utilization of Negotiated Tuition Aid Benefits. A Summary of the Study "Where Are the Women? A Study of the Underutilization of Tuition Aid Plans."

    ERIC Educational Resources Information Center

    Abramovitz, Mimi

    A chapter from the forthcoming book, "Practitioners' Guide to Education for Working Adults," describes a year-long study to explore the low utilization of tuition aid plans in three unionized companies. The research has shown that the use of tuition aid programs is in inverse ratio to need. Workers who tend to utilize tuition aid are those who…

  5. Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

    PubMed Central

    Schulz-Drost, Stefan; Oppel, Pascal; Grupp, Sina; Schmitt, Sonja; Carbon, Roman Th.; Mauerer, Andreas; Hennig, Friedrich F.; Buder, Thomas

    2015-01-01

    Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture’s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology. PMID

  6. 47 CFR 87.395 - Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and Air Navigation Aids (Short Title: SCATANA). 87.395 Section 87.395 Telecommunication FEDERAL... Communications § 87.395 Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA). (a) The Plan for the Security Control of Air Traffic and Air Navigation Aids (SCATANA)...

  7. 75 FR 60846 - Notice of Intent To Establish the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... of Intent To Establish the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board, hereinafter referred to as ``the Board.'' The Board serves the Global AIDS Coordinator (``the Coordinator'') in a solely...

  8. 47 CFR 87.395 - Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and Air Navigation Aids (Short Title: SCATANA). 87.395 Section 87.395 Telecommunication FEDERAL... Communications § 87.395 Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA). (a) The Plan for the Security Control of Air Traffic and Air Navigation Aids (SCATANA)...

  9. 47 CFR 87.395 - Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and Air Navigation Aids (Short Title: SCATANA). 87.395 Section 87.395 Telecommunication FEDERAL... Communications § 87.395 Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA). (a) The Plan for the Security Control of Air Traffic and Air Navigation Aids (SCATANA)...

  10. 75 FR 78338 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-15

    ... of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board will meet on January 6-7, 2011 at the St.... Global AIDS Coordinator, Ambassador Eric Goosby, who leads implementation of the President's...

  11. 47 CFR 87.395 - Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and Air Navigation Aids (Short Title: SCATANA). 87.395 Section 87.395 Telecommunication FEDERAL... Communications § 87.395 Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA). (a) The Plan for the Security Control of Air Traffic and Air Navigation Aids (SCATANA)...

  12. 47 CFR 87.395 - Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... and Air Navigation Aids (Short Title: SCATANA). 87.395 Section 87.395 Telecommunication FEDERAL... Communications § 87.395 Plan for the Security Control of Air Traffic and Air Navigation Aids (Short Title: SCATANA). (a) The Plan for the Security Control of Air Traffic and Air Navigation Aids (SCATANA)...

  13. The President's Emergency Plan for AIDS Relief: Report on Education

    ERIC Educational Resources Information Center

    US Department of State, 2006

    2006-01-01

    For too many children, education has been a casualty of the HIV/AIDS pandemic. Yet schooling remains an essential element of a robust individual and societal future, and partnerships with the education sector provide important opportunities to fight back against the pandemic. The United States Government (USG) supports efforts to address the…

  14. Planning, Implementation, and Evaluation of AIDS Education Programs for Dentists.

    ERIC Educational Resources Information Center

    Gerbert, Barbara; And Others

    1991-01-01

    An office-based continuing education program on acquired immune deficiency syndrome (AIDS) for dentists is described, including needs assessment, model development, local piloting, national implementation with 119 dentists, and evaluation phases. Program evaluation indicated an improvement in risk perception, knowledge, and practice resulted, but…

  15. D Modelling and Rapid Prototyping for Cardiovascular Surgical Planning - Two Case Studies

    NASA Astrophysics Data System (ADS)

    Nocerino, E.; Remondino, F.; Uccheddu, F.; Gallo, M.; Gerosa, G.

    2016-06-01

    In the last years, cardiovascular diagnosis, surgical planning and intervention have taken advantages from 3D modelling and rapid prototyping techniques. The starting data for the whole process is represented by medical imagery, in particular, but not exclusively, computed tomography (CT) or multi-slice CT (MCT) and magnetic resonance imaging (MRI). On the medical imagery, regions of interest, i.e. heart chambers, valves, aorta, coronary vessels, etc., are segmented and converted into 3D models, which can be finally converted in physical replicas through 3D printing procedure. In this work, an overview on modern approaches for automatic and semiautomatic segmentation of medical imagery for 3D surface model generation is provided. The issue of accuracy check of surface models is also addressed, together with the critical aspects of converting digital models into physical replicas through 3D printing techniques. A patient-specific 3D modelling and printing procedure (Figure 1), for surgical planning in case of complex heart diseases was developed. The procedure was applied to two case studies, for which MCT scans of the chest are available. In the article, a detailed description on the implemented patient-specific modelling procedure is provided, along with a general discussion on the potentiality and future developments of personalized 3D modelling and printing for surgical planning and surgeons practice.

  16. Application of computer-aided dispatch in law enforcement: An introductory planning guide

    NASA Technical Reports Server (NTRS)

    Sohn, R. L.; Gurfield, R. M.; Garcia, E. A.; Fielding, J. E.

    1975-01-01

    A set of planning guidelines for the application of computer-aided dispatching (CAD) to law enforcement is presented. Some essential characteristics and applications of CAD are outlined; the results of a survey of systems in the operational or planning phases are summarized. Requirements analysis, system concept design, implementation planning, and performance and cost modeling are described and demonstrated with numerous examples. Detailed descriptions of typical law enforcement CAD systems, and a list of vendor sources, are given in appendixes.

  17. [Surgical care for the wounded in an armed conflict: the organization and support of first aid, prehospital and initial medical care (1)].

    PubMed

    Efimenko, N A; Gumanenko, E K; Samokhvalov, I M; Trusov, A A

    1999-06-01

    The article is devoted to surgical care organization to the battle casualties in Northern Caucasus, analysis of size and structure of "sanitary losses" (wounded in actions), questions of rendering first aid, battalion medical specialist aid and initial physician care. Gunshot wounds prevailed (64.1%) in the structure of battle surgical casualties. The blunt traumas and non-gunshot injuries have made of 33.2%, burns--4.1%, frost-bites--1.3%. The efficiency of medical care in this armed conflict is investigated on the own experience and retrospective analysis of graduated care to the 1030 casualties. Significance of duly rendering of the first aid to battle casualties is shown: the morality in this group had made 1.3%. Among wounded, which the first aid did not appear, the morality was of 7.0%.

  18. Predictive / Reactive Planning and Scheduling of a Surgical Suite with Emergency Patient Arrival.

    PubMed

    Heydari, Mehdi; Soudi, Asie

    2016-01-01

    This paper surveys the problem of predictive / reactive scheduling of an integrated operating theatre with two types of demand for surgery: 1) elective or known demand; 2) emergency or uncertain demand. The stochastic arrival of emergency patients with uncertain surgery time enforces the scheduler to react to disruption and modify scheduling plan of elective patients. We focus on this predictive / reactive scheduling problem which has not been investigated in such way before. As in hospitals, at the time of occurrence a disruption in a surgical suite, the scheduler has not enough time to make the best decision; we propose a new approach based on two-stage stochastic programming model with recourse which determines the best recourse strategy in advance of any disruption occurrence. Using the proposed approach, the primary schedule is generated in such a way that it can absorb disruption with minimum effect on planned elective surgeries. For the first time in operating theatre planning, two new significant sets of performance measures comprising "robustness" and "stability" measures are considered in generation of primary schedule which will be shown to be of great importance in efficiency of surgical suite planning. Computational experiments performed on sets of generated problem based on the data obtained from a non-profit hospital. In order to demonstrate efficiency of the proposed method, computational results of the proposed approach are compared with classic approach.

  19. Development of a High Resolution 3D Infant Stomach Model for Surgical Planning

    NASA Astrophysics Data System (ADS)

    Chaudry, Qaiser; Raza, S. Hussain; Lee, Jeonggyu; Xu, Yan; Wulkan, Mark; Wang, May D.

    Medical surgical procedures have not changed much during the past century due to the lack of accurate low-cost workbench for testing any new improvement. The increasingly cheaper and powerful computer technologies have made computer-based surgery planning and training feasible. In our work, we have developed an accurate 3D stomach model, which aims to improve the surgical procedure that treats the infant pediatric and neonatal gastro-esophageal reflux disease (GERD). We generate the 3-D infant stomach model based on in vivo computer tomography (CT) scans of an infant. CT is a widely used clinical imaging modality that is cheap, but with low spatial resolution. To improve the model accuracy, we use the high resolution Visible Human Project (VHP) in model building. Next, we add soft muscle material properties to make the 3D model deformable. Then we use virtual reality techniques such as haptic devices to make the 3D stomach model deform upon touching force. This accurate 3D stomach model provides a workbench for testing new GERD treatment surgical procedures. It has the potential to reduce or eliminate the extensive cost associated with animal testing when improving any surgical procedure, and ultimately, to reduce the risk associated with infant GERD surgery.

  20. Surgical planning for radical prostatectomies using three-dimensional visualization and a virtual reality display system

    NASA Astrophysics Data System (ADS)

    Kay, Paul A.; Robb, Richard A.; King, Bernard F.; Myers, R. P.; Camp, Jon J.

    1995-04-01

    Thousands of radical prostatectomies for prostate cancer are performed each year. Radical prostatectomy is a challenging procedure due to anatomical variability and the adjacency of critical structures, including the external urinary sphincter and neurovascular bundles that subserve erectile function. Because of this, there are significant risks of urinary incontinence and impotence following this procedure. Preoperative interaction with three-dimensional visualization of the important anatomical structures might allow the surgeon to understand important individual anatomical relationships of patients. Such understanding might decrease the rate of morbidities, especially for surgeons in training. Patient specific anatomic data can be obtained from preoperative 3D MRI diagnostic imaging examinations of the prostate gland utilizing endorectal coils and phased array multicoils. The volumes of the important structures can then be segmented using interactive image editing tools and then displayed using 3-D surface rendering algorithms on standard work stations. Anatomic relationships can be visualized using surface displays and 3-D colorwash and transparency to allow internal visualization of hidden structures. Preoperatively a surgeon and radiologist can interactively manipulate the 3-D visualizations. Important anatomical relationships can better be visualized and used to plan the surgery. Postoperatively the 3-D displays can be compared to actual surgical experience and pathologic data. Patients can then be followed to assess the incidence of morbidities. More advanced approaches to visualize these anatomical structures in support of surgical planning will be implemented on virtual reality (VR) display systems. Such realistic displays are `immersive,' and allow surgeons to simultaneously see and manipulate the anatomy, to plan the procedure and to rehearse it in a realistic way. Ultimately the VR systems will be implemented in the operating room (OR) to assist the

  1. Complete, accurate, mammalian phylogenies aid conservation planning, but not much

    PubMed Central

    Rodrigues, Ana S. L.; Grenyer, Richard; Baillie, Jonathan E. M.; Bininda-Emonds, Olaf R. P.; Gittlemann, John L.; Hoffmann, Michael; Safi, Kamran; Schipper, Jan; Stuart, Simon N.; Brooks, Thomas

    2011-01-01

    In the face of unprecedented global biodiversity loss, conservation planning must balance between refining and deepening knowledge versus acting on current information to preserve species and communities. Phylogenetic diversity (PD), a biodiversity measure that takes into account the evolutionary relationships between species, is arguably a more meaningful measure of biodiversity than species diversity, but cannot yet be applied to conservation planning for the majority of taxa for which phylogenetic trees have not yet been developed. Here, we investigate how the quality of data on the taxonomy and/or phylogeny of species affects the results of spatial conservation planning in terms of the representation of overall mammalian PD. The results show that the better the quality of the biodiversity data the better they can serve as a basis for conservation planning. However, decisions based on incomplete data are remarkably robust across different levels of degrading quality concerning the description of new species and the availability of phylogenetic information. Thus, given the level of urgency and the need for action, conservation planning can safely make use of the best available systematic data, limited as these data may be. PMID:21844044

  2. Complete, accurate, mammalian phylogenies aid conservation planning, but not much.

    PubMed

    Rodrigues, Ana S L; Grenyer, Richard; Baillie, Jonathan E M; Bininda-Emonds, Olaf R P; Gittlemann, John L; Hoffmann, Michael; Safi, Kamran; Schipper, Jan; Stuart, Simon N; Brooks, Thomas

    2011-09-27

    In the face of unprecedented global biodiversity loss, conservation planning must balance between refining and deepening knowledge versus acting on current information to preserve species and communities. Phylogenetic diversity (PD), a biodiversity measure that takes into account the evolutionary relationships between species, is arguably a more meaningful measure of biodiversity than species diversity, but cannot yet be applied to conservation planning for the majority of taxa for which phylogenetic trees have not yet been developed. Here, we investigate how the quality of data on the taxonomy and/or phylogeny of species affects the results of spatial conservation planning in terms of the representation of overall mammalian PD. The results show that the better the quality of the biodiversity data the better they can serve as a basis for conservation planning. However, decisions based on incomplete data are remarkably robust across different levels of degrading quality concerning the description of new species and the availability of phylogenetic information. Thus, given the level of urgency and the need for action, conservation planning can safely make use of the best available systematic data, limited as these data may be.

  3. Perinatal AIDS: Permanency Planning for the African-American Community.

    ERIC Educational Resources Information Center

    Taylor-Brown, Susan; And Others

    1992-01-01

    Conducted a retrospective chart review utilizing Norwood's model on the families of the 83 infants whose cord blood was positive for maternal HIV antibodies or who were congenitally infected with HIV. Discusses implications for permanency planning in the context of their impact on the African-American community. (KS)

  4. College Savings Plans, Financial Aid, and Tax Strategy

    ERIC Educational Resources Information Center

    Whiteside, Richard; Mentz, George S.

    2004-01-01

    A college degree is one of the most expensive purchases an American family can make. While today's costs are higher than ever before, parents have many more options whose sheer number and complexity have given rise to a whole new field-financial planning for college. This article, which is based on materials created for the enrollment management…

  5. Boolean Combinations of Implicit Functions for Model Clipping in Computer-Assisted Surgical Planning

    PubMed Central

    2016-01-01

    This paper proposes an interactive method of model clipping for computer-assisted surgical planning. The model is separated by a data filter that is defined by the implicit function of the clipping path. Being interactive to surgeons, the clipping path that is composed of the plane widgets can be manually repositioned along the desirable presurgical path, which means that surgeons can produce any accurate shape of the clipped model. The implicit function is acquired through a recursive algorithm based on the Boolean combinations (including Boolean union and Boolean intersection) of a series of plane widgets’ implicit functions. The algorithm is evaluated as highly efficient because the best time performance of the algorithm is linear, which applies to most of the cases in the computer-assisted surgical planning. Based on the above stated algorithm, a user-friendly module named SmartModelClip is developed on the basis of Slicer platform and VTK. A number of arbitrary clipping paths have been tested. Experimental results of presurgical planning for three types of Le Fort fractures and for tumor removal demonstrate the high reliability and efficiency of our recursive algorithm and robustness of the module. PMID:26751685

  6. Boolean Combinations of Implicit Functions for Model Clipping in Computer-Assisted Surgical Planning.

    PubMed

    Zhan, Qiqin; Chen, Xiaojun

    2016-01-01

    This paper proposes an interactive method of model clipping for computer-assisted surgical planning. The model is separated by a data filter that is defined by the implicit function of the clipping path. Being interactive to surgeons, the clipping path that is composed of the plane widgets can be manually repositioned along the desirable presurgical path, which means that surgeons can produce any accurate shape of the clipped model. The implicit function is acquired through a recursive algorithm based on the Boolean combinations (including Boolean union and Boolean intersection) of a series of plane widgets' implicit functions. The algorithm is evaluated as highly efficient because the best time performance of the algorithm is linear, which applies to most of the cases in the computer-assisted surgical planning. Based on the above stated algorithm, a user-friendly module named SmartModelClip is developed on the basis of Slicer platform and VTK. A number of arbitrary clipping paths have been tested. Experimental results of presurgical planning for three types of Le Fort fractures and for tumor removal demonstrate the high reliability and efficiency of our recursive algorithm and robustness of the module.

  7. A visual display aid for planning rover traversals

    NASA Technical Reports Server (NTRS)

    Bernard, Herbert F.; Ellis, Stephen R.

    1992-01-01

    An interactive graphical planning system has been developed, which allows a human operator to design and check traversals (cross-country paths) for a planetary rover vehicle. The display provides the operator with necessary information about the terrain and indicates violations of operational or dynamic constraints on the rover. The operator can select different kinds of two-dimensional maps as well as a perspective view of the rover environment to plan the traversals. An experiment has been carried out to determine the ability of the operator to estimate the rover attitude in a large variety of situations. It turned out that the estimation error is highly dependent on the rover attitude itself. This result can be used to determine a vertical scale for the perspective representation of the terrain which avoids an underestimation of dangerous rover attitudes.

  8. Traffic Network Aided Plan and Road Line Optimization in Intelligent Traffic System

    NASA Astrophysics Data System (ADS)

    Liu, Bin; Qin, Guofeng

    2008-11-01

    In ITS(intelligent traffic system), traffic network plan is important. Public traffic network is a basic part in contemporary intelligent traffic and a basis of the municipal infrastructure construction. To construct the public traffic network aided plan, two problems are studied. One is how to plan traffic road line in order to cover the traffic districts; the other is how to choice the best way from the start point to the end. For the first one, a traffic road line aided plan algorithm is taken forward. The other is a road line optimization algorithm. It utilizes the topology theory to analyze the spatial character in public traffic network, and designs the best choice method to meet the user's requirements. The two algorithms are realized, and proved by a case in the graphical interface of GIS(Geographic Information System), including simulation for rationalization of the public traffic network.

  9. Statistical Analysis of Interactive Surgical Planning Using Shape Descriptors in Mandibular Reconstruction with Fibular Segments

    PubMed Central

    2016-01-01

    This study was performed to quantitatively analyze medical knowledge of, and experience with, decision-making in preoperative virtual planning of mandibular reconstruction. Three shape descriptors were designed to evaluate local differences between reconstructed mandibles and patients’ original mandibles. We targeted an asymmetrical, wide range of cutting areas including the mandibular sidepiece, and defined a unique three-dimensional coordinate system for each mandibular image. The generalized algorithms for computing the shape descriptors were integrated into interactive planning software, where the user can refine the preoperative plan using the spatial map of the local shape distance as a visual guide. A retrospective study was conducted with two oral surgeons and two dental technicians using the developed software. The obtained 120 reconstruction plans show that the participants preferred a moderate shape distance rather than optimization to the smallest. We observed that a visually plausible shape could be obtained when considering specific anatomical features (e.g., mental foramen. mandibular midline). The proposed descriptors can be used to multilaterally evaluate reconstruction plans and systematically learn surgical procedures. PMID:27583465

  10. Statistical Analysis of Interactive Surgical Planning Using Shape Descriptors in Mandibular Reconstruction with Fibular Segments.

    PubMed

    Nakao, Megumi; Aso, Shimpei; Imai, Yuichiro; Ueda, Nobuhiro; Hatanaka, Toshihide; Shiba, Mao; Kirita, Tadaaki; Matsuda, Tetsuya

    2016-01-01

    This study was performed to quantitatively analyze medical knowledge of, and experience with, decision-making in preoperative virtual planning of mandibular reconstruction. Three shape descriptors were designed to evaluate local differences between reconstructed mandibles and patients' original mandibles. We targeted an asymmetrical, wide range of cutting areas including the mandibular sidepiece, and defined a unique three-dimensional coordinate system for each mandibular image. The generalized algorithms for computing the shape descriptors were integrated into interactive planning software, where the user can refine the preoperative plan using the spatial map of the local shape distance as a visual guide. A retrospective study was conducted with two oral surgeons and two dental technicians using the developed software. The obtained 120 reconstruction plans show that the participants preferred a moderate shape distance rather than optimization to the smallest. We observed that a visually plausible shape could be obtained when considering specific anatomical features (e.g., mental foramen. mandibular midline). The proposed descriptors can be used to multilaterally evaluate reconstruction plans and systematically learn surgical procedures. PMID:27583465

  11. Decision aids for advance care planning: an overview of the state of the science.

    PubMed

    Butler, Mary; Ratner, Edward; McCreedy, Ellen; Shippee, Nathan; Kane, Robert L

    2014-09-16

    Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies. PMID:25069709

  12. 77 FR 70874 - Notice of Charter Renewal of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ... of Charter Renewal of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board SUMMARY: The Office of the U.S. Global AIDS Coordinator (S/GAC) announces the charter renewal of... Office of the U.S. Global AIDS Coordinator, and led by Ambassador Eric Goosby, who leads...

  13. Incorporating AIDS prevention activities into a family planning organization in Colombia.

    PubMed

    Vernon, R; Ojeda, G; Murad, R

    1990-01-01

    Three AIDS prevention activities were incorporated into the services offered by PROFAMILIA in two operations research projects. The activities included: (1) informative talks given both to the general public and to members of target groups by PROFAMILIA's community marketing (CM) program field workers (or instructors); (2) the establishment of condom distribution posts in meeting places of target groups; and (3) mass-media information campaigns on AIDS prevention. Community-based distributors were able to successfully provide information on AIDS to their regular audiences as well as to deliver information and condoms to special target groups without negatively affecting family planning information/education/communication activities and contraceptive sales. A radio campaign that promoted condom use for AIDS prevention did not affect public perceptions about the condom and did not jeopardize PROFAMILIA's image.

  14. QUALITY ASSURANCE PROJECT PLANS: A USELESS PAPER EXERCISE OR VALUABLE AID?

    EPA Science Inventory

    Two perspectives on the fundamental question "Are quality assurance project plans (QAPPS) a useless paper exercise or a valuable aid?" will be explored. These perspectives include those of a Branch Chief (i.e., the supervisor/manager) and an active researcher. As a Branch Chief, ...

  15. U.S. Department of Education Federal Student Aid Five-Year Plan, 2006-2010

    ERIC Educational Resources Information Center

    US Department of Education, 2006

    2006-01-01

    This document reflects Federal Student Aid's solid progress in meeting strategic objectives since becoming a Performance-Based Organization. Specifically, the plan addresses continuing efforts to increase program integrity, improve customer service and achieve measurable results in the management and administration of the Title IV student…

  16. Improving the quality of vascular surgical discharge planning in a hub centre.

    PubMed

    Wariyapola, C; Littlehales, E; Abayasekara, K; Fall, D; Parker, V; Hatton, G

    2016-04-01

    Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered 'delayed' and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.

  17. 78 FR 55326 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ... of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... is open to the public. The meeting will be hosted by the Office of the U.S. Global AIDS Coordinator, and led by Ambassador Eric Goosby, who leads implementation of the President's Emergency Plan for...

  18. Predictors of Child Custody Plans for Children Whose Parents Are Living with AIDS in New York City

    ERIC Educational Resources Information Center

    Lightfoot, Marguerita; Rotheram-Borus, Mary Jane

    2004-01-01

    Custody planning among parents living with HIV or AIDS (PLHAs) can buffer the negative impact of parental death. The formal and informal custody plans for 594 children by 253 PLHAs and the relationships among custody plans, parental health, and psychosocial status were examined. About one-half of the parents had no formal custody plan. Parents…

  19. Computer aided production planning - SWZ system of order verification

    NASA Astrophysics Data System (ADS)

    Krenczyk, D.; Skolud, B.

    2015-11-01

    SWZ (System of order verification) is a computer implementation of the methodology that support fast decision making on the acceptability of a production order, which allows to determine not the best possible solution, but admissible solution that is possible to find in an acceptable time (feasible solution) and acceptable due to the existing constraints. The methodology uses the propagation of constraints techniques and reduced to test a sequence of arbitrarily selected conditions. Fulfilment of all the conditions (the conjunction) provides the ability to perform production orders. In the paper examples of the application of SWZ system comprising the steps of planning and control is presented. The obtained results allowing the determination of acceptable production flow in the system - determination of the manufacturing system parameters those that ensure execution of orders in time under the resource constraints. SWZ also allows to generate the dispatching rules as a sequence of processing operations for each production resource, performed periodically during the production flow in the system. Furthermore the example of SWZ and simulation system integration is shown. SWZ has been enhanced with a module generating files containing the script code of the system model using the internal language of simulation and visualization system.

  20. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

    PubMed Central

    Drew, Howard

    2015-01-01

    The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis. PMID:25632356

  1. Exploring Effectiveness of Computer-Aided Planning in Implant Positioning for a Single Immediate Implant Placement.

    PubMed

    Edelmann, Alexander R; Hosseini, Bashir; Byrd, Warren C; Preisser, John S; Tyndall, Donald A; Nguyen, Tung; Bencharit, Sompop

    2016-06-01

    The value of computer-aided implant planning using cone-beam computerized tomography (CBCT) for single immediate implants was explored. Eighteen patients requiring extraction of a tooth followed by a single immediate implant were enrolled. Small volume preoperative CBCT scans were used to plan the position of the implant. A taper screwed-type implant was immediately placed into a fresh socket using only the final 1 or 2 drills for osteotomy. Postoperative CBCTs were used for the analysis of actual implant placement positioning. Measurements of the planned and the actual implant position were made with respect to their position relative to the adjacent teeth. Mesio-distal displacements and the facial-lingual deviation of the implant from the planned position were determined. Changes in the angulation of the planned and actual implant position in relation to the clinical crown were also measured. To statistically summarize the results, box plots and 95% CIs for means of paired differences were used. The analysis showed no statistical difference between the planned position and final implant placement position in any measurement. The CBCT scans coupled with the computer-aided implant planning program along with a final 1-to-2 drill protocol may improve the accuracy of single immediate implant placement for taper screwed-type implants. PMID:26652644

  2. Exploring Effectiveness of Computer-Aided Planning in Implant Positioning for a Single Immediate Implant Placement.

    PubMed

    Edelmann, Alexander R; Hosseini, Bashir; Byrd, Warren C; Preisser, John S; Tyndall, Donald A; Nguyen, Tung; Bencharit, Sompop

    2016-06-01

    The value of computer-aided implant planning using cone-beam computerized tomography (CBCT) for single immediate implants was explored. Eighteen patients requiring extraction of a tooth followed by a single immediate implant were enrolled. Small volume preoperative CBCT scans were used to plan the position of the implant. A taper screwed-type implant was immediately placed into a fresh socket using only the final 1 or 2 drills for osteotomy. Postoperative CBCTs were used for the analysis of actual implant placement positioning. Measurements of the planned and the actual implant position were made with respect to their position relative to the adjacent teeth. Mesio-distal displacements and the facial-lingual deviation of the implant from the planned position were determined. Changes in the angulation of the planned and actual implant position in relation to the clinical crown were also measured. To statistically summarize the results, box plots and 95% CIs for means of paired differences were used. The analysis showed no statistical difference between the planned position and final implant placement position in any measurement. The CBCT scans coupled with the computer-aided implant planning program along with a final 1-to-2 drill protocol may improve the accuracy of single immediate implant placement for taper screwed-type implants.

  3. Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer.

    PubMed

    Muelleman, Thomas John; Peterson, Jeremy; Chowdhury, Naweed Iffat; Gorup, Jason; Camarata, Paul; Lin, James

    2016-06-01

    Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures. PMID:27175320

  4. Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer.

    PubMed

    Muelleman, Thomas John; Peterson, Jeremy; Chowdhury, Naweed Iffat; Gorup, Jason; Camarata, Paul; Lin, James

    2016-06-01

    Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.

  5. Mainstreaming risk reduction in urban planning and housing: a challenge for international aid organisations.

    PubMed

    Wamsler, Christine

    2006-06-01

    The effects of 'natural' disasters in cities can be worse than in other environments, with poor and marginalised urban communities in the developing world being most at risk. To avoid post-disaster destruction and the forced eviction of these communities, proactive and preventive urban planning, including housing, is required. This paper examines current perceptions and practices within international aid organisations regarding the existing and potential roles of urban planning as a tool for reducing disaster risk. It reveals that urban planning confronts many of the generic challenges to mainstreaming risk reduction in development planning. However, it faces additional barriers. The main reasons for the identified lack of integration of urban planning and risk reduction are, first, the marginal position of both fields within international aid organisations, and second, an incompatibility between the respective professional disciplines. To achieve better integration, a conceptual shift from conventional to non-traditional urban planning is proposed. This paper suggests related operative measures and initiatives to achieve this change. PMID:16689916

  6. Principles of teaching in a structured training programme, the rotations, and the surgical training plan.

    PubMed

    Steiger, H J

    2004-01-01

    The present paper is divided into two parts. In the first part it summarises the essentials of transfer of knowledge and personality from trainer to trainee. The training capacity of a programme should be identified first since the number of residents in training has implications on the structure of the programme. The capacity is limited by the number of surgical "resident cases", which should at least amount to 70 per year and resident. For the future, more emphasis should be laid on the acquirement of methods of self-teaching and continuous self-education, in order to provide the trainees with the ability to cope with changes during their later career more easily. In part two the organisation of rotations as well as the structured surgical training plan are discussed. Teaching can be organised either as a gradual exposure to more and more complex procedures or as a sequence of speciality rotations. Structured teaching of theoretical contents should accompany practical teaching and in academic programmes a scientific rotation should be integrated. The ongoing subspecialisation is currently exceeding the limits of complete coverage during a six-year-programme.

  7. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    PubMed

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.

  8. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection

    PubMed Central

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun

    2015-01-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach. PMID:26446661

  9. Update on the Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II): statistical analysis plan

    PubMed Central

    2012-01-01

    Background Previous studies had suggested that the outcome for patients with spontaneous lobar intracerebral haemorrhage (ICH) and no intraventricular haemorrhage (IVH) might be improved with early evacuation of the haematoma. The Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) set out to establish whether a policy of earlier surgical evacuation of the haematoma in selected patients with spontaneous lobar ICH would improve outcome compared to a policy of initial conservative treatment. It is an international, multi-centre, prospective randomised parallel group trial of early surgery in patients with spontaneous lobar ICH. Outcome is measured at six months via a postal questionnaire. Results Recruitment to the study began on 27 November 2006 and closed on 15 August 2012 by which time 601 patients had been recruited. The protocol was published in Trials (http://www.trialsjournal.com/content/12/1/124/). This update presents the analysis plan for the study without reference to the unblinded data. The trial data will not be unblinded until after follow-up is completed in early 2013. The main trial results will be presented in spring 2013 with the aim to publish in a peer-reviewed journal at the same time. Conclusion The data from the trial will provide evidence on the benefits and risks of early surgery in patients with lobar ICH. Trial registration ISRCTN: ISRCTN22153967 PMID:23171588

  10. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    PubMed

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

  11. Metatarsal Reconstruction with a Fibular Osteocutaneous Flap: A Novel Approach Utilizing Virtual Surgical Planning

    PubMed Central

    Steele, Thomas N.; Delatte, Stephen; Hebert, Christopher K.; Canizares, Orlando

    2014-01-01

    Summary: Craniofacial reconstruction remains the main application for virtual surgical planning (VSP). We present a case in which this technology was applied to reconstruct a bony defect of the first metatarsal bone from a gunshot injury. VSP was used to facilitate a 1-stage reconstruction with a fibular osteocutaneous flap. A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone. Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators. Successful reconstruction of the metatarsal bone was achieved with excellent functional outcomes. We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time. PMID:25506541

  12. Functional MRI in clinical practice: Assessment of language and motor for pre-surgical planning

    PubMed Central

    Azar, Ramyar; Shoar, Majid Haghighat; Hooshmand, Sina; Mahdavi, Arash; Kharrazi, Homayoon Hadizadeh

    2015-01-01

    Functional magnetic resonance imaging (fMRI) has been widely used for pre-neurosurgical planning and may eventually become a routine pre-surgical imaging modality. The validity of fMRI for clinical application depends on various factors such as proper task selection, correct statistical analysis and threshold setting with appropriate patient cooperation. This study was performed on 40 patients with different types of brain mass lesions or hippocampal sclerosis to assess the role of appropriate patient selection for achieving a reliable fMRI result. Accurate and reproducible fMRI strongly depends on the patient’s cooperation. In this study we observed that a pre-test mock fMRI session held by a radiologist may help to predict which patients are more or less suitable candidates for fMRI. PMID:26443298

  13. Interictal epileptiform discharge effects on neuropsychological assessment and epilepsy surgical planning.

    PubMed

    Drane, Daniel L; Ojemann, Jeffrey G; Kim, Michelle S; Gross, Robert E; Miller, John W; Faught, R Edward; Loring, David W

    2016-03-01

    Both animal research and human research suggest that interictal epileptiform discharges (IEDs) may affect cognition, although the significance of such findings remains controversial. We review a wide range of literature with bearing on this topic and present relevant epilepsy surgery cases, which suggest that the effects of IEDs may be substantial and informative for surgical planning. In the first case, we present a patient with epilepsy with left anterior temporal lobe (TL) seizure onset who experienced frequent IEDs during preoperative neuropsychological assessment. Cognitive results strongly lateralized to the left TL. Because the patient failed performance validity tests and appeared amnestic for verbal materials inconsistent with his work history, selected neuropsychological tests were repeated 6 weeks later. Scores improved one to two standard deviations over the initial evaluation and because of this improvement, were only mildly suggestive of left TL impairment. The second case involves another patient with documented left TL epilepsy who experienced epileptiform activity while undergoing neurocognitive testing and simultaneous ambulatory EEG recording. This patient's verbal memory performance was impaired during the period that IEDs were present but near normal when such activity was absent. Overall, although the presence of IEDs may be helpful in confirming laterality of seizure onset, frequent IEDs might disrupt focal cognitive functions and distort accurate measurement of neuropsychological ability, interfering with accurate characterization of surgical risks and benefits. Such transient effects on daily performance may also contribute to significant functional compromise. We include a discussion of the manner in which IED effects during presurgical assessment can hinder individual patient presurgical planning as well as distort outcome research (e.g., IEDs occurring during presurgical assessment may lead to an underestimation of postoperative

  14. Interictal epileptiform discharge effects on neuropsychological assessment and epilepsy surgical planning.

    PubMed

    Drane, Daniel L; Ojemann, Jeffrey G; Kim, Michelle S; Gross, Robert E; Miller, John W; Faught, R Edward; Loring, David W

    2016-03-01

    Both animal research and human research suggest that interictal epileptiform discharges (IEDs) may affect cognition, although the significance of such findings remains controversial. We review a wide range of literature with bearing on this topic and present relevant epilepsy surgery cases, which suggest that the effects of IEDs may be substantial and informative for surgical planning. In the first case, we present a patient with epilepsy with left anterior temporal lobe (TL) seizure onset who experienced frequent IEDs during preoperative neuropsychological assessment. Cognitive results strongly lateralized to the left TL. Because the patient failed performance validity tests and appeared amnestic for verbal materials inconsistent with his work history, selected neuropsychological tests were repeated 6 weeks later. Scores improved one to two standard deviations over the initial evaluation and because of this improvement, were only mildly suggestive of left TL impairment. The second case involves another patient with documented left TL epilepsy who experienced epileptiform activity while undergoing neurocognitive testing and simultaneous ambulatory EEG recording. This patient's verbal memory performance was impaired during the period that IEDs were present but near normal when such activity was absent. Overall, although the presence of IEDs may be helpful in confirming laterality of seizure onset, frequent IEDs might disrupt focal cognitive functions and distort accurate measurement of neuropsychological ability, interfering with accurate characterization of surgical risks and benefits. Such transient effects on daily performance may also contribute to significant functional compromise. We include a discussion of the manner in which IED effects during presurgical assessment can hinder individual patient presurgical planning as well as distort outcome research (e.g., IEDs occurring during presurgical assessment may lead to an underestimation of postoperative

  15. Stereolithographic Surgical Template: A Review

    PubMed Central

    Dandekeri, Shilpa Sudesh; Sowmya, M.K.; Bhandary, Shruthi

    2013-01-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955

  16. The value of stereolithographic models for preoperative diagnosis of craniofacial deformities and planning of surgical corrections.

    PubMed

    Sailer, H F; Haers, P E; Zollikofer, C P; Warnke, T; Carls, F R; Stucki, P

    1998-10-01

    The purpose of this study was to assess the importance of stereolithographic models (SLMs) for preoperative diagnosis and planning in craniofacial surgery and to examine whether these models offer valuable additional information as compared to normal CT scans and 3D CT images. Craniofacial SLMs of 20 patients with craniomaxillofacial pathology were made. A helical volume CT scan of the anatomic area involved delivered the necessary data for their construction. These were built with an SLA 250 stereolithography apparatus (3D-Systems, Valencia, CA, USA), steered by FORM-IT/DCS software (University of Zurich, Switzerland). The stereolithography models were classified according to pathology, type of surgery and their relevance for surgical planning. Though not objectively measurable, it was beyond doubt that relevant additional information for the surgeon was obtained in cases of hypertelorism, severe asymmetries of the neuro- and viscerocranium, complex cranial synostoses and large skull defects. The value of these models as realistic "duplicates" of complex or rare dysmorphic craniofacial pathology for the purpose of creating a didactic collection should also be emphasized. The models proved to be less useful in cases of consolidated fractures of the periorbital and naso-ethmoidal complex, except where there was major dislocation.

  17. Integration of 3-dimensional surgical and orthodontic technologies with orthognathic "surgery-first" approach in the management of unilateral condylar hyperplasia.

    PubMed

    Janakiraman, Nandakumar; Feinberg, Mark; Vishwanath, Meenakshi; Nalaka Jayaratne, Yasas Shri; Steinbacher, Derek M; Nanda, Ravindra; Uribe, Flavio

    2015-12-01

    Recent innovations in technology and techniques in both surgical and orthodontic fields can be integrated, especially when treating subjects with facial asymmetry. In this article, we present a treatment method consisting of 3-dimensional computer-aided surgical and orthodontic planning, which was implemented with the orthognathic surgery-first approach. Virtual surgical planning, fabrication of surgical splints using the computer-aided design/computer-aided manufacturing technique, and prediction of final orthodontic occlusion using virtual planning with robotically assisted customized archwires were integrated for this patient. Excellent esthetic and occlusal outcomes were obtained in a short period of 5.5 months. PMID:26672712

  18. Patient-specific model of a scoliotic torso for surgical planning

    NASA Astrophysics Data System (ADS)

    Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean

    2013-03-01

    A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

  19. Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania.

    PubMed

    Agarwal, Smisha; Lasway, Christine; L'Engle, Kelly; Homan, Rick; Layer, Erica; Ollis, Steve; Braun, Rebecca; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

    2016-06-20

    To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by supervisors

  20. Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania.

    PubMed

    Agarwal, Smisha; Lasway, Christine; L'Engle, Kelly; Homan, Rick; Layer, Erica; Ollis, Steve; Braun, Rebecca; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

    2016-06-20

    To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by supervisors

  1. Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania

    PubMed Central

    Agarwal, Smisha; Lasway, Christine; L’Engle, Kelly; Homan, Rick; Layer, Erica; Ollis, Steve; Braun, Rebecca; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

    2016-01-01

    Abstract To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by

  2. Health Care Assisting Lesson Planning Guide for Long-Term Care Aide Certification. South Carolina Health Occupations Education.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia. Office of Occupational Education.

    This document consists of 13 competency outlines/lesson plans that have been developed for use in preparing students for certification as long-term care aides through South Carolina's health occupations education program. The following competencies are covered in the individual lessons: identify the function and responsibilities of nurses aides;…

  3. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.

    PubMed

    Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong

    2016-01-01

    The "robotic-assisted liver tumor coagulation therapy" (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor therapy

  4. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy

    PubMed Central

    Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong

    2016-01-01

    The “robotic-assisted liver tumor coagulation therapy” (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles’ operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot’s movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle “collision-free reachable workspace” (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor

  5. Accuracy of a newly developed cone-beam computerized tomography-aided surgical guidance system for dental implant placement: an ex vivo study.

    PubMed

    Murat, Sema; Kamburoğlu, Kivanç; Özen, Tuncer

    2012-12-01

    The aim of the present study was to measure the accuracy of the cone-beam computerized tomography (CBCT)- aided StentCad Beyond surgical guidance system and to compare bone-supported and tooth/bone-supported guidance by using this system in dental implant placement ex vivo. Five cadaver mandibles were scanned using an Iluma CBCT scanner. After scanning, DICOM slices were transferred to the StentCad Beyond implant simulation software, which was used for preoperative implant planning. Using the StentCad Beyond guidance system, 9 implant drills were inserted using a bone-supported guidance system and 11 using a tooth/bone-supported guidance system. Mandibles were scanned again and these data were transferred to the StentCad Beyond software. Pre- and postoperative information was superimposed using the Rhinoceros version 4 software program, and deviations between planned and actual drill positions were calculated for each implant. In addition, differences between bone-supported and tooth/bone-supported guidance systems were analyzed by t-test, with a significance level of P < .05. Data analysis found a mean coronal deviation of 1.2 ± 0.3 mm and 0.6 ± 0.6 mm, mean apical deviation of 1.3 ± 0.6 mm and 0.7 ± 0.6 mm, mean apical and coronal depth deviation of 1.4 ± 0.3 mm and 1.3 ± 0.3 mm, and mean angular deviation of 4.2° ± 2.0° and 3.0° ± 1.5° for tooth/bone supported and bone-supported guides, respectively. No statistical differences were found in depth or angular deviations between groups (P > .05); however, statistically significant differences between groups were found in mean horizontal coronal deviation (P = .016) and mean horizontal apical deviation (P = .047). The StentCad Beyond system was found to be a reliable guide for placing implants ex vivo.

  6. Minimizing MRI Geometric Distortions for Improved Stereotactic Surgical Planning Accuracy: a Theoretical and Experimental Analysis

    NASA Astrophysics Data System (ADS)

    Bertolina, James A.

    1995-01-01

    Accurate localization of internal structures is essential for successful stereotactic surgical planning. Magnetic resonance imaging (MRI) is an attractive modality for stereotactic imaging because it is highly sensitive to soft-tissue differences. Unfortunately, it has been shown to be susceptible to geometric distortions. These distortions contribute to object shifting and also to object -shape deformations. Research analyzing these distortions has found them to be complex and attributable to a variety of different sources. Furthermore, a wide range of stereotactic errors has been reported in numerous clinical studies, intimating that these errors are site specific. Because of the complexity of these distortions and the uncertainty of their effects from one imaging site to the next, most clinical sites choose either to ignore the likelihood that distortions exist, or image concurrently with MRI (for tissue specificity) and x-ray computed tomography (for geometric accuracy). Both of these strategies are unsatisfactory, however, as they either compromise patient care or induce unnecessary cost and inconvenience. This uncertainty in the accuracy of MRI was the impetus that prompted a comprehensive study of geometric distortion contributors and their subsequent effects on both imaged objects and stereotactic accuracy. This dissertation is a report of that study. As far as is known, it is the first comprehensive analysis (theoretical and experimental) of all of the individual distortion contributors that affect MRI geometric accuracy. Additionally, it is the first work that individually analyzes distortion effects on the stereotactic referencing system as well as on imaged objects. The dissertation begins with a brief history of the role of medical imaging in stereotactic surgical planning. Individual contributors to MRI geometric distortions are then analyzed theoretically and experimentally. How they affect both object distortions and stereotactic accuracy is

  7. Computer-assisted three-dimensional surgical planing and simulation. 3D soft tissue planning and prediction.

    PubMed

    Xia, J; Samman, N; Yeung, R W; Wang, D; Shen, S G; Ip, H H; Tideman, H

    2000-08-01

    The purpose of this paper is to report a new technique for three-dimensional facial soft-tissue-change prediction after simulated orthognathic surgical planning. A scheme for soft tissue deformation, "Computer-assisted three-dimensional virtual reality soft tissue planning and prediction for orthognathic surgery (CASP)", is presented. The surgical planning was based on three-dimensional reconstructed CT visualization. Soft tissue changes were predicted by two newly devised algorithms: Surface Normal-based Model Deformation Algorithm and Ray Projection-based Model Deformation Algorithm. A three-dimensional color facial texture-mapping technique was also used for generating the color photo-realistic facial model. As a final result, a predicted and simulated patient's color facial model can be visualized from arbitrary viewing points.

  8. A web-based federated neuroinformatics model for surgical planning and clinical research applications in epilepsy.

    PubMed

    Cao, Xinhua; Wong, Stephen T C; Hoo, Kent Soo; Tjandra, Donny; Fu, J C; Lowenstein, Daniel H

    2004-01-01

    There is an increasing need to efficiently share diverse clinical and image data among different clinics, labs, and departments of a medical center enterprise to facilitate better quality care and more effective clinical research. In this paper, we describe a web-based, federated information model as a viable technical solution with applications in medical refractory epilepsy and other neurological disorders. We describe four such online applications developed in a federated system prototype: surgical planning, image analysis, statistical data analysis, and dynamic extraction, transforming, and loading (ETL) of data from a heterogeneous collection of data sources into an epilepsy multimedia data warehouse (EMDW). The federated information system adopts a three-tiered architecture, consisting of a user-interface layer, an application logic layer, and a data service layer. We implemented two complementary federated information technologies, i.e., XML (eXtensible Markup Language) and CORBA (Common Object Request Broker Architecture), in the prototype to enable multimedia data exchange and brain images transmission. The preliminary results show that the federated prototype system provides a uniform interface, heterogeneous information integration and efficient data sharing for users in our institution who are concerned with the care of patients with epilepsy and who pursue research in this area.

  9. The renal tumor morphological characteristics that affect surgical planning for laparoscopic or open partial nephrectomy.

    PubMed

    Funahashi, Yasuhito; Murotani, Kenta; Yoshino, Yasushi; Sassa, Naoto; Ishida, Shohei; Gotoh, Momokazu

    2015-02-01

    The purpose of this study is to investigate the morphological characteristics of renal tumors which affect the surgeons' decision-making for the selection of open or laparoscopic partial nephrectomy. We included 147 patients who underwent partial nephrectomy for renal masses with elective indications in this study. Laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) were performed in 72 and 75 patients, respectively. Preoperative trans-sectional images were used to assess tumor characteristics such as tumor size, endophyticity, distance from the sinus, distance from the kidney equator, hilar designation, inside designation, and R.E.N.A.L. nephrometry score. Univariate logistic regression analyses demonstrated that tumor size, endophyticity, distance from the sinus, hilar designation, inside designation, and R.E.N.A.L. nephrometry score were associated with decision of laparoscopic partial nephrectomy. Among these factors, multiple regression analyses showed that endophyticity (odds ratio = 0.92, p = 0.007) and distance from the sinus (odds ratio = 1.201, p < 0.001) had statistically significant associations with the type of operation performed. ROC analyses demonstrated cut-off values of 16 mm for endophyticity (sensitivity 69%, specificity 77%) and of 4 mm for distance from the sinus (sensitivity 79%, specificity 65%) for predicting the selection of laparoscopic surgery. In conclusion, this study revealed that endophyticity and distance from the sinus were important for the surgical planning of partial nephrectomy.

  10. Men who have sex with men inadequately addressed in African AIDS National Strategic Plans.

    PubMed

    Makofane, Keletso; Gueboguo, Charles; Lyons, Daniel; Sandfort, Theo

    2013-01-01

    Through an analysis of AIDS National Strategic Plans (NSPs), this study investigated the responses of African governments to the HIV epidemics faced by men who have sex with men (MSM). NSPs from 46 African countries were systematically analysed, with attention focused on (1) the representation of MSM and their HIV risk, (2) the inclusion of epidemiologic information on the HIV epidemic among MSM and (3) government-led interventions addressing MSM. Out of 46 NSPs, 34 mentioned MSM. While two-thirds of these NSPs acknowledged the vulnerability of MSM to HIV infection, fewer than half acknowledged the role of stigma or criminalisation. Four NSPs showed estimated HIV prevalence among MSM, and one included incidence. Two-thirds of the NSPs proposed government-led HIV interventions that address MSM. Those that did plan to intervene planned to do so through policy interventions, social interventions, HIV-prevention interventions, HIV-treatment interventions and monitoring activities. Overall, the governments of the countries included in the study exhibited little knowledge of HIV disease dynamics among MSM and little knowledge of the social dynamics behind MSM's HIV risk. Concerted action is needed to integrate MSM into NSPs and governmental health policies in a way that acknowledges this population and its specific HIV/AIDS-related needs.

  11. Creating a strategic plan for configuration management using computer aided software engineering (CASE) tools

    SciTech Connect

    Smith, P.R.; Sarfaty, R.

    1993-05-01

    This paper provides guidance in the definition, documentation, measurement, enhancement of processes, and validation of a strategic plan for configuration management (CM). The approach and methodology used in establishing a strategic plan is the same for any enterprise, including the Department of Energy (DOE), commercial nuclear plants, the Department of Defense (DOD), or large industrial complexes. The principles and techniques presented are used world wide by some of the largest corporations. The authors used industry knowledge and the areas of their current employment to illustrate and provide examples. Developing a strategic configuration and information management plan for DOE Idaho Field Office (DOE-ID) facilities is discussed in this paper. A good knowledge of CM principles is the key to successful strategic planning. This paper will describe and define CM elements, and discuss how CM integrates the facility`s physical configuration, design basis, and documentation. The strategic plan does not need the support of a computer aided software engineering (CASE) tool. However, the use of the CASE tool provides a methodology for consistency in approach, graphics, and database capability combined to form an encyclopedia and a method of presentation that is easily understood and aids the process of reengineering. CASE tools have much more capability than those stated above. Some examples are supporting a joint application development group (JAD) to prepare a software functional specification document and, if necessary, provide the capability to automatically generate software application code. This paper briefly discusses characteristics and capabilities of two CASE tools that use different methodologies to generate similar deliverables.

  12. DICOM-based computer-aided evaluation of intensity modulated radiation therapy (IMRT) treatment plans

    NASA Astrophysics Data System (ADS)

    Cheung, Fion W. K.; Law, Maria Y. Y.

    2011-03-01

    Intensity-modulated radiation therapy (IMRT) has gained popularity in the treatment of cancers because of its excellent local control with decreased normal tissue complications. Yet, computer planning for the treatment relies heavily on human inspection of resultant radiation dose distribution within the irradiated region of the body. Even for experienced planners, comparison of IMRT plans is definitely cumbersome and not error-free. To solve this problem, a computer-aided decision-support system was built for automatic evaluation of IMRT plans based on the DICOM standard. A DICOM based IMRT plan with DICOM and DICOM-RT objects including CT images, RT Structure Set, RT Dose and RT Plan were retrieved from the Treatment Planning System for programming. Utilizing the MATLAB program language, the decoding-encoding software applications were developed on the basis of the DICOM information object definitions. After tracing the clinical workflow and understanding the needs and expectations from radiation oncologists, a set of routines were written to parse key data items such as isodose curves, region of interests, dose-volume histogram from the DICOM-RT objects. Then graphical user interfaces (GUIs) were created to allow planners to query for parameters such as overdose or underdose areas. A total of 30 IMRT plans were collected in a Department of Clinical Oncology for systematic testing of the DICOM-based decision-support system. Both structural and functional tests were implemented as a major step on the road to software maturity. With promising test results, this decision-support system could represent a major breakthrough in the routine IMRT planning workflow.

  13. Computer-aided patch planning for treatment of complex coarctation of the aorta

    NASA Astrophysics Data System (ADS)

    Rietdorf, Urte; Riesenkampff, Eugénie; Kuehne, Titus; Huebler, Michael; Meinzer, Hans-Peter; Wolf, Ivo

    2009-02-01

    Between five and eight percent of all children born with congenitally malformed hearts suffer from coarctations of the aorta. Some severe coarctations can only be treated by surgical repair. Untreated, this defect can cause serious damage to organ development or even lead to death. Patch repair requires open surgery. It can affect patients of any age: newborns with severe coarctation and/or hypoplastic aortic arch as well as older patients with late diagnosis of coarctation of the aorta. Another patient group are patients of varying age with re-coarctation of the aorta or hypoplastic aortic arch after surgical and/or interventional repair. If anatomy is complex and interventional treatment by catheterization, balloon angioplasty or stent placement is not possible, surgery is indicated. The choice of type of surgery depends not only on the given anatomy but also on the experience the surgical team has with each method. One surgical approach is patch repair. A patch of a suitable shape and size is sewed into the aorta to expand the aortic lumen at the site of coarctation. At present, the shape and size of the patch are estimated intra-operatively by the surgeon. We have developed a software application that allows planning of the patch pre-operatively on the basis of magnetic resonance angiographic data. The application determines the diameter of the coarctation and/or hypoplastic segment and constructs a patch proposal by calculating the difference to the normal vessel diameter pre-operatively. Evaluation of MR angiographic datasets from 12 test patients with different kinds of aortic arch stenosis shows a divergence of only (1.5+/-1.2) mm in coarctation diameters between manual segmentations and our approach, with comparable time expenditure. Following this proposal the patch can be prepared and adapted to the patient's anatomy pre-operatively. Ideally, this leads to shorter operation times and a better long-term outcome with a reduced rate of residual stenosis and

  14. Computer aided process planning and die design in simulation environment in sheet metal forming

    NASA Astrophysics Data System (ADS)

    Tisza, Miklós; Lukács, Zsolt

    2013-12-01

    During the recent 10-15 years, Computer Aided Process Planning and Die Design evolved as one of the most important engineering tools in sheet metal forming, particularly in the automotive industry. This emerging role is strongly emphasized by the rapid development of Finite Element Modeling, as well. The purpose of this paper is to give a general overview about the recent achievements in this very important field of sheet metal forming and to introduce some special results in this development activity. Therefore, in this paper, an integrated process simulation and die design system developed at the University of Miskolc, Department of Mechanical Engineering will be analyzed. The proposed integrated solutions have great practical importance to improve the global competitiveness of sheet metal forming in the very important segment of industry. The concept described in this paper may have specific value both for process planning and die design engineers.

  15. United States global health policy: HIV/AIDS, maternal and child health, and The President's Emergency Plan for AIDS Relief (PEPFAR).

    PubMed

    Leeper, Sarah C; Reddi, Anand

    2010-09-10

    The Obama administration has unveiled a new 6-year, $63 billion Global Health Initiative. In addition to the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR) to fund HIV/AIDS, tuberculosis, and malaria, the plan also supports maternal and child health (MCH) initiatives that are rooted in a proposal known as the Mother and Child Campaign. The architects of the Obama administration's Global Health Initiative recommend funding the Mother and Child Campaign at the expense of future funding increases for PEPFAR. The idea that differing global health initiatives must compete with each other lacks not only ethical legitimacy but also scientific merit. We believe that MCH need not to be framed in opposition to PEPFAR. Confronting illness in isolation - whether by funding PEPFAR at the expense of programs that target MCH or vice versa - cannot be our way forward. Given the intimate connection between HIV/AIDS and MCH, we affirm supporting PEPFAR and MCH programs together. We argue that policies that de-emphasize PEPFAR threaten to undermine, rather than support, MCH in countries with high HIV/AIDS prevalence. PEPFAR has directly and indirectly supported the care and treatment of other milieu specific diseases, including those afflicting mothers and children, bringing about broad benefits to the primary healthcare systems of recipient countries. We advocate the vertical integration of MCH initiatives into PEPFAR in order to create a comprehensive approach to addressing MCH against the global backdrop of HIV/AIDS.

  16. Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on 8 implants placed with a bone-supported surgical computer-planned guide: a case report.

    PubMed

    Amorfini, Leonardo; Storelli, Stefano; Romeo, Eugenio

    2011-03-01

    The use of technologies that merge computerized tomography X-ray imaging and 3-dimensional (3D) planning software allow the surgeon to digitally elaborate on the computer the position, length, and diameter of every implant to be placed. Following this approach, the placement is guided in a 3D digital model, and the implants are placed in the final position avoiding eventual anatomic structures. In this case report, the patient's remaining mandibular teeth were extracted, and the patient received 8 implants with the help of a computer surgical guide. The case was planned using SimPlant and a bone-supported guide. Because of the high precision of the planning, it was possible to realize a provisional rehabilitation before the actual surgery. The planning allows placement of parallel implants to optimize the prosthetic procedure and outcome. An immediate provisional implant was fixed with a flow composite on the temporary abutments and then refined in the dental laboratory. The patient received the provisional rehabilitation the same day of the surgery. After 6 weeks of healing, the final impression was taken and the prosthesis was finalized with a computer-aided design/computer-aided manufacturing titanium full-arch screwed framework with composite veneering. A 6-month follow-up showed good integration of the prostheses and success of all 8 implants. The use of surgical computer-guided planning changes the surgeon's approach: whereas before the use of conventional guides permitted a certain degree of offset from what was planned, the use of computer guides allows the implant to be inserted in a far more precise way. It is obvious that careful planning is the key factor to avoid implant misplacement.

  17. Implant surgical guides: From the past to the present

    PubMed Central

    Ramasamy, Manikandan; Giri; Raja, Ramesh; Subramonian; Karthik; Narendrakumar, Rachuri

    2013-01-01

    Advent of osseointegration has rapidly led to use of dental implants over recent years. Implant complications are often inadvertent sequelae of improper diagnosis, treatment planning, surgical method, and placement. This can be overcome by using surgical guides for implant positioning. Although conventionally made surgical guide are used, the clinical outcome is often unpredictable, and even if the implants are well placed, the location and deviation of the implants may not meet the optimal prosthodontic requirements. High accuracy in planning and execution of surgical procedures is important in securing a high success rate without causing iatrogenic damage. This can be achieved by computed tomography, 3D implant planning software, image-guided template production techniques, and computer-aided surgery. This article evaluates about the various systems of conventionally made surgical guide using radiograph and also the newer computer generated surgical guide in detail. PMID:23946587

  18. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  19. New approach for virtual surgical planning and mandibular reconstruction using a fibula free flap.

    PubMed

    Mottini, Matthias; Seyed Jafari, S M; Shafighi, Maziar; Schaller, Benoît

    2016-08-01

    Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap.

  20. New approach for virtual surgical planning and mandibular reconstruction using a fibula free flap.

    PubMed

    Mottini, Matthias; Seyed Jafari, S M; Shafighi, Maziar; Schaller, Benoît

    2016-08-01

    Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap. PMID:27344375

  1. A Resource Planning Analysis of District Hospital Surgical Services in the Democratic Republic of the Congo

    PubMed Central

    Sion, Melanie; Rajan, Dheepa; Kalambay, Hyppolite; Lokonga, Jean-Pierre; Bulakali, Joseph; Mossoko, Mathias; Kwete, Dieudonne; Schmets, Gerard; Kelley, Edward; Elongo, Tarcisse; Sambo, Luis; Cherian, Meena

    2015-01-01

    Abstract Background: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC). Methods: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well as in 2 of the 12 hospitals in which we conducted the situational analysis (Demba and Kabare District Hospitals). For the cost analysis, we used WHO's integrated Healthcare Technology Package tool. Results: Of the 32 surgical interventions surveyed, only 2 of the 12 hospitals provided all essential services. The deficits in procedures varied from no deficits to 17 services that could not be provided, with an average of 7 essential procedures unavailable. Many of the hospitals did not have basic infrastructure such as running water and electricity; 9 of 12 had no or interrupted water and 7 of 12 had no or interrupted electricity. On average, 21% of lifesaving surgical interventions were absent from the facilities, compared with the model normative hospital. According to the normative hospital, all surgical services would cost US$2.17 per inhabitant per year, representing 33.3% of the total patient caseload but only 18.3% of the total district hospital operating budget. At Demba Hospital, the operating budget required for surgical interventions was US$0.08 per inhabitant per year, and at Kabare Hospital, US$0.69 per inhabitant per year. Conclusion: A significant portion of the health problems addressed at Congolese district hospitals is surgical in nature, but there is a current inability to meet

  2. Predictors of child custody plans for children whose parents are living with AIDS in New York City.

    PubMed

    Lightfoot, Marguerita; Rotheram-Borus, Mary Jane

    2004-07-01

    Custody planning among parents living with HIV or AIDS (PLHAs) can buffer the negative impact of parental death. The formal and informal custody plans for 594 children by 253 PLHAs and the relationships among custody plans, parental health, and psychosocial status were examined. About one-half of the parents had no formal custody plan. Parents were more likely to make plans for younger children. In addition, formal custody planning was more likely to occur among parents who reported using positive action, withdrawal-depressive, passive problem solving, social support, or spiritual coping styles and who reported higher parental self-esteem. Parent's substance use and emotional distress were not significantly related to custody plans. These data suggest the need for interventions to encourage formal custody planning.

  3. Computer aided diagnosis and treatment planning for developmental dysplasia of the hip

    NASA Astrophysics Data System (ADS)

    Li, Bin; Lu, Hongbing; Cai, Wenli; Li, Xiang; Meng, Jie; Liang, Zhengrong

    2005-04-01

    The developmental dysplasia of the hip (DDH) is a congenital malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Early diagnosis and treatment is important because failure to diagnose and improper treatment can result in significant morbidity. In this paper, we designed and implemented a computer aided system for the diagnosis and treatment planning of this disease. With the design, the patient received CT (computed tomography) or MRI (magnetic resonance imaging) scan first. A mixture-based PV partial-volume algorithm was applied to perform bone segmentation on CT image, followed by three-dimensional (3D) reconstruction and display of the segmented image, demonstrating the special relationship between the acetabulum and femurs for visual judgment. Several standard procedures, such as Salter procedure, Pemberton procedure and Femoral Shortening osteotomy, were simulated on the screen to rehearse a virtual treatment plan. Quantitative measurement of Acetabular Index (AI) and Femoral Neck Anteversion (FNA) were performed on the 3D image for evaluation of DDH and treatment plans. PC graphics-card GPU architecture was exploited to accelerate the 3D rendering and geometric manipulation. The prototype system was implemented on PC/Windows environment and is currently under clinical trial on patient datasets.

  4. A clinician's experience with the President's Emergency Plan for AIDS Relief in Nigeria: a transformative decade of hope.

    PubMed

    Idoko, John

    2012-07-01

    Prior to the start of the President's Emergency Plan for AIDS Relief (PEPFAR), Nigeria struggled to fight HIV/AIDS. PEPFAR changed everything. I witnessed this change firsthand by directing the response to AIDS, first in my hospital in Jos, in central Nigeria, and now as Nigeria's HIV/AIDS coordinator. When the first AIDS case was diagnosed in Nigeria in 1986, my country had one of the world's poorest health systems, and as the pandemic spread, most Nigerians with AIDS died. Eventually, effective new drugs were developed, but they were too costly for all but a few Nigerians. Then there was a miracle: PEPFAR gave us resources, direction, and expertise to treat hundreds of thousands of people around the country. Today, Nigeria is providing treatment to 500,000 people with AIDS, and 80 percent of them receive treatment supported by PEPFAR. The US effort did more than help us treat people with HIV/AIDS; it also enabled Nigeria to strengthen its health system, improve care for pregnant women and infants, increase the provision of vaccinations, build modern laboratories, and train thousands of new health care workers and technicians.

  5. Hillary Clinton takes up defense of U.S. aid for family planning overseas.

    PubMed

    Cohen, S A

    1996-12-20

    In November 1996 during her address to the Sixth Conference of Wives of Heads of State and Government of the Americas in La Paz, Colombia, and in her weekly newspaper column, US first lady Hillary Rodham Clinton pledged her own and the Clinton administration's complete support for reversing the severe reduction in funds for the international family planning program imposed by the 104th Congress. This revelation reflected the administration's preparation for a strong and vocal defense of the international family planning program, which will be facing its greatest political test in February 1997. Bolivia has the highest maternal mortality rate in South America, and half the deaths are due to illegal, unsafe abortions. Mrs. Clinton presented a $2.25 million USAID award to a $5 million Pan American Health Organization program that aims to reduce maternal mortality. In her December 3, 1996, column, she used family planning campaigns in Bolivia as an illustration of sensible, cost-effective, and long-term strategies for improving women's health, strengthening families, and reducing the abortion rate. Such programs educate people about the benefits of birth spacing, breast feeding, good nutrition, prenatal and postpartum visits, and safe deliveries. Mrs. Clinton has also visited other poor countries to learn about the special needs and conditions of women's lives. UN Ambassador Madeleine Albright has recently been nominated to be the first female Secretary of State. Many people see her commitment to improving the status of women through development efforts and her recognition of the close relationship between development and diplomacy as encouraging. The concern and commitment of these two powerful women could prove valuable in the upcoming test for international family planning aid. Congress must vote on a resolution to approve Clinton's report that the reduced funding is having a negative impact no later than February 28. If both the House and the Senate pass the

  6. Hillary Clinton takes up defense of U.S. aid for family planning overseas.

    PubMed

    Cohen, S A

    1996-12-20

    In November 1996 during her address to the Sixth Conference of Wives of Heads of State and Government of the Americas in La Paz, Colombia, and in her weekly newspaper column, US first lady Hillary Rodham Clinton pledged her own and the Clinton administration's complete support for reversing the severe reduction in funds for the international family planning program imposed by the 104th Congress. This revelation reflected the administration's preparation for a strong and vocal defense of the international family planning program, which will be facing its greatest political test in February 1997. Bolivia has the highest maternal mortality rate in South America, and half the deaths are due to illegal, unsafe abortions. Mrs. Clinton presented a $2.25 million USAID award to a $5 million Pan American Health Organization program that aims to reduce maternal mortality. In her December 3, 1996, column, she used family planning campaigns in Bolivia as an illustration of sensible, cost-effective, and long-term strategies for improving women's health, strengthening families, and reducing the abortion rate. Such programs educate people about the benefits of birth spacing, breast feeding, good nutrition, prenatal and postpartum visits, and safe deliveries. Mrs. Clinton has also visited other poor countries to learn about the special needs and conditions of women's lives. UN Ambassador Madeleine Albright has recently been nominated to be the first female Secretary of State. Many people see her commitment to improving the status of women through development efforts and her recognition of the close relationship between development and diplomacy as encouraging. The concern and commitment of these two powerful women could prove valuable in the upcoming test for international family planning aid. Congress must vote on a resolution to approve Clinton's report that the reduced funding is having a negative impact no later than February 28. If both the House and the Senate pass the

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

    NASA Astrophysics Data System (ADS)

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

    2012-03-01

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

  8. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  9. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity. PMID:27630506

  10. Personal Finance. Predrafted Individual Short-Term Plan/Records (Secondary Level): Directions for Resource Teachers, Teachers and Aides.

    ERIC Educational Resources Information Center

    Flores, Merced, Comp.

    Developed by experienced migrant education teachers incorporating Sight and Sound Program concepts, this volume presents predrafted individual short-term Plan/Records for personal finance for secondary level students, plus step-by-step directions for their use by Oregon resource teachers, classroom teachers, and aides. This approach assumes that…

  11. Educational Finance Law: Constitutional Challenges to State Aid Plan--An Analysis of Strategies. NOLPE Monograph Series, No. 50.

    ERIC Educational Resources Information Center

    Wood, R. Craig; Thompson, David C.

    This book offers an overview of educational finance law and examines constitutional challenges to state aid plans. Chapter 1 provides an introduction to education finance litigation, including the early history of education finance litigation and early education finance theory. Chapter 2 discusses the states' responsibilities for providing equal…

  12. Science. Predrafted Individual Short-Term Plan/Records (Secondary Level): Directions for Resource Teachers, Teachers and Aides.

    ERIC Educational Resources Information Center

    Flores, Merced, Comp.

    Developed by experienced migrant education teachers incorporating Sight and Sound Program concepts, this volume presents predrafted individual short-term Plan/Records for secondary level chemistry, biology, and physics, plus step-by-step directions for their use by Oregon resource teachers, classroom teachers, and aides. The approach assumes that…

  13. The United States President's Emergency Plan for AIDS Relief: a story of partnerships and smart investments to turn the tide of the global AIDS pandemic.

    PubMed

    Goosby, Eric; Dybul, Mark; Fauci, Anthony S; Fauci, Anthony A; Fu, Joe; Walsh, Thomas; Needle, Richard; Bouey, Paul

    2012-08-15

    The United States President's Emergency Plan for AIDS Relief (PEPFAR) has played a key leadership role in the global response to the HIV/AIDS pandemic. PEPFAR was inspired by the principles of the historic Monterrey Consensus (United Nations. Monterrey Consensus on Financing for Development, Monterrey, Mexico, March 18-22, 2002. New York: United Nations; 2002. Available at: http://www.un.org/esa/ffd/monterrey/MonterreyConsensus.pdf. Accessed April 21, 2012), which changed the underlying conceptual framework for international development, and therefore global health--a shift from paternalism to partnership that begins with country ownership and requires good governance, a results-based approach, and engagement of all sectors of society. PEPFAR began with a focus on the growing emergency of the HIV/AIDS pandemic by rapidly expanding HIV services, building clinical capacity, implementing strategic information systems, and building a coalition of partners to lead the response. Within the first years of implementation, there was a shift to sustainability, including the advent of Partnership Frameworks. The PEPFAR reauthorization in 2008 codified into law, the evolution in policies and programs for the next phase of implementation. In 2011 alone, PEPFAR supported nearly 4 million people on treatment, supported programs that provided more than 1.5 million HIV-positive pregnant women with antiretroviral drugs to prevent HIV transmission to their children, and supported HIV testing for more than 40 million people. This article provides an overview of how smart investments and partnerships across sectors and US agencies have helped achieve unprecedented results in increasing HIV/AIDS services and engaging partner countries and organizations in sharing the responsibility for an AIDS-free generation.

  14. The United States President's Emergency Plan for AIDS Relief: a story of partnerships and smart investments to turn the tide of the global AIDS pandemic.

    PubMed

    Goosby, Eric; Dybul, Mark; Fauci, Anthony S; Fauci, Anthony A; Fu, Joe; Walsh, Thomas; Needle, Richard; Bouey, Paul

    2012-08-15

    The United States President's Emergency Plan for AIDS Relief (PEPFAR) has played a key leadership role in the global response to the HIV/AIDS pandemic. PEPFAR was inspired by the principles of the historic Monterrey Consensus (United Nations. Monterrey Consensus on Financing for Development, Monterrey, Mexico, March 18-22, 2002. New York: United Nations; 2002. Available at: http://www.un.org/esa/ffd/monterrey/MonterreyConsensus.pdf. Accessed April 21, 2012), which changed the underlying conceptual framework for international development, and therefore global health--a shift from paternalism to partnership that begins with country ownership and requires good governance, a results-based approach, and engagement of all sectors of society. PEPFAR began with a focus on the growing emergency of the HIV/AIDS pandemic by rapidly expanding HIV services, building clinical capacity, implementing strategic information systems, and building a coalition of partners to lead the response. Within the first years of implementation, there was a shift to sustainability, including the advent of Partnership Frameworks. The PEPFAR reauthorization in 2008 codified into law, the evolution in policies and programs for the next phase of implementation. In 2011 alone, PEPFAR supported nearly 4 million people on treatment, supported programs that provided more than 1.5 million HIV-positive pregnant women with antiretroviral drugs to prevent HIV transmission to their children, and supported HIV testing for more than 40 million people. This article provides an overview of how smart investments and partnerships across sectors and US agencies have helped achieve unprecedented results in increasing HIV/AIDS services and engaging partner countries and organizations in sharing the responsibility for an AIDS-free generation. PMID:22797740

  15. Computer Aided Process Planning for Non-Axisymmetric Deep Drawing Products

    NASA Astrophysics Data System (ADS)

    Park, Dong Hwan; Yarlagadda, Prasad K. D. V.

    2004-06-01

    In general, deep drawing products have various cross-section shapes such as cylindrical, rectangular and non-axisymmetric shapes. The application of the surface area calculation to non-axisymmetric deep drawing process has not been published yet. In this research, a surface area calculation for non-axisymmetric deep drawing products with elliptical shape was constructed for a design of blank shape of deep drawing products by using an AutoLISP function of AutoCAD software. A computer-aided process planning (CAPP) system for rotationally symmetric deep drawing products has been developed. However, the application of the system to non-axisymmetric components has not been reported yet. Thus, the CAPP system for non-axisymmetric deep drawing products with elliptical shape was constructed by using process sequence design. The system developed in this work consists of four modules. The first is recognition of shape module to recognize non-axisymmetric products. The second is a three-dimensional (3-D) modeling module to calculate the surface area for non-axisymmetric products. The third is a blank design module to create an oval-shaped blank with the identical surface area. The forth is a process planning module based on the production rules that play the best important role in an expert system for manufacturing. The production rules are generated and upgraded by interviewing field engineers. Especially, the drawing coefficient, the punch and die radii for elliptical shape products are considered as main design parameters. The suitability of this system was verified by applying to a real deep drawing product. This CAPP system constructed would be very useful to reduce lead-time for manufacturing and improve an accuracy of products.

  16. Knowledge-based system for computer-aided process planning of laser sensor 3D digitizing

    NASA Astrophysics Data System (ADS)

    Bernard, Alain; Davillerd, Stephane; Sidot, Benoit

    1999-11-01

    This paper introduces some results of a research work carried out on the automation of digitizing process of complex part using a precision 3D-laser sensor. Indeed, most of the operations are generally still manual to perform digitalization. In fact, redundancies, lacks or forgetting in point acquisition are possible. Moreover, digitization time of a part, i.e. immobilization of the machine, is thus not optimized overall. So, it is important, for time- compression during product development, to minimize time consuming of reverse engineering step. A new way to scan automatically a complex 3D part is presented to order to measure and to compare the acquired data with the reference CAD model. After introducing digitization, the environment used for the experiments is presented, based on a CMM machine and a plane laser sensor. Then the proposed strategy is introduced for the adaptation of this environment to a robotic CAD software in order to be able to simulate and validate 3D-laser-scanning paths. The CAPP (Computer Aided Process Planning) system used for the automatic generation of the laser scanning process is also presented.

  17. Preliminary Development of a Workstation for Craniomaxillofacial Surgical Procedures: Introducing a Computer-Assisted Planning and Execution System

    PubMed Central

    Gordon, Chad R.; Murphy, Ryan J.; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

    2014-01-01

    Introduction Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation. Methods We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Results Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions The initial development of the CAPE workstation demonstrated integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution. PMID:24406592

  18. Combining supine MRI and 3D optical scanning for improved surgical planning of breast conserving surgeries

    NASA Astrophysics Data System (ADS)

    Pallone, Matthew J.; Poplack, Steven P.; Barth, Richard J., Jr.; Paulsen, Keith D.

    2012-02-01

    Image-guided wire localization is the current standard of care for the excision of non-palpable carcinomas during breast conserving surgeries (BCS). The efficacy of this technique depends upon the accuracy of wire placement, maintenance of the fixed wire position (despite patient movement), and the surgeon's understanding of the spatial relationship between the wire and tumor. Notably, breast shape can vary significantly between the imaging and surgical positions. Despite this method of localization, re-excision is needed in approximately 30% of patients due to the proximity of cancer to the specimen margins. These limitations make wire localization an inefficient and imprecise procedure. Alternatively, we investigate a method of image registration and finite element (FE) deformation which correlates preoperative supine MRIs with 3D optical scans of the breast surface. MRI of the breast can accurately define the extents of very small cancers. Furthermore, supine breast MR reduces the amount of tissue deformation between the imaging and surgical positions. At the time of surgery, the surface contour of the breast may be imaged using a handheld 3D laser scanner. With the MR images segmented by tissue type, the two scans are approximately registered using fiducial markers present in both acquisitions. The segmented MRI breast volume is then deformed to match the optical surface using a FE mechanical model of breast tissue. The resulting images provide the surgeon with 3D views and measurements of the tumor shape, volume, and position within the breast as it appears during surgery which may improve surgical guidance and obviate the need for wire localization.

  19. Computer-assisted three-dimensional surgical planning: 3D virtual articulator: technical note.

    PubMed

    Ghanai, S; Marmulla, R; Wiechnik, J; Mühling, J; Kotrikova, B

    2010-01-01

    This study presents a computer-assisted planning system for dysgnathia treatment. It describes the process of information gathering using a virtual articulator and how the splints are constructed for orthognathic surgery. The deviation of the virtually planned splints is shown in six cases on the basis of conventionally planned cases. In all cases the plaster models were prepared and scanned using a 3D laser scanner. Successive lateral and posterior-anterior cephalometric images were used for reconstruction before surgery. By identifying specific points on the X-rays and marking them on the virtual models, it was possible to enhance the 2D images to create a realistic 3D environment and to perform virtual repositioning of the jaw. A hexapod was used to transfer the virtual planning to the real splints. Preliminary results showed that conventional repositioning could be replicated using the virtual articulator.

  20. Fracture risk assessment: improved evaluation of vertebral integrity among metastatic cancer patients to aid in surgical decision-making

    NASA Astrophysics Data System (ADS)

    Augustine, Kurt E.; Camp, Jon J.; Holmes, David R.; Huddleston, Paul M.; Lu, Lichun; Yaszemski, Michael J.; Robb, Richard A.

    2012-03-01

    Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit. Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment (SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis software is undergoing clinical validation studies. We expect this approach will facilitate patient management and utilization of reliable guidelines for selecting among various treatment option based on fracture risk.

  1. Computational Fluid Dynamics (CFD) as surgical planning tool: a pilot study on middle turbinate resection

    PubMed Central

    Zhao, Kai; Malhotra, Prashant; Rosen, David; Dalton, Pamela; Pribitkin, Edmund A

    2014-01-01

    Controversies exist regarding the resection or preservation of the middle turbinate (MT) during functional endoscopic sinus surgery (FESS). Any MT resection will perturb nasal airflow and may affect the mucociliary dynamics of the osteomeatal complex. Neither rhinometry nor computed tomography (CT) can adequately quantify nasal airflow pattern changes following surgery. This study explores the feasibility of assessing changes in nasal airflow dynamics following partial MT resection using computational fluid dynamics (CFD) techniques. We retrospectively converted the pre- and post-operative CT scans of a patient who underwent isolated partial MT concha bullosa resection into anatomically accurate three-dimensional numerical nasal models. Pre- and post-surgery nasal airflow simulations showed that the partial MT resection resulted in a shift of regional airflow towards the area of MT removal with a resultant decreased airflow velocity, decreased wall shear stress and increased local air pressure. However, the resection did not strongly affect the overall nasal airflow patterns, flow distributions in other areas of the nose, or the odorant uptake rate to the olfactory cleft mucosa. Morever, CFD predicted the patient's failure to perceive an improvement in his unilateral nasal obstruction following surgery. Accordingly, CFD techniques can be used to predict changes in nasal airflow dynamics following partial MT resection. However, the functional implications of this analysis await further clinical studies. Nevertheless, such techniques may potentially provide a quantitative evaluation of surgical effectiveness and may prove useful in preoperatively modeling the effects of surgical interventions. PMID:25312372

  2. Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

    PubMed Central

    Galbusera, Fabio; Bassani, Tito; La Barbera, Luigi; Ottardi, Claudia; Schlager, Benedikt; Brayda-Bruno, Marco; Villa, Tomaso; Wilke, Hans-Joachim

    2015-01-01

    In decades of technical developments after the first surgical corrections of spinal deformities, the set of devices, techniques, and tools available to the surgeons has widened dramatically. Nevertheless, the rate of complications due to mechanical failure of the fixation or the instrumentation remains rather high. Indeed, basic and clinical research about the principles of deformity correction and the optimal surgical strategies (i.e., the choice of the fusion length, the most appropriate instrumentation, and the degree of tolerable correction) did not progress as much as the implantable devices and the surgical techniques. In this work, a software approach for the biomechanical simulation of the correction of patient-specific spinal deformities aimed to the identification of its biomechanical principles is presented. The method is based on three-dimensional reconstructions of the spinal anatomy obtained from biplanar radiographic images. A user-friendly graphical user interface allows for the planning of the desired deformity correction and to simulate the implantation of pedicle screws. Robust meshing of the instrumented spine is provided by using consolidated computational geometry and meshing libraries. Based on a finite element simulation, the program is able to predict the loads and stresses acting in the instrumentation as well as those in the biological tissues. A simple test case (reduction of a low-grade spondylolisthesis at L3–L4) was simulated as a proof of concept, and showed plausible results. Despite the numerous limitations of this approach which will be addressed in future implementations, the preliminary outcome is promising and encourages a wide effort toward its refinement. PMID:26579518

  3. Reporting of planned statistical methods in published surgical randomised trial protocols: a protocol for a methodological systematic review

    PubMed Central

    Madden, Kim; Arseneau, Erika; Evaniew, Nathan; Smith, Christopher S; Thabane, Lehana

    2016-01-01

    Introduction Poor reporting can lead to inadequate presentation of data, confusion regarding research methodology used, selective reporting of results, and other misinformation regarding health research. One of the most recent attempts to improve quality of reporting comes from the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Group, which makes recommendations for the reporting of protocols. In this report, we present a protocol for a systematic review of published surgical randomised controlled trial (RCT) protocols, with the purpose of assessing the reporting quality and completeness of the statistical aspects. Methods We will include all published protocols of randomised trials that investigate surgical interventions. We will search MEDLINE, EMBASE, and CENTRAL for relevant studies. Author pairs will independently review all titles, abstracts, and full texts identified by the literature search, and extract data using a structured data extraction form. We will extract the following: year of publication, country, sample size, description of study population, description of intervention and control, primary outcome, important methodological qualities, and quality of reporting of planned statistical methods based on the SPIRIT guidelines. Ethics and dissemination The results of this review will demonstrate the quality of statistical reporting of published surgical RCT protocols. This knowledge will inform recommendations to surgeons, researchers, journal editors and peer reviewers, and other knowledge users that focus on common deficiencies in reporting and how to rectify them. Ethics approval for this study is not required. We will disseminate the results of this review in peer-reviewed publications and conference presentations, and at a doctoral independent study of oral defence. PMID:27259528

  4. Integrating social preference in GIS-aided planning for forestry and conservation activities: a case study from rural SE Asia.

    PubMed

    Webb, Edward L; Thiha

    2002-08-01

    Land-use planning using geographic information systems (GIS) commonly emphasizes biophysical spatial data; however planning can be improved by integrating spatial sets of socioeconomic data into the GIS. As an example, we compared a traditional GIS-aided forestry planning protocol that considered only biophysical suitability, with an integrated GIS-aided approach that incorporated both biophysical and socioeconomic suitability. The analyses were conducted for the planning of plantation investments in the Kyaukpadaung Township in the dry zone of central Myanmar. The traditional approach used three biophysical layers for suitability: land use, slope, and accessibility. In contrast, the integrated GIS approach included biophysical suitability data, perceptions and preferences of local villagers towards forestry (social suitability), and quantitative socioeconomic data. The results indicated that the integrated approach provided two principal benefits over the traditional method. First, the integrated method resulted in a more precise idea of suitable sites for plantation investment that could benefit more rural people and also lead to greater investment efficiency. Second, incorporating social preference into the GIS takes into account the crucial element of social capital (viz., social preference), which should lead to higher levels of community acceptance of plantation projects because those plantations would be established on socially suitable land. A second GIS exercise showed how conservation investment decisions could be informed using the integrated method. The results of this study support the idea that GIS-aided planning activities can be enhanced through the incorporation of social data into the analysis. When applicable, spatial data collection efforts for GIS-based planning exercises should incorporate spatial socioeconomic data.

  5. Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films

    SciTech Connect

    Gunderson, L.L.; Russell, A.H.; Llewellyn, H.J.; Doppke, K.P.; Tepper, J.E.

    1985-07-01

    For colorectal cancer, the adjuvant radiation dose levels required to achieve a high incidence of local control closely parallel the radiation tolerance of small bowel (4500-5000 rad), and for patients with partially resected or unresected disease, the dose levels exceed tolerance (6000-7000 rad). Therefore, both the surgeon and the radiation oncologist should use techniques that localize tumor volumes and decrease the amount of small intestine within the irradiation field. Surgical options include pelvic reconstruction and clip placement. Radiation options include the use of radiographs to define small bowel location and mobility combined with treatment techniques using multiple fields, bladder distention, shrinking or boost fields, and/or patient position changes. When both specialties interact in optimum fashion, local control can be increased with minimal side effects to the small intestine.

  6. Intention to use hearing aids: a survey based on the theory of planned behavior

    PubMed Central

    Meister, Hartmut; Grugel, Linda; Meis, Markus

    2014-01-01

    Objective To determine the intention to use hearing aids (HAs) by applying the theory of planned behavior (TPB). Design The TPB is a widely used decision-making model based on three constructs hypothesized to influence the intention to perform a specific behavior; namely, “attitude toward the behavior”, “subjective norm”, and “behavioral control”. The survey was based on a TPB-specific questionnaire addressing factors relevant to HA provision. Study sample Data from 204 individuals reporting hearing problems were analyzed. Different subgroups were established according to the stage of their hearing help-seeking. Results The TPB models’ outcome depended on the subgroup. The intention of those participants who had recognized their hearing problems but had not yet consulted an ear, nose, and throat specialist was largely dominated by the “subjective norm” construct, whereas those who had already consulted an ear, nose, and throat specialist or had already tried out HAs were significantly influenced by all constructs. The intention of participants who already owned HAs was clearly less affected by the “subjective norm” construct but was largely dominated by their “attitude toward HAs”. Conclusion The intention to use HAs can be modeled on the basis of the constructs “attitude toward the behavior”, “subjective norm”, and “behavioral control”. Individual contribution of the constructs to the model depends on the patient’s stage of hearing help-seeking. The results speak well for counseling strategies that explicitly consider the individual trajectory of hearing help-seeking. PMID:25258520

  7. High-energy laser tactical decision aid (HELTDA) for mission planning and predictive avoidance

    NASA Astrophysics Data System (ADS)

    Burley, Jarred L.; Fiorino, Steven T.; Randall, Robb M.; Bartell, Richard J.; Cusumano, Salvatore J.

    2012-06-01

    This study demonstrates the development of a high energy laser tactical decision aid (HELTDA) by the AFIT/CDE for mission planning High Energy Laser (HEL) weapon system engagements as well as centralized, decentralized, or hybrid predictive avoidance (CPA/DPA/HPA) assessments. Analyses of example HEL mission engagements are described as well as how mission planners are expected to employ the software. Example HEL engagement simulations are based on geographic location and recent/current atmospheric weather conditions. The atmospheric effects are defined through the AFIT/CDE Laser Environmental Effects Definition and Reference (LEEDR) model or the High Energy Laser End-to-End Operational Simulation (HELEEOS) model upon which the HELTDA is based. These models enable the creation of vertical profiles of temperature, pressure, water vapor content, optical turbulence, and atmospheric particulates and hydrometeors as they relate to line-by-line layer extinction coefficient magnitude at wavelengths from the UV to the RF. Seasonal and boundary layer variations (summer/winter) and time of day variations for a range of relative humidity percentile conditions are considered to determine optimum efficiency in a specific environment. Each atmospheric particulate/hydrometeor is evaluated based on its wavelength-dependent forward and off-axis scattering characteristics and absorption effects on the propagating environment to and beyond the target. In addition to realistic vertical profiles of molecular and aerosol absorption and scattering, correlated optical turbulence profiles in probabilistic (percentile) format are included. Numerical weather model forecasts are incorporated in the model to develop comprehensive understanding of HEL weapon system performance.

  8. Analysis of computer-aided techniques for virtual planning in nasoalveolar moulding.

    PubMed

    Loeffelbein, D J; Ritschl, L M; Rau, A; Wolff, K-D; Barbarino, M; Pfeifer, S; Schönberger, M; Wintermantel, E

    2015-05-01

    We compared two methods of planning virtual alveolar moulding as the first step in nasoalveolar moulding to provide the basis for an automated process to fabricate nasoalveolar moulding appliances by using computer-assisted design and computer-aided manufacturing (CAD/CAM). First, the initial intraoral casts taken from seven newborn babies with complete unilateral cleft lip and palate were digitised. This was repeated for the target models after conventional nasoalveolar moulding had been completed. The initial digital model for each patient was then virtually modified by two different modelling techniques to achieve the corresponding target model: parametric and freeform modelling with the software Geomagic(®). The digitally-remodelled casts were quantitatively compared with the actual target model for each patient, and the comparison between the two modified models and the target model showed that freeform modelling of the initial cast was successful (mean (SD) deviation n=7, +0.723 (0.148) to -0.694 (0.157)mm) but needed continuous orientation and was difficult to automate. The results from the parametric modelling (mean (SD) deviation, n=7, +1.168 (0.185) to -1.067 (0.221)mm) were not as good as those from freeform modelling. During parametric modelling, we found some irregularities on the surface, and transverse growth of the maxilla was not accounted for. However, this method seems to be the right one as far as automation is concerned. In addition, an external algorithm must be implemented because the function of the commercial software is limited.

  9. Three-Dimensional Printing Surgical Applications

    PubMed Central

    Griffin, Michelle F.; Butler, Peter E.

    2015-01-01

    Introduction: Three-dimensional printing, a technology used for decades in the industrial field, gains a lot of attention in the medical field for its potential benefits. With advancement of desktop printers, this technology is accessible and a lot of research is going on in the medical field. Objective: To evaluate its application in surgical field, which may include but not limited to surgical planning, surgical education, implants, and prosthesis, which are the focus of this review. Methods: Research was conducted by searching PubMed, Web of science, and other reliable sources. We included original articles and excluded articles based on animals, those more than 10 years old, and those not in English. These articles were evaluated, and relevant studies were included in this review. Discussion: Three-dimensional printing shows a potential benefit in surgical application. Printed implants were used in patient in a few cases and show successful results; however, longer follow-up and more trials are needed. Surgical and medical education is believed to be more efficient with this technology than the current practice. Printed surgical instrument and surgical planning are also believed to improve with three-dimensional printing. Conclusion: Three-dimensional printing can be a very powerful tool in the near future, which can aid the medical field that is facing a lot of challenges and obstacles. However, despite the reported results, further research on larger samples and analytical measurements should be conducted to ensure this technology's impact on the practice. PMID:26301002

  10. Office of Student Financial Aid Quality Improvement Program: Design and Implementation Plan.

    ERIC Educational Resources Information Center

    Advanced Technology, Inc., Reston, VA.

    The purpose and direction of the quality improvement program of the U.S. Department of Education's Office of Student Financial Aid (OSFA) are described. The improvement program was designed to develop a systematic approach to identify, measure, and correct errors in the student aid delivery system. Information is provided on the general approach…

  11. USAID's HIV / AIDS strategy for Asia: promoting early intervention. An inverview with Kerri-Ann Jones of the U.S. Agency for International Development's Asia Bureau about the USAID HIV / AIDS Strategic Plan for Asia.

    PubMed

    1994-08-01

    Although the World Health Organization estimates that $1.5-2.9 billion is needed per year to adequately support global HIV/AIDS prevention efforts, less than $200 million/year is being spent to prevent the transmission of HIV in the developing world. Worse still, US Agency for International Development (USAID) resources are shrinking. Two factors make HIV/AIDS prevention action in Asia a particularly urgent priority: more than half of the world's population lives in the region and the AIDS epidemic is still in its formative stages there. Rapid urbanization, high levels of migration, and large commercial sex and transportation industries are also typical in most countries of the region. In this context, the Asia Bureau of USAID adopted a strategic plan against HIV/AIDS in June 1993. In so doing, the bureau plans to work with the AIDSCAP program to coordinate prevention efforts and maximize the use of all available resources against the epidemic. Strategy focuses upon policy dialogue, communication to promote behavior change, improving the management of sexually transmitted diseases, improving access to condoms, monitoring and evaluation, and behavioral research. Interventions recommended by the plan, USAID coordination with other donors in the region, coordination with other AIDS prevention efforts already underway in a country, mission response to the plan, the interest of Asian governments in AIDS prevention, and the mechanism by which the plan is carried out are discussed.

  12. Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps

    NASA Astrophysics Data System (ADS)

    Schlosser, Stefan; Wirth, Raphael; Plock, Jan A.; Serov, Alexandre; Banic, Andrej; Erni, Dominique

    2010-05-01

    There is a demand for technologies able to assess the perfusion of surgical flaps quantitatively and reliably to avoid ischemic complications. The aim of this study is to test a new high-speed high-definition laser Doppler imaging (LDI) system (FluxEXPLORER, Microvascular Imaging, Lausanne, Switzerland) in terms of preoperative mapping of the vascular supply (perforator vessels) and postoperative flow monitoring. The FluxEXPLORER performs perfusion mapping of an area 9×9 cm with a resolution of 256×256 pixels within 6 s in high-definition imaging mode. The sensitivity and predictability to localize perforators is expressed by the coincidence of preoperatively assessed LDI high flow spots with intraoperatively verified perforators in nine patients. 18 free flaps are monitored before, during, and after total ischemia. 63% of all verified perforators correspond to a high flow spot, and 38% of all high flow spots correspond to a verified perforator (positive predictive value). All perfused flaps reveal a value of above 221 perfusion units (PUs), and all values obtained in the ischemic flaps are beneath 187 PU. In summary, we conclude that the present LDI system can serve as a reliable, fast, and easy-to-handle tool to detect ischemia in free flaps, whereas perforator vessels cannot be detected appropriately.

  13. Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure.

    PubMed

    de Zélicourt, Diane A; Kurtcuoglu, Vartan

    2016-01-01

    The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework. PMID:26183962

  14. Integrated surgical emergency training plan in the internship: A step toward improving the quality of training and emergency center management

    PubMed Central

    Akhlaghi, Mohammad Reza; Vafamehr, Vajiheh; Dadgostarnia, Mohammad; Dehghani, Alireza

    2013-01-01

    Introduction: In this study, by using a problem-oriented approach in the needs assessment, identifying the defects and deficiencies in emergency health training centers has been determined as the basis for the requirements. The main objective of the study was the implementation of surgical emergencies integration of the five surgical groups (general surgery, urology, orthopedics, neurosurgery, and ENT) to meet the needs and determining its efficacy. Materials and Methods: This interventional study was conducted in three phases: (1) Phase I (design and planning): Needs assessment, recognition of implementation barriers and providing the objectives and training program for integrated emergencies. (2) Phase II (implementation): Justification of the main stakeholders of the project, preparation of students’ duties in the emergency department, preparation of on-duty plans, supervising the implementation of the program, and reviewing the plan in parallel with the implementation based on the problems. (3) Phase III (evaluation): Reviewing the evidences based on the amount of efficiency of the plan and justification for its continuation. In the first and the second phase, the data were collected through holding focus group meetings and interviews. In the third phase, the opened-reply and closed-reply researcher-made questionnaires were used. The questionnaire face and content validity were confirmed by experts and the reliability was assessed by calculating the Cronbach's alpha. Results: According to the views of the interns, assistants, teachers, and emergency personnel, the positive features of the plan included the following: Increasing the patients’ satisfaction, reducing the patients’ stay in the Emergency Department, increasing the speed of handling the patients, balancing the workloads of the interns, direct training of interns by young teachers of emergency medicine, giving the direct responsibility of the patient to the intern, practical and operational

  15. Diffusion tensor imaging tractography of the optic radiation for epilepsy surgical planning: a comparison of two methods.

    PubMed

    Winston, Gavin P; Mancini, Laura; Stretton, Jason; Ashmore, Jonathan; Symms, Mark R; Duncan, John S; Yousry, Tarek A

    2011-11-01

    The optic radiation is a key white matter structure at risk during epilepsy surgery involving the temporal, parietal or occipital lobes. It shows considerable anatomical variability, cannot be delineated on clinical MRI sequences and damage may cause a disabling visual field deficit. Diffusion tensor imaging tractography allows non-invasive mapping of this pathway. Numerous methods have been published but direct comparison is difficult as patient, acquisition and analysis parameters differ. Two methods for delineating the optic radiation were applied to 6 healthy controls and 4 patients with epileptogenic lesions near the optic radiation. By comparing methods with the same datasets, many of the parameters could be controlled. The first method was previously developed to accurately identify Meyer's loop for planning anterior temporal lobe resection. The second aimed to address limitations of this method by using a more automated technique to reduce operator time and to depict the entire optic radiation. Whilst the core of the tract was common to both methods, there was significant variability between the methods. Method 1 gave a more consistent depiction of Meyer's loop with fewer spurious tracts. Method 2 gave a better depiction of the entire optic radiation, particularly in more posterior portions, but did not identify Meyer's loop in one patient. These results show that whilst tractography is a promising technique, there is significant variability depending on the method chosen even when the majority of parameters are fixed. Different methods may need to be chosen for surgical planning depending on the individual clinical situation.

  16. Diffusion tensor imaging tractography of the optic radiation for epilepsy surgical planning: A comparison of two methods

    PubMed Central

    Winston, Gavin P.; Mancini, Laura; Stretton, Jason; Ashmore, Jonathan; Symms, Mark R.; Duncan, John S.; Yousry, Tarek A.

    2011-01-01

    Summary The optic radiation is a key white matter structure at risk during epilepsy surgery involving the temporal, parietal or occipital lobes. It shows considerable anatomical variability, cannot be delineated on clinical MRI sequences and damage may cause a disabling visual field deficit. Diffusion tensor imaging tractography allows non-invasive mapping of this pathway. Numerous methods have been published but direct comparison is difficult as patient, acquisition and analysis parameters differ. Two methods for delineating the optic radiation were applied to 6 healthy controls and 4 patients with epileptogenic lesions near the optic radiation. By comparing methods with the same datasets, many of the parameters could be controlled. The first method was previously developed to accurately identify Meyer's loop for planning anterior temporal lobe resection. The second aimed to address limitations of this method by using a more automated technique to reduce operator time and to depict the entire optic radiation. Whilst the core of the tract was common to both methods, there was significant variability between the methods. Method 1 gave a more consistent depiction of Meyer's loop with fewer spurious tracts. Method 2 gave a better depiction of the entire optic radiation, particularly in more posterior portions, but did not identify Meyer's loop in one patient. These results show that whilst tractography is a promising technique, there is significant variability depending on the method chosen even when the majority of parameters are fixed. Different methods may need to be chosen for surgical planning depending on the individual clinical situation. PMID:21885257

  17. Pneumoperitoneum simulation based on mass-spring-damper models for laparoscopic surgical planning.

    PubMed

    Nimura, Yukitaka; Di Qu, Jia; Hayashi, Yuichiro; Oda, Masahiro; Kitasaka, Takayuki; Hashizume, Makoto; Misawa, Kazunari; Mori, Kensaku

    2015-10-01

    Laparoscopic surgery, which is one minimally invasive surgical technique that is now widely performed, is done by making a working space (pneumoperitoneum) by infusing carbon dioxide ([Formula: see text]) gas into the abdominal cavity. A virtual pneumoperitoneum method that simulates the abdominal wall and viscera motion by the pneumoperitoneum based on mass-spring-damper models (MSDMs) with mechanical properties is proposed. Our proposed method simulates the pneumoperitoneum based on MSDMs and Newton's equations of motion. The parameters of MSDMs are determined by the anatomical knowledge of the mechanical properties of human tissues. Virtual [Formula: see text] gas pressure is applied to the boundary surface of the abdominal cavity. The abdominal shapes after creation of the pneumoperitoneum are computed by solving the equations of motion. The mean position errors of our proposed method using 10 mmHg virtual gas pressure were [Formula: see text], and the position error of the previous method proposed by Kitasaka et al. was 35.6 mm. The differences in the errors were statistically significant ([Formula: see text], Student's [Formula: see text]-test). The position error of the proposed method was reduced from [Formula: see text] to [Formula: see text] using 30 mmHg virtual gas pressure. The proposed method simulated abdominal wall motion by infused gas pressure and generated deformed volumetric images from a preoperative volumetric image. Our method predicted abdominal wall deformation by just giving the [Formula: see text] gas pressure and the tissue properties. Measurement of the visceral displacement will be required to validate the visceral motion.

  18. Barriers to the Assessment of Unmet Need in Planning HIV/AIDS Prevention Programs.

    ERIC Educational Resources Information Center

    Valdiserri, Ronald O.; West, Gary R.

    1994-01-01

    Major barriers to conducting needs assessment for AIDS prevention are resource deficits, technical deficits, environmental complexity, and apprehension about expectations. Comprehensive, methodologically sound assessments conducted collaboratively by consumers and providers of prevention services are essential. (SK)

  19. PRE-OPERATIVE PLANNING AND SURGICAL TECHNIQUE OF THE OPEN WEDGE SUPRACONDYLAR OSTEOTOMY FOR CORRECTION OF VALGUS KNEE AND FIXATION WITH A FIXED-ANGLE IMPLANT

    PubMed Central

    Paccola, Cleber Antonio Jansen

    2015-01-01

    The step-by-step preoperative planning for supracondylar opening wedge osteotomy of the femur for precise correction of the load axis of the lower limb using a fixed-angle implant (95° AO blade plate) is presented. The surgical technique and the use of a bone graft from the same site for filling in the defect are also presented. PMID:27026976

  20. Planning Future Strategies for Domestic and International NeuroAIDS Research, July 24-25, 2008.

    PubMed

    Joseph, Jeymohan; Clifford, David; Douglas, Steven D; Fox, Howard; Gendelman, Howard E; Gonzalez-Scarano, Francisco; Grant, Igor; Major, Eugene; McArthur, Justin

    2009-09-01

    The National Institute of Mental Health in cooperation with the National Institute on Drug Abuse and the National Institute of Neurological Disorders and Stroke organized a meeting on July 24-25, 2008 to develop novel research directions for neuroAIDS research. The deliberations of this meeting are outlined in this brief report. Several critical research areas in neuroAIDS were identified as areas of emphasis. Opportunities for collaborations between large NIH-funded projects were also discussed.

  1. Computer-aided beam arrangement based on similar cases in radiation treatment-planning databases for stereotactic lung radiation therapy.

    PubMed

    Magome, Taiki; Arimura, Hidetaka; Shioyama, Yoshiyuki; Mizoguchi, Asumi; Tokunaga, Chiaki; Nakamura, Katsumasa; Honda, Hiroshi; Ohki, Masafumi; Toyofuku, Fukai; Hirata, Hideki

    2013-05-01

    The purpose of this study was to develop a computer-aided method for determination of beam arrangements based on similar cases in a radiotherapy treatment-planning database for stereotactic lung radiation therapy. Similar-case-based beam arrangements were automatically determined based on the following two steps. First, the five most similar cases were searched, based on geometrical features related to the location, size and shape of the planning target volume, lung and spinal cord. Second, five beam arrangements of an objective case were automatically determined by registering five similar cases with the objective case, with respect to lung regions, by means of a linear registration technique. For evaluation of the beam arrangements five treatment plans were manually created by applying the beam arrangements determined in the second step to the objective case. The most usable beam arrangement was selected by sorting the five treatment plans based on eight plan evaluation indices, including the D95, mean lung dose and spinal cord maximum dose. We applied the proposed method to 10 test cases, by using an RTP database of 81 cases with lung cancer, and compared the eight plan evaluation indices between the original treatment plan and the corresponding most usable similar-case-based treatment plan. As a result, the proposed method may provide usable beam arrangements, which have no statistically significant differences from the original beam arrangements (P > 0.05) in terms of the eight plan evaluation indices. Therefore, the proposed method could be employed as an educational tool for less experienced treatment planners.

  2. International response to the HIV/AIDS epidemic: planning for success.

    PubMed Central

    Piot, P.; Coll Seck, A. M.

    2001-01-01

    More assertive political leadership in the global response to AIDS in both poor and rich countries culminated in June 2001 at the UN General Assembly Special Session on AIDS. Delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. This points the way to achievable progress in the fight against HIV/AIDS. Evidence of success in tackling the spread of AIDS comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. It also comes from diverse countries, including India, the Russian Federation, Senegal, Thailand, the United Republic of Tanzania, and Zambia. Their common feature is the combination of focused approaches with attention to the societywide context within which risk occurs. Similarly, building synergies between prevention and care has underpinned success in Brazil and holds great potential for sub-Saharan Africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. Success also involves overcoming stigma, which undermines community action and blocks access to services. Work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. Accompanying attention to the conditions for success against HIV/AIDS is global consensus on the need for additional resources. The detailed estimate of required AIDS spending in low- and middle-income countries is US$ 9.2 billion annually, compared to the $ 2 billion currently spent. Additional spending should be mobilized by the new global fund to fight AIDS, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. Commitment and capacity to scale up HIV prevention and care have never been stronger. The moment must be seized to prevent a global catastrophe

  3. MR imaging for surgical planning and postoperative assessment in early osteoarthritis.

    PubMed

    Azer, Nigel M; Winalski, Carl S; Minas, Tom

    2004-01-01

    Chondral lesions in young active patients are a common problem encountered by orthopedic surgeons. Owing to the lack of vascularity, isolated chondral lesions do not heal spontaneously and may lead to osteoarthritis, creating a difficult treatment conundrum. Arthroscopic lavage and debridement provide temporary symptomatic relief without addressing the underlying pathology. Marrow stimulation techniques fill the defects with fibrocartilage that is believed to be biomechanically inferior. Osteoarticular autografts are useful for small lesions but are technically demanding. ACI can provide durable hyaline cartilage even in salvage reconstruction scenarios; however, complications such as periosteal overgrowth, arthrofibrosis, and failure of graft incorporation may occur and require reoperation. Arthroplasty remains the ultimate salvage for the arthritic joint, but biomechanical limitations preclude its use in young athletic adults. MR imaging has a crucial role in the diagnosis and treatment planning of chondral lesions and continues to remain valuable in followup of cartilage reconstructions longitudinally. MR imaging shows promise in reducing the need for more costly and invasive diagnostic arthroscopy. PMID:15049522

  4. The medical exploration toolkit: an efficient support for visual computing in surgical planning and training.

    PubMed

    Mühler, Konrad; Tietjen, Christian; Ritter, Felix; Preim, Bernhard

    2010-01-01

    Application development is often guided by the usage of software libraries and toolkits. For medical applications, the toolkits currently available focus on image analysis and volume rendering. Advance interactive visualizations and user interface issues are not adequately supported. Hence, we present a toolkit for application development in the field of medical intervention planning, training, and presentation--the MEDICALEXPLORATIONTOOLKIT (METK). The METK is based on the rapid prototyping platform MeVisLab and offers a large variety of facilities for an easy and efficient application development process. We present dedicated techniques for advanced medical visualizations, exploration, standardized documentation, adn interface widgets for common tasks. These include, e.g., advanced animation facilities, viewpoint selection, several illustrative rendering techniques, and new techniques for object selection in 3D surface models. No extended programming skills are needed for application building, since a graphical programming approach can be used. the toolkit is freely available and well documented to facilitate the use and extension of the toolkit. PMID:19910667

  5. Surgical innovation as sui generis surgical research.

    PubMed

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  6. "In the driver's seat": the Health Sector Strategic Master Plan as an instrument for aid coordination in Mongolia.

    PubMed

    Ulikpan, Anar; Narula, Indermohan; Malik, Asmat; Hill, Peter

    2014-04-03

    In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan's structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community. The study is based on document review, key-informant interviews and authors' experience and participation in the MoH planning processes. The HSSMP process improved alignment and harmonisation. It enabled a better local understanding of the benefits of aid coordination, and the recognition that aid coordination as not only a mere administrative task, but a strategic step towards comprehensive management of both domestic and external resources. The process was not challenge free; the fractious political environment, the frequent turnover of key MoH staff, the resistance of some donors towards MoH scrutiny over their programmes and the dismantling of the central coordination and return of seconded staff following completion of the HSSMP, has slowed the pace of reform. Despite the challenges, the approach resulted in positive outcomes in the areas of ownership and better aid coordination, with HSSMP development emphasising ownership and capacity building. This contrasted with the usual outcomes focus, and neglect of the capacity building learning processes and structural and policy changes needed to ensure sustainable change. The largest and most influential programmes in the health sector are now largely aligned with HSSMP strategies, enabling the MoH to utilize these opportunities to

  7. "In the driver's seat": the Health Sector Strategic Master Plan as an instrument for aid coordination in Mongolia.

    PubMed

    Ulikpan, Anar; Narula, Indermohan; Malik, Asmat; Hill, Peter

    2014-01-01

    In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan's structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community. The study is based on document review, key-informant interviews and authors' experience and participation in the MoH planning processes. The HSSMP process improved alignment and harmonisation. It enabled a better local understanding of the benefits of aid coordination, and the recognition that aid coordination as not only a mere administrative task, but a strategic step towards comprehensive management of both domestic and external resources. The process was not challenge free; the fractious political environment, the frequent turnover of key MoH staff, the resistance of some donors towards MoH scrutiny over their programmes and the dismantling of the central coordination and return of seconded staff following completion of the HSSMP, has slowed the pace of reform. Despite the challenges, the approach resulted in positive outcomes in the areas of ownership and better aid coordination, with HSSMP development emphasising ownership and capacity building. This contrasted with the usual outcomes focus, and neglect of the capacity building learning processes and structural and policy changes needed to ensure sustainable change. The largest and most influential programmes in the health sector are now largely aligned with HSSMP strategies, enabling the MoH to utilize these opportunities to

  8. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication.

    PubMed

    Yang, Long; Shang, Xian-Wen; Fan, Jian-Nan; He, Zhi-Xu; Wang, Jian-Ji; Liu, Miao; Zhuang, Yong; Ye, Chuan

    2016-01-01

    To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A) and the no-3D printing assisted-design group (Group B). In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P < 0.05). Patient satisfaction using the 3D-printed prototype and the communication score were 9.3 ± 0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication. PMID:27446944

  9. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication

    PubMed Central

    Yang, Long; Shang, Xian-Wen; Fan, Jian-Nan; He, Zhi-Xu; Wang, Jian-Ji; Liu, Miao; Zhuang, Yong

    2016-01-01

    To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A) and the no-3D printing assisted-design group (Group B). In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P < 0.05). Patient satisfaction using the 3D-printed prototype and the communication score were 9.3 ± 0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication. PMID:27446944

  10. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication.

    PubMed

    Yang, Long; Shang, Xian-Wen; Fan, Jian-Nan; He, Zhi-Xu; Wang, Jian-Ji; Liu, Miao; Zhuang, Yong; Ye, Chuan

    2016-01-01

    To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A) and the no-3D printing assisted-design group (Group B). In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P < 0.05). Patient satisfaction using the 3D-printed prototype and the communication score were 9.3 ± 0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication.

  11. Development of preoperative liver and vascular system segmentation and modeling tool for image-guided surgery and surgical planning

    NASA Astrophysics Data System (ADS)

    Li, Senhu; Waite, Jonathan M.; Lennon, Brian T.; Stefansic, James D.; Li, Rui; Dawant, Benoit M.

    2008-03-01

    Interactive image-guided liver surgery (Linasys device, Pathfinder Therapeutics, Inc., Nashville, TN) requires a user-oriented, easy-to-use, fast segmentation preoperative surgical planning system. This system needs to build liver models displaying the liver surface, tumors, and the vascular system of the liver. A robust and efficient tool for this purpose was developed and evaluated. For the liver surface or other bulk shape organ segmentation, the delineation was conducted on multiple slices of a CT image volume with a region growing algorithm. This algorithm incorporates both spatial and temporal information of a propagating front to advance the segmenting contour. The user can reduce the number of delineation slices during the processing by using interpolation. When comparing our liver segmentation results to those from MeVis (Breman, Germany), the average overlap percentage was 94.6%. For portal and hepatic vein segmentation, three-dimensional region growing based on image intensity was used. All second generation branches can be identified without time-consuming image filtering and manual editing. The two veins are separated by using mutually exclusive region growing. The tool can be used to conduct segmentation and modeling of the liver, veins, and other organs and can prepare image data for export to Linasys within one hour.

  12. [The Spanish AIDS Study Group and Spanish National AIDS Plan (GESIDA/Secretaría del Plan Nacional sobre el Sida) recommendations for the treatment of tuberculosis in HIV-infected individuals (Updated January 2013)].

    PubMed

    Rivero, Antonio; Pulido, Federico; Caylá, Joan; Iribarren, José A; Miró, José M; Moreno, Santiago; Pérez-Camacho, Inés

    2013-12-01

    This consensus document was prepared by an expert panel of the Grupo de Estudio de Sida (GESIDA [Spanish AIDS Study Group]) and the Plan Nacional sobre el Sida (PNS [Spanish National AIDS Plan]). The document updates current guidelines on the treatment of tuberculosis (TB) in HIV-infected individuals contained in the guidelines on the treatment of opportunistic infections published by GESIDA and PNS in 2008. The document aims to facilitate the management and treatment of HIV-infected patients with TB in Spain, and includes specific sections and recommendations on the treatment of drug-sensitive TB, multidrug-resistant TB, and extensively drug-resistant TB, in this population. The consensus guidelines also make recommendations on the treatment of HIV-infected patients with TB in special situations, such as chronic liver disease, pregnancy, kidney failure, and transplantation. Recommendations are made on the timing and initial regimens of antiretroviral therapy in patients with TB, and on immune reconstitution syndrome in HIV-infected patients with TB who are receiving antiretroviral therapy. The document does not cover the diagnosis of TB, diagnosis/treatment of latent TB, or treatment of TB in children. The quality of the evidence was evaluated and the recommendations graded using the approach of the Grading of Recommendations Assessment, Development and Evaluation Working Group.

  13. Assessment of Discharge Planning Referral to Nursing Homes for People with AIDS and HIV Infection.

    ERIC Educational Resources Information Center

    Linsk, Nathan L.; Marder, Reggi E.

    This study was conducted to identify efforts by hospital discharge planners to refer clients with human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) to nursing homes; to determine the responses of the facilities contacted; and to identify gaps in services, discharge planner practices, and relationships between…

  14. Assessing Pricing and Aid Strategies: Rethinking Planning and Evaluation Practices. AIR 1994 Annual Forum Paper.

    ERIC Educational Resources Information Center

    St. John, Edward P.

    This paper explores the need for a better understanding of the influences of prices and student aid on student enrollment and college budgets. The theory of net price has not been found to adequately explain changes in enrollment. Based on a critical review of recent research on student price response, this paper develops an alternative approach…

  15. Como preparar un programa de informacion sobre la asistencia economica (Planning a Financial Aid Awareness Program).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    This booklet, written in Spanish, is intended to be used with a set of slides as part of a presentation to students on "How To Apply for Federal Student Aid" ("Como Solicitar la Asistencia Economica Federal para Estudiantes"). The first part of the book is a script based on the slides. After the script is a guide to hosting a financial aid…

  16. The Development of a Health Promotion Workbook for AIDS Education Programs. Curriculum and Program Planning.

    ERIC Educational Resources Information Center

    Hobbs, Stephen; Baskett, Morris

    The purpose of this study was to develop a valid and reliable health promotion workbook to assist staff and volunteers of the AIDS Calgary Awareness Association in the systematic design, development, administration, and evaluation of preventive health promotion programs. Information was gleaned from a review of health promotion, social marketing,…

  17. Office of Student Financial Aid Quality Improvement Program: Design and Implementation Plan.

    ERIC Educational Resources Information Center

    Advanced Technology, Inc., Reston, VA.

    The purpose and direction of the Office of Student Financial Aid (OSFA) quality improvement program are described. The background and context for the Pell Grant quality control (QC) design study and the meaning of QC are reviewed. The general approach to quality improvement consists of the following elements: a strategic approach that enables OSFA…

  18. New Jersey: A State Organizing To Fight AIDS. A Plan for the 1990's. Recommendations of the State Commissioner of Health.

    ERIC Educational Resources Information Center

    New Jersey State Dept. of Health, Trenton.

    This document presents the New Jersey statewide plan for combating the Acquired Immune Deficiency Syndrome (AIDS) epidemic. Ten recommendations of the New Jersey State Commissioner of Health focus on such issues as public/private partnerships, protecting confidentiality, and fighting discrimination. The introduction notes that the plan is driven…

  19. Orthodontic-orthognathic interventions in orthognathic surgical cases: “Paper surgery” and “model surgery” concepts in surgical orthodontics

    PubMed Central

    Gandedkar, Narayan H.; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the “paper surgery” to establish “surgical-plan.” Furthermore, the “paper surgery” is emulated in “model surgery” such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing “paper surgery” and an occlusion is set up during “model surgery” for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from “treatment planning” to “execution” for successful management of aforementioned dentofacial deformity. PMID:27630506

  20. Orthodontic-orthognathic interventions in orthognathic surgical cases: “Paper surgery” and “model surgery” concepts in surgical orthodontics

    PubMed Central

    Gandedkar, Narayan H.; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the “paper surgery” to establish “surgical-plan.” Furthermore, the “paper surgery” is emulated in “model surgery” such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing “paper surgery” and an occlusion is set up during “model surgery” for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from “treatment planning” to “execution” for successful management of aforementioned dentofacial deformity.

  1. A reconfigurable digital filterbank for hearing-aid systems with a variety of sound wave decomposition plans.

    PubMed

    Wei, Ying; Liu, Debao

    2013-06-01

    Current hearing-aid systems have fixed sound wave decomposition plans due to the use of fixed filterbanks, thus cannot provide enough flexibility for the compensation of different hearing impairment cases. In this paper, a reconfigurable filterbank that consists of a multiband-generation block and a subband-selection block is proposed. Different subbands can be produced according to the control parameters without changing the structure of the filterbank system. The use of interpolation, decimation, and frequency-response masking enables us to reduce the computational complexity by realizing the entire system with only three prototype filters. Reconfigurability of the proposed filterbank enables hearing-impaired people to customize hearing aids based on their own specific conditions to improve their hearing ability. We show, by means of examples, that the proposed filterbank can achieve a better matching to the audiogram and has smaller complexity compared with the fixed filterbank. The drawback of the proposed method is that the throughput delay is relatively long (>20 ms), which needs to be further reduced before it can be used in a real hearing-aid application.

  2. Federal Student Aid (FSA) Five-Year Strategic Plan. FY 2004-2008

    ERIC Educational Resources Information Center

    US Department of Education, 2004

    2004-01-01

    The FSA Five-Year Strategic Plan is a roadmap for FY 2004-2008 that identifies five long-range strategic objectives, tactical short-term goals, and performance management initiatives. In working toward the goals outlined in the plan, FSA will address a number of key challenges, including legacy system migration, business process re-engineering,…

  3. An empirical evaulation of computerized tools to aid in enroute flight planning

    NASA Technical Reports Server (NTRS)

    Smith, Philip J.; Mccoy, C. Elaine; Layton, Charles

    1993-01-01

    The paper describes an experiment using the Flight Planning Testbed (FPT) in which 27 airline dispatchers were studied. Five general questions was addresses in the study: Under what circumstances does the introduction of computer-generated suggestions (flight plans) influence the planning behavior of dispatchers; what is the nature of such influences; How beneficial are the general design concepts underlying FPT; How effective are the specific implementation decisions made in realizing these general design concepts; How effectively do dispatchers evaluate situations requiring replanning and how effectively do they identify appropriate solutions to these situations. The study leaves little doubt that the introduction of computer-generated suggestions for solving a flight planning problem can have a marked impact on the cognitive processes of the user and on the ultimate plan selected.

  4. Low-cost generic drugs under the President's Emergency Plan for AIDS Relief drove down treatment cost; more are needed.

    PubMed

    Venkatesh, Kartik K; Mayer, Kenneth H; Carpenter, Charles C J

    2012-07-01

    The President's Emergency Plan for AIDS Relief (PEPFAR) was originally authorized in 2003 with the goal of supporting HIV prevention, treatment, and care within fifteen focus countries in the developing world. By September 2011 nearly 13 million people around the world were receiving HIV/AIDS-related care through PEPFAR, and 3.9 million were receiving antiretroviral treatment. However, in the early years of the program, access to antiretroviral drugs was hampered by the lack of a licensing process that the US government recognized for generic versions of these medications. Ultimately, the obstacle to approval of generic antiretroviral drugs was removed, which led to PEPFAR's considerable success at making these treatments widely available. This article outlines PEPFAR's evolving use of generic antiretroviral drugs to treat HIV in the developing world, highlights ongoing initiatives to increase access to generic antiretrovirals, and points to the need for mechanisms that will speed up the approval of new generic drugs. The striking decline in antiretroviral treatment costs, from $1,100 per person annually in 2004 to $335 per person annually in 2012, is due to the availability of effective generic antiretrovirals. Given growing resistance to existing drugs and the planned expansion of treatment to millions more people, access to newer generations of generic antiretrovirals will have to be expedited.

  5. Planning and pre-testing: the key to effective AIDS education materials.

    PubMed

    Ostfield, M L; Romocki, L S

    1991-06-01

    The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process.

  6. Planning and pre-testing: the key to effective AIDS education materials.

    PubMed

    Ostfield, M L; Romocki, L S

    1991-06-01

    The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process. PMID:12316892

  7. Surgical management of congenital heart disease: contribution of the Aristotle complexity score to planning and budgeting in the German diagnosis-related groups system.

    PubMed

    Sinzobahamvya, Nicodème; Photiadis, Joachim; Kopp, Thorsten; Arenz, Claudia; Haun, Christoph; Schindler, Ehrenfried; Hraska, Viktor; Asfour, Boulos

    2012-01-01

    Planning and budgeting for congenital heart surgery depend primarily on how closely reimbursement matches costs and on the number and complexity of the surgical procedures. Aristotle complexity scores for the year 2010 were correlated with hospital costs and with reimbursement according to the German diagnosis-related groups (DRG) system. Unit surgical performance was estimated as surgical performance (complexity score × hospital survival) times the number of primary procedures. This study investigated how this performance evolved during years 2006 to 2010. Hospital costs and reimbursements correlated highly with Aristotle comprehensive complexity levels (Spearman r = 1). Mean costs and reimbursement reached 35,050 ± 32,665 and 31,283 ± 34,732, respectively, for an underfunding of 10.7%. Basic and comprehensive unit surgical performances were respectively 3036 ± 1009 and 3891 ± 1591 points in 2006. Both performances increased in sigmoid fashion to reach 3883 ± 1344 and 5335 ± 1314 points, respectively, in 2010. Top performances would be achieved in year 2011, and extrapolated costs would comprise about 19,434,094.92 (95% confidence interval, 11,961,491.22-22,495,764.42). The current underfunding of congenital heart surgery needs correction. The Aristotle score can help to adjust reimbursement according to complexity of procedures. Unit surgical performance allows accurate budgeting in the current German DRG system.

  8. Passive fMRI mapping of language function for pediatric epilepsy surgical planning: validation using Wada, ECS, and FMAER

    PubMed Central

    Suarez, Ralph O.; Taimouri, Vahid; Boyer, Katrina; Vega, Clemente; Rotenberg, Alexander; Madsen, Joseph R.; Loddenkemper, Tobias; Duffy, Frank; Prabhu, Sanjay; Warfield, Simon K.

    2014-01-01

    In this study we validate passive language fMRI protocols designed for clinical application in pediatric epilepsy surgical planning as they do not require overt participation from patients. We introduced a set of quality checks that assess reliability of noninvasive fMRI mappings utilized for clinical purposes. We initially compared two fMRI language mapping paradigms, one active in nature (requiring participation from the patient) and the other passive in nature (requiring no participation from the patient). Group-level analysis in a healthy control cohort demonstrated similar activation of the putative language centers of the brain in the inferior frontal (IFG) and temporoparietal (TPG) regions. Additionally, we showed that passive language fMRI produced more left-lateralized activation in TPG (LI = +0.45) compared to the active task; with similarly robust left-lateralized IFG (LI = +0.24) activations using the passive task. We validated our recommended fMRI mapping protocols in a cohort of 15 pediatric epilepsy patients by direct comparison against the invasive clinical gold-standards. We found that language-specific TPG activation by fMRI agreed to within 9.2 mm to subdural localizations by invasive functional mapping in the same patients, and language dominance by fMRI agreed with Wada test results at 80% congruency in TPG and 73% congruency in IFG. Lastly, we tested the recommended passive language fMRI protocols in a cohort of very young patients and confirmed reliable language-specific activation patterns in that challenging cohort. We concluded that language activation maps can be reliably achieved using the passive language fMRI protocols we proposed even in very young (average 7.5 years old) or sedated pediatric epilepsy patients. PMID:25445239

  9. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  10. Building Assets with Community Effort: Computerized Mapping Aids Long-Term Planning.

    ERIC Educational Resources Information Center

    Whyman, Wynne; Mael, Stan; Kunkel, Mary

    1999-01-01

    To facilitate an integrated 10-year development plan, a Colorado Girl Scouts council collaborated with an architecture firm to create computer-generated maps of its camp properties, with links to relevant information. Maps and software provided unprecedented accuracy and access, were easily updated, and facilitated funding presentations. Sidebars…

  11. PREPARATION AIDS FOR THE DEVELOPMENT OF CATEGORY I QUALITY ASSURANCE PROJECT PLANS

    EPA Science Inventory

    Data collection activities performed for the Risk Reduction Engineering aboratory (RREL) of the U.S. Environmental Protection Agency are divided into tour categories, depending on the intended use of the data. uality Assurance (QA) Project Plans are written to ensure that project...

  12. PREPARATION AIDS FOR THE DEVELOPMENT OF CATEGORY IV QUALITY ASSURANCE PROJECT PLANS

    EPA Science Inventory

    Data collection activities performed for the Risk Reduction Engineering Laboratory (RREL) of the U.S. Environmental Protection Agency are divided into four categories, depending on the intended use of the data. uality Assurance (QA) Project Plans are written to ensure that projec...

  13. PREPARATION AIDS FOR THE DEVELOPMENT OF CATEGORY II QUALITY ASSURANCE PROJECT PLANS

    EPA Science Inventory

    Data collection activities performed for the Risk Reduction Engineering aboratory (RREL) of the U.S. Environmental Protection Agency are divided into tour categories, depending on the intended use of the data. uality Assurance (QA) Project Plans are written to ensure that project...

  14. PREPARATION AIDS FOR THE DEVELOPMENT OF CATEGORY III QUALITY ASSURANCE PROJECT PLANS

    EPA Science Inventory

    Data collection activities performed for the Risk Reduction Engineering Laboratory (RREL) of the U.S. Environmental Protection Agency are divided into four categories, depending on the intended use of the data. uality Assurance (QA) Project Plans are written to ensure that projec...

  15. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices

    PubMed Central

    Rodney, Robert C.; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca

    2016-01-01

    Abstract With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level. PMID:27346694

  16. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices.

    PubMed

    McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca

    2016-09-01

    With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level. PMID:27346694

  17. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices.

    PubMed

    McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca

    2016-09-01

    With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level.

  18. The President's Emergency Plan for AIDS Relief: from successes of the emergency response to challenges of sustainable action.

    PubMed

    Merson, Michael H; Curran, James W; Griffith, Caroline Hope; Ragunanthan, Braveen

    2012-07-01

    The President's Emergency Plan for AIDS Relief (PEPFAR) has made a major contribution to the reduction of the global HIV/AIDS burden. The program initially focused on rapidly scaling up treatment and prevention services in fifteen low-income countries, then transitioned to an approach that emphasizes sustainability, defined as the capacity to maintain program services after financial, managerial, and technical assistance from the United States and other external donors essentially ceases. Today, PEPFAR continues to expand its HIV prevention, treatment, and care activities while also supporting capacity-building initiatives, coordination efforts, and implementation science. The latter is research focused on improving service delivery, maximizing cost-effectiveness, and achieving public health impact. Recent advances in both scientific knowledge and the provision of prevention, treatment, and care services have bred cautious optimism about greatly reducing the spread of HIV. However, success will require a substantial increase in resources, strengthened health systems, renewed commitment to HIV prevention, and well-financed efforts to develop an effective HIV vaccine.

  19. Generation Of Manufacturing Routing And Operations Using Structured Knowledge As Basis To Application Of Computer Aided In Process Planning

    NASA Astrophysics Data System (ADS)

    Oswaldo, Luiz Agostinho

    2011-01-01

    The development of computer aided resources in automation of generation of manufacturing routings and operations is being mainly accomplished through the search of similarities between existent ones, resulting standard process routings that are grouped by analysis of similarities between parts or routings. This article proposes the development of manufacturing routings and operations detailment using a methodology which steps will define the initial, intermediate and final operations, starting from the rough piece and going up to the final specifications, that must have binunivocal relationship with the part design specifications. Each step will use the so called rules of precedence to link and chain the routing operations. The rules of precedence order and prioritize the knowledge of various manufacturing processes, taking in account the theories of machining, forging, assembly, and heat treatments; also, utilizes the theories of accumulation of tolerances and process capabilities, between others. It is also reinforced the availability of manufacturing databases related to process tolerances, deviations of machine tool- cutting tool- fixturing devices—workpiece, and process capabilities. The statement and application of rules of precedence, linking and joining manufacturing concepts in a logical and structured way, and their application in the methodology steps will make viable the utilization of structured knowledge instead of tacit one currently available in the manufacturing engineering departments, in the generation of manufacturing routing and operations. Consequently, the development of Computer Aided in Process Planning will be facilitated, due to the structured knowledge applied with this methodology.

  20. Methods to model and predict the ViewRay treatment deliveries to aid patient scheduling and treatment planning.

    PubMed

    Liu, Shi; Wu, Yu; Wooten, H Omar; Green, Olga; Archer, Brent; Li, Harold; Yang, Deshan

    2016-01-01

    A software tool is developed, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance image-guided radiation therapy (MR-IGRT) delivery system. This tool is necessary for managing patient treatment scheduling in our clinic. The predicted treatment delivery time and the assessment of plan complexities could also be useful to aid treatment planning. A patient's total treatment delivery time, not including time required for localization, is modeled as the sum of four components: 1) the treatment initialization time; 2) the total beam-on time; 3) the gantry rotation time; and 4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam-on time can be calculated using both the planned beam-on time and the decay-corrected dose rate. To predict the remain-ing components, we retrospectively analyzed the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, linear regression is applied to predict the gantry rotation time. The MLC motion time is calculated using the leaves delay modeling method and the leaf motion speed. A quantitative analysis was performed to understand the correlation between the total treatment time and the plan complexity. The proposed algorithm is able to predict the ViewRay treatment delivery time with the average prediction error 0.22min or 1.82%, and the maximal prediction error 0.89 min or 7.88%. The analysis has shown the correlation between the plan modulation (PM) factor and the total treatment delivery time, as well as the treatment delivery duty cycle. A possibility has been identified to significantly reduce MLC motion time by optimizing the positions of closed MLC pairs. The accuracy of

  1. A web-based computer aided system for liver surgery planning: initial implementation on RayPlus

    NASA Astrophysics Data System (ADS)

    Luo, Ming; Yuan, Rong; Sun, Zhi; Li, Tianhong; Xie, Qingguo

    2016-03-01

    At present, computer aided systems for liver surgery design and risk evaluation are widely used in clinical all over the world. However, most systems are local applications that run on high-performance workstations, and the images have to processed offline. Compared with local applications, a web-based system is accessible anywhere and for a range of regardless of relative processing power or operating system. RayPlus (http://rayplus.life.hust.edu.cn), a B/S platform for medical image processing, was developed to give a jump start on web-based medical image processing. In this paper, we implement a computer aided system for liver surgery planning on the architecture of RayPlus. The system consists of a series of processing to CT images including filtering, segmentation, visualization and analyzing. Each processing is packaged into an executable program and runs on the server side. CT images in DICOM format are processed step by to interactive modeling on browser with zero-installation and server-side computing. The system supports users to semi-automatically segment the liver, intrahepatic vessel and tumor from the pre-processed images. Then, surface and volume models are built to analyze the vessel structure and the relative position between adjacent organs. The results show that the initial implementation meets satisfactorily its first-order objectives and provide an accurate 3D delineation of the liver anatomy. Vessel labeling and resection simulation are planned to add in the future. The system is available on Internet at the link mentioned above and an open username for testing is offered.

  2. Using the theory of planned behaviour to understand the motivation to learn about HIV/AIDS prevention among adolescents in Tigray, Ethiopia.

    PubMed

    Gebreeyesus Hadera, H; Boer, H; Kuiper, W A J M

    2007-08-01

    Various studies indicate that school- or university-based HIV prevention curricula can reduce the prevalence of sexual risk behaviour among adolescent youth in Sub-Saharan Africa. However, effective HIV/AIDS prevention education may be problematic, if the needs of youth are not served adequately. To date, little attention has been given to the motivation of youth to learn about HIV/AIDS and about their preferences for HIV/AIDS curriculum design options. The aim of this study was to get insight into the determinants of the motivation of youth to learn about HIV/AIDS prevention and to assess their curriculum design preferences. Students from a university in Tigray, Ethiopia, filled out a structured questionnaire, which assessed demographics, variables that according to the Theory of Planned Behaviour are related to the motivation to learn, and their preferences for independent, carrier and integrated HIV/AIDS curriculum designs. On average, participants were highly motivated to learn about HIV/AIDS. Motivation to learn was primarily related to social norms and was not related to self-efficacy to discuss HIV/AIDS in class. The often discussed reluctance to discuss sexuality and condom use in curricula in Sub-Saharan Africa, seems to be more related to existing negative social norms, than to lack of self-efficacy. Participants revealed a high preference for the independent, carrier and integrated curriculum design options. However, students with a higher motivation to learn about HIV/AIDS were more attracted to the independent course design.

  3. Preparation aids for the development of Category 2 quality-assurance project plans

    SciTech Connect

    Simes, G.F.

    1991-02-01

    Data collection activities performed for the Risk Reduction Engineering Laboratory (RREL) of the U.S. Environmental Protection Agency are divided into four categories, depending on the intended use of the data. Quality Assurance (QA) Project Plans are written to ensure that project needs will be met and that quality control procedures are sufficient for obtaining data of known quality. Projects that are of sufficient scope and substance that their results could be combined with the results of other projects of similar scope to produce narratives that would be used for rule-making, regulation making, or policy making are identified as Category 2 projects. The Category 2 manual contains detailed descriptions of each of the 12 required elements of a Category 2 QA Project Plan. Also included are definitions and explanations of frequently used terms, examples of QA forms and charts, sample equations and numerous types of tables suggested for summarizing information.

  4. A homotopy-based sparse representation for fast and accurate shape prior modeling in liver surgical planning.

    PubMed

    Wang, Guotai; Zhang, Shaoting; Xie, Hongzhi; Metaxas, Dimitris N; Gu, Lixu

    2015-01-01

    Shape prior plays an important role in accurate and robust liver segmentation. However, liver shapes have complex variations and accurate modeling of liver shapes is challenging. Using large-scale training data can improve the accuracy but it limits the computational efficiency. In order to obtain accurate liver shape priors without sacrificing the efficiency when dealing with large-scale training data, we investigate effective and scalable shape prior modeling method that is more applicable in clinical liver surgical planning system. We employed the Sparse Shape Composition (SSC) to represent liver shapes by an optimized sparse combination of shapes in the repository, without any assumptions on parametric distributions of liver shapes. To leverage large-scale training data and improve the computational efficiency of SSC, we also introduced a homotopy-based method to quickly solve the L1-norm optimization problem in SSC. This method takes advantage of the sparsity of shape modeling, and solves the original optimization problem in SSC by continuously transforming it into a series of simplified problems whose solution is fast to compute. When new training shapes arrive gradually, the homotopy strategy updates the optimal solution on the fly and avoids re-computing it from scratch. Experiments showed that SSC had a high accuracy and efficiency in dealing with complex liver shape variations, excluding gross errors and preserving local details on the input liver shape. The homotopy-based SSC had a high computational efficiency, and its runtime increased very slowly when repository's capacity and vertex number rose to a large degree. When repository's capacity was 10,000, with 2000 vertices on each shape, homotopy method cost merely about 11.29 s to solve the optimization problem in SSC, nearly 2000 times faster than interior point method. The dice similarity coefficient (DSC), average symmetric surface distance (ASD), and maximum symmetric surface distance measurement

  5. Foraminal deposition of calcium pyrophosphate dihydrate crystals in the thoracic spine: possible relationship with disc herniation and implications for surgical planning. Report of two cases.

    PubMed

    Paolini, Sergio; Ciappetta, Pasquale; Guiducci, Antonio; Principi, Massimo; Missori, Paolo; Delfini, Roberto

    2005-01-01

    The authors report two cases of nodular calcium pyrophosphate dihydrate (CPPD) crystal deposition close to the thoracic neural foramen, which caused chronic radiculopathy. Preoperatively, the lesions were interpreted as calcified disc herniations. Both patients underwent surgery in which an extended transfacet pedicle-sparing approach was used. Incision of the posterior longitudinal ligament released soft degenerated material. In both cases, histological examination showed abundant degenerative debris along with CPPD crystals. Spinal CPPD deposition is a comparatively rare disease that almost invariably involves the posterior aspect of the spinal canal, typically the ligamentum flavum. The exceptional foraminal location of the lesions reported here, combined with the surgical findings, indicated that the CPPD crystals were deposited on a laterally herniated disc fragment. A distinctive feature in both cases was the soft consistency of the resected tissue. The consistency of the disc material and the location of the lesion in the axial plane (that is, median compared with lateral) are key factors in determining the optimal surgical approach to thoracic disc herniations. In describing consistency, terms such as "calcified" and "hard" have been used interchangeably in the literature. In the cases reported here, what appeared on computerized tomography and magnetic resonance imaging studies to be densely calcified lesions were shown intraoperatively to be soft herniations. The authors' experience underscores that not all densely calcified herniated discs are hard. Although detection of this discrepancy would have left surgical planning for the lateral disc herniations unchanged, it could have altered planning for centrally or centrolaterally located disc herniations.

  6. A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery.

    PubMed

    Motohashi, N; Kuroda, T

    1999-06-01

    The purpose of this article is to describe a newly developed 3D computer-aided design (CAD) system for the diagnostic set-up of casts in orthodontic diagnosis and treatment planning, and its preliminary clinical applications. The system comprises a measuring unit which obtains 3D information from the dental model using laser scanning, and a personal computer to generate the 3D graphics. When measuring the 3D shape of the model, to minimize blind sectors, the model is scanned from two different directions with the slit-ray laser beam by rotating the mounting angle of the model on the measuring device. For computed simulation of tooth movement, the representative planes, defined by the anatomical reference points, are formed for each individual tooth and are arranged along a guideline descriptive of the individual arch form. Subsequently, the 3D shape is imparted to each of the teeth arranged on the representative plane to form an arrangement of the 3D profile. When necessary, orthognathic surgery can be simulated by moving the mandibular dental arch three-dimensionally to establish the optimum occlusal relationship. Compared with hand-made set-up models, the computed diagnostic cast has advantages such as high-speed processing and quantitative evaluation on the amount of 3D movement of the individual tooth relative to the craniofacial plane. Trial clinical applications demonstrated that the use of this system facilitated the otherwise complicated and time-consuming mock surgery for treatment planning in orthognathic surgery.

  7. Machine learning aid for knowledge engineering: learning new plans for Pilot's Associate

    NASA Astrophysics Data System (ADS)

    Miller, Christopher A.; Levi, Keith R.; Druhan, Barry; Shalin, Valerie L.

    1992-08-01

    DARPA and Lockheed's Pilot's Associate (PA) represents one of the largest and most complex artificially intelligent systems constructed to date. Its architecture of five modular, cooperative expert systems posses a knowledge engineering problem unique in its scope, though not in its basic nature. The knowledge bases for each of PA's modules will be very large, constantly changing (in response to new tactics and new technological capabilities), and highly specialized for the task of the specific module. For efficiency, each module must contain only that knowledge necessary for its task, yet for cooperation, each system's knowledge must be consistent with the others'. Machine learning approaches hold the promise of greatly reducing knowledge acquisition and knowledge engineering time and of making the entire PA system more flexible, more accurate, and more consistent. We present the results of a three-year program investigating an Explanation-Based Learning approach to acquiring new plans from a simulator-based learning scenario and then propagating this knowledge to two of the five PA modules--as a tactical plan which focuses on changing world states for the Tactics Planner module, and as a list of pilot information needs for the dynamic display configuration algorithm used in the Pilot-Vehicle Interface module.

  8. An Examination of the Predictive Relationships of Self-Evaluation Capacity and Staff Competency on Strategic Planning in Hong Kong Aided Secondary Schools

    ERIC Educational Resources Information Center

    Cheng, Eric C. K.

    2011-01-01

    This article aims to examine the predictive relationships of self-evaluation capacity and staff competency on the effect of strategic planning in aided secondary schools in Hong Kong. A quantitative questionnaire survey was compiled to collect data from principals of the participating schools. Confirmatory factor analysis and reliability tests…

  9. How do national strategic plans for HIV and AIDS in southern and eastern Africa address gender-based violence? A women's rights perspective.

    PubMed

    Gibbs, Andrew; Mushinga, Mildred; Crone, E Tyler; Willan, Samantha; Mannell, Jenevieve

    2012-12-15

    Gender-based violence (GBV) is a significant human rights violation and a key driver of the HIV epidemic in southern and eastern Africa. We frame GBV from a broad human rights approach that includes intimate partner violence and structural violence. We use this broader definition to review how National Strategic Plans for HIV and AIDS (NSPs) in southern and eastern Africa address GBV. NSPs for HIV and AIDS provide the national-level framework that shapes government, business, donor, and non-governmental responses to HIV within a country. Our review of these plans for HIV and AIDS suggests that attention to GBV is poorly integrated; few recognize GBV and program around GBV. The programming, policies, and interventions that do exist privilege responses that support survivors of violence, rather than seeking to prevent it. Furthermore, the subject who is targeted is narrowly constructed as a heterosexual woman in a monogamous relationship. There is little consideration of GBV targeting women who have non-conforming sexual or gender identities, or of the need to tackle structural violence in the response to HIV and AIDS. We suggest that NSPs are not sufficiently addressing the human rights challenge of tackling GBV in the response to HIV and AIDS in southern and eastern Africa. It is critical that they do so.

  10. Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief.

    PubMed

    Chi, Benjamin H; Adler, Michelle R; Bolu, Omotayo; Mbori-Ngacha, Dorothy; Ekouevi, Didier K; Gieselman, Anna; Chipato, Tsungai; Luo, Chewe; Phelps, B Ryan; McClure, Craig; Mofenson, Lynne M; Stringer, Jeffrey S A

    2012-08-15

    In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide. PMID:22797744

  11. Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief.

    PubMed

    Chi, Benjamin H; Adler, Michelle R; Bolu, Omotayo; Mbori-Ngacha, Dorothy; Ekouevi, Didier K; Gieselman, Anna; Chipato, Tsungai; Luo, Chewe; Phelps, B Ryan; McClure, Craig; Mofenson, Lynne M; Stringer, Jeffrey S A

    2012-08-15

    In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide.

  12. Boundary conditions of patient-specific fluid dynamics modelling of cavopulmonary connections: possible adaptation of pulmonary resistances results in a critical issue for a virtual surgical planning

    PubMed Central

    Pennati, Giancarlo; Corsini, Chiara; Cosentino, Daria; Hsia, Tain-Yen; Luisi, Vincenzo S.; Dubini, Gabriele; Migliavacca, Francesco

    2011-01-01

    Cavopulmonary connections are surgical procedures used to treat a variety of complex congenital cardiac defects. Virtual pre-operative planning based on in silico patient-specific modelling might become a powerful tool in the surgical decision-making process. For this purpose, three-dimensional models can be easily developed from medical imaging data to investigate individual haemodynamics. However, the definition of patient-specific boundary conditions is still a crucial issue. The present study describes an approach to evaluate the vascular impedance of the right and left lungs on the basis of pre-operative clinical data and numerical simulations. Computational fluid dynamics techniques are applied to a patient with a bidirectional cavopulmonary anastomosis, who later underwent a total cavopulmonary connection (TCPC). Multi-scale models describing the surgical region and the lungs are adopted, while the flow rates measured in the venae cavae are used at the model inlets. Pre-operative and post-operative conditions are investigated; namely, TCPC haemodynamics, which are predicted using patient-specific pre-operative boundary conditions, indicates that the pre-operative balanced lung resistances are not compatible with the TCPC measured flows, suggesting that the pulmonary vascular impedances changed individually after the surgery. These modifications might be the consequence of adaptation to the altered pulmonary blood flows. PMID:22670201

  13. Floriculture Aide.

    ERIC Educational Resources Information Center

    Martin, Joyce; Looney, Era

    Designed for use in a self-paced, open-entry/open-exit vocational training program for a floriculture aide, this program guide is one of six for teachers of adult women offenders from a correctional institution. Module topic outlines and sample lesson plans are presented on eleven topics: occupational opportunities in the retail florist industry;…

  14. Improving health aid for a better planet: The planning, monitoring and evaluation tool (PLANET)

    PubMed Central

    Sridhar, Devi; Car, Josip; Chopra, Mickey; Campbell, Harry; Woods, Ngaire; Rudan, Igor

    2015-01-01

    Background International development assistance for health (DAH) quadrupled between 1990 and 2012, from US$ 5.6 billion to US$ 28.1 billion. This generates an increasing need for transparent and replicable tools that could be used to set investment priorities, monitor the distribution of funding in real time, and evaluate the impact of those investments. Methods In this paper we present a methodology that addresses these three challenges. We call this approach PLANET, which stands for planning, monitoring and evaluation tool. Fundamentally, PLANET is based on crowdsourcing approach to obtaining information relevant to deployment of large–scale programs. Information is contributed in real time by a diverse group of participants involved in the program delivery. Findings PLANET relies on real–time information from three levels of participants in large–scale programs: funders, managers and recipients. At each level, information is solicited to assess five key risks that are most relevant to each level of operations. The risks at the level of funders involve systematic neglect of certain areas, focus on donor’s interests over that of program recipients, ineffective co–ordination between donors, questionable mechanisms of delivery and excessive loss of funding to “middle men”. At the level of managers, the risks are corruption, lack of capacity and/or competence, lack of information and /or communication, undue avoidance of governmental structures / preference to non–governmental organizations and exclusion of local expertise. At the level of primary recipients, the risks are corruption, parallel operations / “verticalization”, misalignment with local priorities and lack of community involvement, issues with ethics, equity and/or acceptability, and low likelihood of sustainability beyond the end of the program’s implementation. Interpretation PLANET is intended as an additional tool available to policy–makers to prioritize, monitor and evaluate

  15. Lessons from the President's Emergency Plan for AIDS Relief: from quick ramp-up to the role of strategic partnership.

    PubMed

    Simonds, R J; Carrino, Constance A; Moloney-Kitts, Michele

    2012-07-01

    In its first five years, the President's Emergency Plan for AIDS Relief (PEPFAR)--the largest commitment ever by any nation to combat a single disease--succeeded in getting 2.1 million people on antiretroviral treatment and 10.1 million people in care; prevented an estimated 237,600 HIV infections in infants; and saved an estimated 3.28 million adult years of life. Much of the global program's success can be attributed to early decisions to implement new structures and approaches designed to meet its ambitious targets quickly, overcome bureaucratic inertia, and ensure continued progress. A unified US government program was created with a single coordinator. There was a focus on quick ramp-up, strategic partnerships, and sustainable local ownership. Accountability and performance were emphasized. These new approaches played critical roles in translating the unprecedented resources and political support for PEPFAR into improved health for millions of people. Successful aspects of the way in which PEPFAR was organized and implemented, along with less successful or deficient ones, offer lessons for any large, complex international health initiative.

  16. CT in ovarian cancer staging: how to review and report with emphasis on abdominal and pelvic disease for surgical planning.

    PubMed

    Sahdev, Anju

    2016-01-01

    CT of the abdomen and pelvis is the first line imaging modality for staging, selecting treatment options and assessing disease response in ovarian cancer. The staging CT provides disease distribution, disease burden and is the imaging surrogate for surgico-pathological FIGO staging. Optimal cyto-reductive surgery offers patients' the best chance for disease control or cure, but sub-optimal resection confers no advantage over chemotherapy and adversely increases the risk of post surgical complications. Although there is extensive literature comparing performance of CT against laparoscopy and surgery, for the staging abdominal and pelvic CT, there are currently no accepted guidelines for interpretation or routinely used minimum data set templates for reporting these complex CT scans often with extensive radiological findings. This review provides a systematic approach for identifying the important radiological findings and highlighting important sites of disease within the abdomen and pelvis, which may alter or preclude surgery at presentation or after adjuvant chemotherapy. The distribution of sites and volume of disease can be used to categorize patients as suitable, probably suitable or not suitable for optimal cyto-reductive surgery. This categorization can potentially assist oncological surgeons and oncologists as a semi objective assessment tool useful for selecting patient treatment, streamlining multi disciplinary discussion and improving the reproducibility and correlation of CT with surgical findings. The review also highlights sites of disease and complications of ovarian cancer which should be included as part of the radiological report as these may require additional surgical input from non gynaecological surgeons or influence treatment selection. PMID:27484100

  17. The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.

    PubMed

    Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph

    2010-06-01

    This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible. PMID:20231048

  18. A Teaching Aids Exhibition.

    ERIC Educational Resources Information Center

    Mahanja, Salah

    1985-01-01

    Describes an exhibition for the benefit of teachers of English in Arab Primary Schools, which was prepared by third-year students at the Teachers College for Arab Teachers. The exhibition included games, songs, audiovisual aids, crossword puzzles, vocabulary, spelling booklets, preposition aids, and worksheet and lesson planning aids. (SED)

  19. Shifting Resources and Focus to Meet the Goals of the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010-2013.

    PubMed

    Flores, Stephen A; Purcell, David W; Fisher, Holly H; Belcher, Lisa; Carey, James W; Courtenay-Quirk, Cari; Dunbar, Erica; Eke, Agatha N; Galindo, Carla A; Glassman, Marlene; Margolis, Andrew D; Neumann, Mary Spink; Prather, Cynthia; Stratford, Dale; Taylor, Raekiela D; Mermin, Jonathan

    2016-01-01

    In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals.

  20. 76 FR 52731 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ..., implementation, and policy issues related to the global response to HIV/AIDS. These issues will be of concern as... Board will determine procedures for public participation. For further information about the meeting, please contact Charles Holmes, Chief Medical Officer, Office of the U.S. Global AIDS Coordinator at...

  1. 77 FR 55891 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-11

    ..., implementation, and policy issues related to the global response to HIV/AIDS. These issues will be of concern as... possible to fulfill. For further information about the meeting, please contact Charles Holmes, Chief Medical Officer, Office of the U.S. Global AIDS Coordinator at (202) 663-2440 or...

  2. Surgical smoke.

    PubMed

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown. PMID:19892630

  3. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  4. Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Non-Cardiac Surgical Patients

    PubMed Central

    Bridges, Kathryn H; Stiegler, Marjorie P; Schell, Randall M; DiLorenzo, Amy N; Ehrenfeld, Jesse M; Nietert, Paul J; McEvoy, Matthew D

    2014-01-01

    BACKGROUND The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline. METHODS Anesthesiology residents at 4 training programs participated in an unblinded prospective randomized cross-over trial in which they completed two tests covering clinical scenarios. One quiz was completed from memory and one with the aid of an electronic decision support tool. Performance was evaluated by overall score (% correct), number of incorrect answers with possibly increased cost or risk of care, and the amount of time required to complete the quizzes both with and without the cognitive aid. The primary outcome was the proportion of correct responses attributable to the use of the decision support tool. RESULTS All anesthesiology residents at four institutions were recruited and 111 residents participated. Use of the decision support tool resulted in a 25% improvement in adherence to guidelines compared to memory alone (p<0.0001), and participants made 77% fewer incorrect responses that would have resulted in increased costs. Use of the tool was associated with a 3.4-minute increase in time to complete the test (p<0.001). CONCLUSIONS Use of an electronic decision support tool significantly improved adherence to the guidelines as compared to memory alone. The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs. PMID:24705442

  5. Considerations and Protocols in Virtual Surgical Planning of Reconstructive Surgery for More Accurate and Esthetic Neomandible with Deep Circumflex Iliac Artery Free Flap

    PubMed Central

    Kim, Nam-Kyoo; Kim, Hyun Young; Kim, Hyung Jun; Cha, In-Ho; Nam, Woong

    2014-01-01

    Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap. PMID:27489828

  6. The sensitivity of approved Ninhydrin and Biuret tests in the assessment of protein contamination on surgical steel as an aid to prevent iatrogenic prion transmission.

    PubMed

    Lipscomb, I P; Pinchin, H E; Collin, R; Harris, K; Keevil, C W

    2006-11-01

    Regulations recommend the routine application of biochemical tests, such as the Ninhydrin or Biuret tests, to confirm the efficacy of hospital sterile service department (SSD) washer-disinfector cycles in removing proteinaceous material, particularly with respect to prions. The effectiveness of these methods relies on both the effective sampling of the instruments and the sensitivity of the tests employed. Two commercially available contamination assessment tests were evaluated for their sensitivity to ME7 brain homogenate on surgical-grade stainless steel surfaces. Controls were visualized by the application of episcopic differential interference contrast/Epi-fluorecence microscopy (EDIC/EF) combined with the sensitive fluorescent reagent, SYPRO Ruby, which has been shown previously to rapidly visualize and assess low levels of contamination on medical devices. The Ninhydrin test displayed a minimum level of detection observed by 75% of volunteers (MLD(75)) of 9.25 microg [95% confidence interval (95% CI) 8.6-10.0 microg]. The Biuret test provided better sensitivity, with a MLD(75) of 6.7 microg (95% CI 5.4-8.2 microg). However, much lower concentrations of proteinaceous soiling (pg) were visualized using the EDIC/EF microscopy method. From these findings, it is clear that these approved colorimetric tests of cleaning are relatively insensitive. This investigation demonstrates how large amounts (up to 6.5 microg) of proteinaceous brain contamination could remain undetected and the instruments deemed clean using such methods. The application of more sensitive cleanliness evaluation methods should be applied to reduce the risk of iatrogenic transmission of prion disease in 'high-risk' instruments such as neurosurgical devices.

  7. Subject-specific analysis of joint contact mechanics: application to the study of osteoarthritis and surgical planning.

    PubMed

    Henak, Corinne R; Anderson, Andrew E; Weiss, Jeffrey A

    2013-02-01

    Advances in computational mechanics, constitutive modeling, and techniques for subject-specific modeling have opened the door to patient-specific simulation of the relationships between joint mechanics and osteoarthritis (OA), as well as patient-specific preoperative planning. This article reviews the application of computational biomechanics to the simulation of joint contact mechanics as relevant to the study of OA. This review begins with background regarding OA and the mechanical causes of OA in the context of simulations of joint mechanics. The broad range of technical considerations in creating validated subject-specific whole joint models is discussed. The types of computational models available for the study of joint mechanics are reviewed. The types of constitutive models that are available for articular cartilage are reviewed, with special attention to choosing an appropriate constitutive model for the application at hand. Issues related to model generation are discussed, including acquisition of model geometry from volumetric image data and specific considerations for acquisition of computed tomography and magnetic resonance imaging data. Approaches to model validation are reviewed. The areas of parametric analysis, factorial design, and probabilistic analysis are reviewed in the context of simulations of joint contact mechanics. Following the review of technical considerations, the article details insights that have been obtained from computational models of joint mechanics for normal joints; patient populations; the study of specific aspects of joint mechanics relevant to OA, such as congruency and instability; and preoperative planning. Finally, future directions for research and application are summarized.

  8. White paper report of the 2012 RAD-AID Conference on International Radiology for Developing Countries: planning the implementation of global radiology.

    PubMed

    Mollura, Daniel J; Mazal, Jonathan; Everton, Kathryn L; Azene, Ezana M; Collaros, Phelosha; Dabek, Filip; DeStigter, Kristen K; El-Shayal, Tarek S; Garra, Brian S; Gill, Tariq; Hayes, Carrie; Iosifescu, Sarah; Jimenez, Pablo; Khandelwal, Niranjan; Kenney, Philip; Lexa, Frank; Lewin, Jonathan S; Lungren, Matthew P; Mayo-Smith, William; Medlen, Kayiba; Nordvig, Anna S; O'Hara-Rusckowski, Deborah; Quansah, Seth; Silfen, Eric; Singh, Tulika; Sydnor, Ryan; Tahvildari, Ali; Teninty, Bill; Timmreck, Emily J; Watson, Liana

    2013-08-01

    The RAD-AID Conference on International Radiology for Developing Countries is a yearly forum addressing global shortages of radiology that contribute to health care disparity. In this paper, the authors present key issues and consensus positions related to the planning, analyzing, implementing, and monitoring of radiology in limited-resource areas on the basis of presentations at the 2012 RAD-AID conference, to advocate for (1) economic development to build health care capacity, (2) multidisciplinary educational strategies, (3) innovative epidemiologic and infrastructural solutions tailored to community needs, (4) advanced technical solutions leveraging the widespread use of wireless telecommunications and phone-based portable devices, and (5) improved dialog across radiology and public health institutions for coordinating global health strategies. PMID:23583085

  9. Breaking the silence: using memory books as a counselling and succession-planning tool with AIDS-affected households in Uganda.

    PubMed

    Witter, Sophie; Were, Beatrice

    2004-11-01

    This article reviews the experience of NACWOLA and Save the Children (UK) in using 'memory books' in AIDS-affected households in Uganda from the mid-1990s to the present. Semi-structured interviews were carried out with key stakeholders in early 2004, including NACWOLA staff and volunteers, Save the Children staff and project participants, such as children, counsellors and local government members. The aim was to investigate the process by which the Memory Book project was developed, its positive and negative impacts at different levels, the costs and what lessons had been learned from the experience to date. A number of significant constraints are highlighted, but the article concludes that memory books, when properly linked to other support mechanisms, have been very effective at improving communication and relationships between parents and children, confronting stigma in the community and encouraging joint planning for the children's future. We recommend that this or similar approaches be incorporated in all AIDS programmes.

  10. Clinical determination of target registration error of an image-guided otologic surgical system using patients with bone-anchored hearing aids

    NASA Astrophysics Data System (ADS)

    Balachandran, Ramya; Labadie, Robert F.; Fitzpatrick, J. Michael

    2007-03-01

    Image guidance in otologic surgery has been thwarted by the need for a non-invasive fiducial system with target registration error (TRE) at the inner ear below 1.5mm. We previously presented a fiducial frame for this purpose that attaches to the upper dentition via patient-specific bite blocks and demonstrated a TRE of 0.73mm (+/-0.23mm) on cadaveric skulls. In that study, TRE measurement depended upon placement of bone-implanted, intracranial target fiducials-clearly impossible to repeat clinically. Using cadaveric specimens, we recently presented a validation method based on an auditory implant system (BAHA System® Cochlear Corp., Denver, CO). That system requires a skull-implanted titanium screw behind the ear upon which a bone-anchored hearing aid (BAHA) is mounted. In our validation, we replace the BAHA with a fiducial marker to permit measurement of TRE. That TRE is then used to estimate TRE at an internal point. While the method can be used to determine accuracy at any point within the head, we focus in this study on the inner ear, in particular the cochlea, and we apply the method to patients (N=5). Physical localizations were performed after varying elapsed times since bite-block fabrication, and TRE at the cochlea was estimated. We found TRE to be 0.97mm at the cochlea within one month and 2.5mm after seven months. Thus, while accuracy deteriorates considerably with delays of seven months or more, if this frame is used within one month of the fabrication of the bite-block, it achieves the goal and in fact exhibits submillimetric accuracy.

  11. Multiscale Mechano-Biological Finite Element Modelling of Oncoplastic Breast Surgery-Numerical Study towards Surgical Planning and Cosmetic Outcome Prediction.

    PubMed

    Vavourakis, Vasileios; Eiben, Bjoern; Hipwell, John H; Williams, Norman R; Keshtgar, Mo; Hawkes, David J

    2016-01-01

    Surgical treatment for early-stage breast carcinoma primarily necessitates breast conserving therapy (BCT), where the tumour is removed while preserving the breast shape. To date, there have been very few attempts to develop accurate and efficient computational tools that could be used in the clinical environment for pre-operative planning and oncoplastic breast surgery assessment. Moreover, from the breast cancer research perspective, there has been very little effort to model complex mechano-biological processes involved in wound healing. We address this by providing an integrated numerical framework that can simulate the therapeutic effects of BCT over the extended period of treatment and recovery. A validated, three-dimensional, multiscale finite element procedure that simulates breast tissue deformations and physiological wound healing is presented. In the proposed methodology, a partitioned, continuum-based mathematical model for tissue recovery and angiogenesis, and breast tissue deformation is considered. The effectiveness and accuracy of the proposed numerical scheme is illustrated through patient-specific representative examples. Wound repair and contraction numerical analyses of real MRI-derived breast geometries are investigated, and the final predictions of the breast shape are validated against post-operative follow-up optical surface scans from four patients. Mean (standard deviation) breast surface distance errors in millimetres of 3.1 (±3.1), 3.2 (±2.4), 2.8 (±2.7) and 4.1 (±3.3) were obtained, demonstrating the ability of the surgical simulation tool to predict, pre-operatively, the outcome of BCT to clinically useful accuracy. PMID:27466815

  12. Multiscale Mechano-Biological Finite Element Modelling of Oncoplastic Breast Surgery—Numerical Study towards Surgical Planning and Cosmetic Outcome Prediction

    PubMed Central

    Eiben, Bjoern; Hipwell, John H.; Williams, Norman R.; Keshtgar, Mo; Hawkes, David J.

    2016-01-01

    Surgical treatment for early-stage breast carcinoma primarily necessitates breast conserving therapy (BCT), where the tumour is removed while preserving the breast shape. To date, there have been very few attempts to develop accurate and efficient computational tools that could be used in the clinical environment for pre-operative planning and oncoplastic breast surgery assessment. Moreover, from the breast cancer research perspective, there has been very little effort to model complex mechano-biological processes involved in wound healing. We address this by providing an integrated numerical framework that can simulate the therapeutic effects of BCT over the extended period of treatment and recovery. A validated, three-dimensional, multiscale finite element procedure that simulates breast tissue deformations and physiological wound healing is presented. In the proposed methodology, a partitioned, continuum-based mathematical model for tissue recovery and angiogenesis, and breast tissue deformation is considered. The effectiveness and accuracy of the proposed numerical scheme is illustrated through patient-specific representative examples. Wound repair and contraction numerical analyses of real MRI-derived breast geometries are investigated, and the final predictions of the breast shape are validated against post-operative follow-up optical surface scans from four patients. Mean (standard deviation) breast surface distance errors in millimetres of 3.1 (±3.1), 3.2 (±2.4), 2.8 (±2.7) and 4.1 (±3.3) were obtained, demonstrating the ability of the surgical simulation tool to predict, pre-operatively, the outcome of BCT to clinically useful accuracy. PMID:27466815

  13. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  14. The accuracy of three-dimensional prediction planning for the surgical correction of facial deformities using Maxilim.

    PubMed

    Shafi, M I; Ayoub, A; Ju, X; Khambay, B

    2013-07-01

    The motivation for orthognathic surgery is to improve facial appearance and quality of life. This study aimed to validate a three-dimensional (3D) orthognathic planning programme (Maxilim) for predicting soft tissue changes following Le Fort I advancements. Cone beam computed tomography (CBCT) scans were taken before surgery (T(1)) and at 6-12 months after surgery (T(2)) for 13 patients. For each patient the 3D hard tissue changes between T(1) and T(2) were determined by CBCT superimposition on the cranial vault. Using Maxilim, each patient's skeletal movements were used to generate a 3D soft tissue prediction. The actual soft tissue mesh at T(2) was compared to the predicted mesh. The face was divided into areas: nose, right and left nares, right and left paranasal regions, upper and lower lip, and chin. The absolute distance between meshes for each region was calculated. A one-sample t-test showed the distances between the meshes for all of the areas were within 3 mm (P<0.05), except for the upper lip which was greater than 3 mm (P=0.577). Using Maxilim, 3D soft tissue predictions for Le Fort I advancements were clinically satisfactory in the regions assessed, but associated with marked errors around the region of the upper lip.

  15. High School Teaching Unit Plans on Inner Asia. Teaching Aids for the Study of Inner Asia, No. 4.

    ERIC Educational Resources Information Center

    Fishman, Rosalind M.; And Others

    Five teaching units for middle, junior high, and senior high school comprise this pamphlet, the fourth in a series of teaching aids about Inner Asia. The units were developed in 1975 by secondary school teachers who attended an inservice institute on Inner Asia at Indiana University. Objectives, activities, and resources are presented for each…

  16. Surgical tracheotomy.

    PubMed

    Rowshan, Henry H; Baur, Dale A

    2010-03-01

    Tracheotomy is a surgical procedure that dates back to early history and medical advancement. The oral and maxillofacial surgeon routinely operates around the airway and should be able to master this procedure by adhering to the surgical principles outlined in this article.

  17. Imaging characteristic analysis of metastatic spine lesions from breast, prostate, lung, and renal cell carcinomas for surgical planning: Osteolytic versus osteoblastic

    PubMed Central

    Reddington, Justin A.; Mendez, Gustavo A.; Ching, Alex; Kubicky, Charlotte Dai; Klimo, Paul; Ragel, Brian T.

    2016-01-01

    Background: Surgeons treating metastatic spine disease can use computed tomography (CT) imaging to determine whether lesions are osteolytic, osteoblastic, or mixed. This enables treatment that considers the structural integrity of the vertebral body (VB), which is impaired with lytic lesions but not blastic lesions. The authors analyzed CT imaging characteristics of spine metastasis from breast, lung, prostate, and renal cell carcinomas (RCCs) to determine the metastasis patterns of each of these common tumors. Methods: The authors identified patients with metastatic spine disease treated during a 3-year period. Variables studied included age, sex, and cancer type. Lesions from breast, lung, prostate, and RCC primary lesions were selected for imaging analysis. Results: Sixty-six patients were identified: 17 had breast metastasis, 14 prostate, 18 lung, and 17 RCC. Breast cancer metastasis involved 33% of VBs with 56%, 20%, and 24% osteolytic, osteoblastic, and mixed, respectively. Prostate cancer metastasis involved 35% of VBs with 14%, 62%, and 24% osteolytic, osteoblastic, and mixed, respectively. Lung cancer metastasis involved 13% of VBs with 64%, 33%, and 3% osteolytic, osteoblastic, and mixed, respectively. RCC metastasis involved 11% of VBs with 91%, 7%, and 2% osteolytic, osteoblastic, and mixed lesions, respectively. Conclusions: To improve surgical planning, we advocate the use of CT prior to surgery to evaluate whether spine metastases are osteolytic or osteoblastic. In cases of osteolytic lesions, the concern is of segmental instability requiring reconstruction and the risk for screw pull out should instrumentation be considered. In cases of osteoblastic lesions, surgeons should consider debulking dense bone. PMID:27274410

  18. “In the driver’s seat”: The Health Sector Strategic Master Plan as an instrument for aid coordination in Mongolia

    PubMed Central

    2014-01-01

    In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan’s structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community. The study is based on document review, key-informant interviews and authors’ experience and participation in the MoH planning processes. The HSSMP process improved alignment and harmonisation. It enabled a better local understanding of the benefits of aid coordination, and the recognition that aid coordination as not only a mere administrative task, but a strategic step towards comprehensive management of both domestic and external resources. The process was not challenge free; the fractious political environment, the frequent turnover of key MoH staff, the resistance of some donors towards MoH scrutiny over their programmes and the dismantling of the central coordination and return of seconded staff following completion of the HSSMP, has slowed the pace of reform. Despite the challenges, the approach resulted in positive outcomes in the areas of ownership and better aid coordination, with HSSMP development emphasising ownership and capacity building. This contrasted with the usual outcomes focus, and neglect of the capacity building learning processes and structural and policy changes needed to ensure sustainable change. The largest and most influential programmes in the health sector are now largely aligned with HSSMP strategies, enabling the MoH to utilize these opportunities to

  19. Benefits planning--what you must know: interview with Daniel Fortuno, AIDS Benefits Counselors. Interview by John S. James.

    PubMed

    Fortuno, D

    1996-09-20

    Daniel Fortuno, a counselor with AIDS Benefits Counselors (ABC), summarizes key insurance and benefits information for persons living with AIDS (PWAs), particularly those who reside in California. Fortuno explains the managed care concept and basic health insurance terms, such as pre-existing conditions, health maintenance organizations (HMOs), preferred provider organizations (PPOs), contestability, and the Consolidated Omnibus Budget Reconciliation Act (COBRA). Fortuno explains a California law that became effective in July 1993 that greatly restricts the ability of health insurance companies to refuse insurance due to preexisting conditions to small groups of persons. This law, AB 1672, makes health insurance available to the sick with little overall rises in prices. Federal insurance laws and regulations that impact PWAs and HIV-positive individuals are outlined. In the interview, Fortuno also discusses Medicaid/Medi-Cal (California's Medicaid), Social Security programs, State disability, and the AIDS Drug Assistance Program. Fortuno offers suggestions for obtaining good private insurance and evaluates the pros and cons of HMOs, PPOs, and indemnity insurance.

  20. Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

    PubMed

    Schaalma, H P; Kok, G; Bosker, R J; Parcel, G S; Peters, L; Poelman, J; Reinders, J

    1996-11-01

    This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process. PMID:8910025

  1. AIDS.gov

    MedlinePlus

    ... Hospitalization and Palliative Care Friends & Family Dating and Marriage Family Planning Mixed-Status Couples Discrimination Legal Issues ... October 15th observance calls attention to the disproportionate impact of HIV/AIDS on the Latinx community. The ...

  2. National Institutes of Health, Office of AIDS Research

    MedlinePlus

    ... Contact Us Main Navigation for the Office of AIDS Research Homepage ABOUT OAR SCIENTIFIC AREAS STRATEGIC PLAN ... HIV/AIDS INFORMATION Welcome to the Office of AIDS Research. Welcome to the Office of AIDS Research ...

  3. National Institutes of Health, Office of AIDS Research

    MedlinePlus

    ... Us Main Navigation for the Office of AIDS Research Homepage ABOUT OAR SCIENTIFIC AREAS STRATEGIC PLAN NIH ... AIDS INFORMATION Welcome to the Office of AIDS Research. Welcome to the Office of AIDS Research Dr. ...

  4. Surgical Technologists

    MedlinePlus

    ... in place during the procedure, or set up robotic surgical equipment. Technologists also may handle specimens taken ... sterilization techniques, how to set up technical or robotic equipment, and preventing and controlling infections. In addition ...

  5. Exploratory benchtop study evaluating the use of surgical design and simulation in fibula free flap mandibular reconstruction

    PubMed Central

    2013-01-01

    Background Surgical design and simulation (SDS) is a useful tool to help surgeons visualize the anatomy of the patient and perform operative maneuvers on the computer before implementation in the operating room. While these technologies have many advantages, further evidence of their potential to improve outcomes is required. The present benchtop study was intended to identify if there is a difference in surgical outcome between free-hand surgery completed without virtual surgical planning (VSP) software and preoperatively planned surgery completed with the use of VSP software. Methods Five surgeons participated in the study. In Session A, participants were asked to do a free-hand reconstruction of a 3d printed mandible with a defect using a 3d printed fibula. Four weeks later, in Session B, the participants were asked to do the same reconstruction, but in this case using a preoperatively digitally designed surgical plan. Digital registration computer software, hard tissue measures and duration of the task were used to compare the outcome of the benchtop reconstructions. Results The study revealed that: (1) superimposed images produced in a computer aided design (CAD) software were effective in comparing pre and post-surgical outcomes, (2) there was a difference, based on hard tissue measures, in surgical outcome between the two scenarios and (3) there was no difference in the time it took to complete the sessions. Conclusion The study revealed that the participants were more consistent in the preoperatively digitally planned surgery than they were in the free hand surgery. PMID:23800209

  6. Magnetic Surgical Instruments for Robotic Abdominal Surgery.

    PubMed

    Leong, Florence; Garbin, Nicolo; Natali, Christian Di; Mohammadi, Alireza; Thiruchelvam, Dhan; Oetomo, Denny; Valdastri, Pietro

    2016-01-01

    This review looks at the implementation of magnetic-based approaches in surgical instruments for abdominal surgeries. As abdominal surgical techniques advance toward minimizing surgical trauma, surgical instruments are enhanced to support such an objective through the exploration of magnetic-based systems. With this design approach, surgical devices are given the capabilities to be fully inserted intraabdominally to achieve access to all abdominal quadrants, without the conventional rigid link connection with the external unit. The variety of intraabdominal surgical devices are anchored, guided, and actuated by external units, with power and torque transmitted across the abdominal wall through magnetic linkage. This addresses many constraints encountered by conventional laparoscopic tools, such as loss of triangulation, fulcrum effect, and loss/lack of dexterity for surgical tasks. Design requirements of clinical considerations to aid the successful development of magnetic surgical instruments, are also discussed.

  7. AIDS and civil disobedience.

    PubMed

    Spiers, H R

    1989-01-01

    Members of groups such as ACT UP (AIDS Coalition to Unleash Power) risk arrest and criminal charges to protest laws and policies they view as unjust to persons with AIDS. Spiers, a founding member of ACT UP, discusses the rationale behind the tactics of civil disobedience employed by AIDS activists. He argues that civil disobedience is justified by American political and legal traditions, and by the federal government's lack of response to the needs of its citizens. Spiers warns that while AIDS protests have been nonviolent and characterized by conscientious planning and execution, violence cannot be ruled out as a "political act born of desperation."

  8. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry.

    PubMed

    Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Li, J; Chen, K-C; Jajoo, A; Nicol, M; Alfi, D M

    2015-12-01

    Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.

  9. Mathematics. Predrafted Individual Short-Term Plan/Records (Secondary Level): Directions for Resource Teachers, Teachers and Aides.

    ERIC Educational Resources Information Center

    Flores, Merced, Comp.

    Developed by experienced migrant education teachers incorporating Sight and Sound Program concepts and Migrant Skills List numbers, this volume presents predrafted individual short-term Plan/Records for secondary level mathematics, algebra, and geometry, plus step-by-step directions for their use by Oregon resource teachers, classroom teachers,…

  10. Image calibration and registration in cone-beam computed tomogram for measuring the accuracy of computer-aided implant surgery

    NASA Astrophysics Data System (ADS)

    Lam, Walter Y. H.; Ngan, Henry Y. T.; Wat, Peter Y. P.; Luk, Henry W. K.; Goto, Tazuko K.; Pow, Edmond H. N.

    2015-02-01

    Medical radiography is the use of radiation to "see through" a human body without breaching its integrity (surface). With computed tomography (CT)/cone beam computed tomography (CBCT), three-dimensional (3D) imaging can be produced. These imagings not only facilitate disease diagnosis but also enable computer-aided surgical planning/navigation. In dentistry, the common method for transfer of the virtual surgical planning to the patient (reality) is the use of surgical stent either with a preloaded planning (static) like a channel or a real time surgical navigation (dynamic) after registration with fiducial markers (RF). This paper describes using the corner of a cube as a radiopaque fiducial marker on an acrylic (plastic) stent, this RF allows robust calibration and registration of Cartesian (x, y, z)- coordinates for linking up the patient (reality) and the imaging (virtuality) and hence the surgical planning can be transferred in either static or dynamic way. The accuracy of computer-aided implant surgery was measured with reference to coordinates. In our preliminary model surgery, a dental implant was planned virtually and placed with preloaded surgical guide. The deviation of the placed implant apex from the planning was x=+0.56mm [more right], y=- 0.05mm [deeper], z=-0.26mm [more lingual]) which was within clinically 2mm safety range. For comparison with the virtual planning, the physically placed implant was CT/CBCT scanned and errors may be introduced. The difference of the actual implant apex to the virtual apex was x=0.00mm, y=+0.21mm [shallower], z=-1.35mm [more lingual] and this should be brought in mind when interpret the results.

  11. HIV / AIDS

    MedlinePlus

    ... Marketing Share this: Main Content Area Understanding HIV/AIDS AIDS was first reported in the United States in ... and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus, or ...

  12. Executive summary of the consensus statement on assistance to women with HIV infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA).

    PubMed

    2014-02-01

    The aim of this paper was to develop a consensus on clinical recommendations for health care assistance for women with HIV infection. To this end, a panel of experts, appointed by the Secretariat of the National AIDS Plan and GeSIDA was assembled, that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, with two members of the panel acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C) and the level of empirical evidence (I, II, III), already used in previous documents from SPNS/GESIDA. Multiple recommendations are provided for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. This document presents recommendations for the treatment of women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, development of disease and treatment between men and women.

  13. Executive summary of the consensus statement on assistance to women with HIV infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA).

    PubMed

    2014-02-01

    The aim of this paper was to develop a consensus on clinical recommendations for health care assistance for women with HIV infection. To this end, a panel of experts, appointed by the Secretariat of the National AIDS Plan and GeSIDA was assembled, that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, with two members of the panel acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C) and the level of empirical evidence (I, II, III), already used in previous documents from SPNS/GESIDA. Multiple recommendations are provided for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. This document presents recommendations for the treatment of women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, development of disease and treatment between men and women. PMID:23931832

  14. The aid of remote sensing and environmental history techniques for planning and successful implementation of decentralized flood reduction

    NASA Astrophysics Data System (ADS)

    Seeling, Stephan; Gross, Michael

    2010-05-01

    The history of European landscapes is a history of changes. Based on the geophysical spatial features like geology, soils or topography the interaction with regional climate and particular human land use practices led to the development of the recent mosaic of European landscapes. For centuries the human incitements behind these actions have been to conquer nature and to optimize human benefit. Hence the maintenance or future development of other landscape functions like biodiversity or buffer and balance functions for energy and mass flows have often been neglected. As a consequence most recent cultivated landscapes feature a deficit of close to nature water retention capacities. Modern catchment orientated water management plans launch at this point and try to recover or even enhance former decentralized landscape abilities for water retention. Additionally remote sensing is a fast, effective and not too expensive tool for conducting landscape inventories or expose trends in land cover changes. Both can be seen as mandatory components for planning and successful implementation of decentralized flood protection measures. For three different landscapes of Southwest Germany we analysed the trends in land use change within the last four decades, based on remote sensing and statistical methods, to deduct on main human driving forces behind these changes. Together with other spatial analyses this offers support for prioritisation and implementation of landscape adapted and locally accepted decentralized flood protection measures.

  15. Computer-designed selective laser sintering surgical guide and immediate loading dental implants with definitive prosthesis in edentulous patient: A preliminary method

    PubMed Central

    Giacomo, Giovanni Di; Silva, Jorge; Martines, Rodrigo; Ajzen, Sergio

    2014-01-01

    Objective: The aim of this study was to analyze a preliminary method of immediately loading dental implants and a definitive prosthesis based on the computer-aided design/computer-aided manufacturing systems, after 2 years of clinical follow-up. Materials and Methods: The study comprised one patient in good general health with edentulous maxilla. Cone beam computer tomography (CBCT) was performed using a radiographic template. The surgical plan was made using the digital imaging and communications in medicine protocol with ImplantViewer (version 1.9, Anne Solutions, Sao Paulo, SP, Brazil), the surgical planning software. These data were used to produce a selective laser sintering surgical template. A maxilla prototype was used to guide the prosthesis technician in producing the prosthesis. Eight dental implants and a definitive prosthesis were installed on the same day. A post-operative CBCT image was fused with the image of the surgical planning to calculate the deviation between the planned and the placed implants positions. Patient was followed for 2 years. Results: On average, the match between the planned and placed angular deviation was within 6.0 ± 3.4° and the difference in coronal deviation was 0.7 ± 0.3 mm. At the end of the follow-up, neither the implant nor the prosthesis was lost. Conclusions: Considering the limited samples number, it was possible to install the dental implants and a definitive prosthesis on the same day with success. PMID:24966755

  16. International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in Leogane, Haiti.

    PubMed

    Kligerman, Maxwell; Barry, Michele; Walmer, David; Bendavid, Eran

    2015-02-01

    The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

  17. Prevention of sexually transmitted HIV infections through the President's Emergency Plan for AIDS Relief: a history of achievements and lessons learned.

    PubMed

    Ryan, Caroline A; Conly, Shanti R; Stanton, David L; Hasen, Nina S

    2012-08-15

    HIV prevention in the President's Emergency Plan for AIDS Relief (PEPFAR) began when both data on HIV prevalence and the toolbox of interventions for prevention of sexual transmission were relatively limited. PEPFAR's early focus was on scaling-up information, education, and communication programs that included messaging on abstinence for youth and faithfulness primarily through nongovernmental organizations, including faith-based organizations. Additional activities included condom promotion, distribution, and social marketing. In epidemics concentrated within key populations, PEPFAR's prevention efforts focused on a minimum package of services including outreach, information, education, and communication programs, STI treatment (where appropriate), and condom promotion and distribution. As more epidemiological data became available and with experience gleaned in these early efforts, the need for tailored and flexible approaches became evident. The next iteration of prevention efforts still emphasized behavioral interventions, but incorporated a sharper focus on key epidemic drivers, especially multiple partners; a data-driven emphasis on high transmission areas and populations, including prevention with people living with HIV; and a more strategic and coordinated approach at the national level. Recently, the paradigm for prevention efforts has shifted yet again. Evidence that biomedical interventions such as male circumcision, treatment for prevention of vertical and horizontal transmission, and treatment itself could lead to declines in incidence has refocused PEPFAR's prevention portfolio. New guidance on sexually transmitted HIV focuses on combination prevention, emphasizing biomedical, behavioral and structural approaches. Landmark speeches by the President and the Secretary of State and new ambitious targets for PEPFAR point toward a new goal: an AIDS-free generation.

  18. Surgical antiseptics.

    PubMed

    Sebben, J E

    1983-11-01

    The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.

  19. Surgical heuristics.

    PubMed

    Patkin, Michael

    2008-12-01

    Heuristics are rules of thumb. Rarely described in surgical or other publications, they are an essential part of safe and expert performance. This study translates such implicit or procedural knowledge into explicit or declarative knowledge, with a view to improving both training and retraining of surgeons in the steps of dissection. Tools used include ordinary observation accompanied by introspection, and study of operative videos. Validation of the value of such heuristics is yet to be achieved.

  20. Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019—Projections with the Spectrum/Goals Model

    PubMed Central

    Korenromp, Eline L.; Gobet, Benjamin; Fazito, Erika; Lara, Joseph; Bollinger, Lori; Stover, John

    2015-01-01

    Introduction Mozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015–2019 national strategic HIV/AIDS plan (NSP). Methods The HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments. Results Implementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for ‘Current targets’, or US$ 495 million in 2019 for ‘Accelerated scale-up’. The ‘Accelerated scale-up’ would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics). Conclusion The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS’ ‘Fast track’ targets will require increased ART coverage and

  1. Computer-Aided Design and Computer-Aided Manufacturing Hydroxyapatite/Epoxide Acrylate Maleic Compound Construction for Craniomaxillofacial Bone Defects.

    PubMed

    Zhang, Lei; Shen, Shunyao; Yu, Hongbo; Shen, Steve Guofang; Wang, Xudong

    2015-07-01

    The aim of this study was to investigate the use of computer-aided design and computer-aided manufacturing hydroxyapatite (HA)/epoxide acrylate maleic (EAM) compound construction artificial implants for craniomaxillofacial bone defects. Computed tomography, computer-aided design/computer-aided manufacturing and three-dimensional reconstruction, as well as rapid prototyping were performed in 12 patients between 2008 and 2013. The customized HA/EAM compound artificial implants were manufactured through selective laser sintering using a rapid prototyping machine into the exact geometric shapes of the defect. The HA/EAM compound artificial implants were then implanted during surgical reconstruction. Color-coded superimpositions demonstrated the discrepancy between the virtual plan and achieved results using Geomagic Studio. As a result, the HA/EAM compound artificial bone implants were perfectly matched with the facial areas that needed reconstruction. The postoperative aesthetic and functional results were satisfactory. The color-coded superimpositions demonstrated good consistency between the virtual plan and achieved results. The three-dimensional maximum deviation is 2.12 ± 0.65  mm and the three-dimensional mean deviation is 0.27 ± 0.07  mm. No facial nerve weakness or pain was observed at the follow-up examinations. Only 1 implant had to be removed 2 months after the surgery owing to severe local infection. No other complication was noted during the follow-up period. In conclusion, computer-aided, individually fabricated HA/EAM compound construction artificial implant was a good craniomaxillofacial surgical technique that yielded improved aesthetic results and functional recovery after reconstruction.

  2. AIDS in South Africa.

    PubMed

    Ijsselmuiden, C; Evian, C; Matjilla, J; Steinberg, M; Schneider, H

    1993-01-01

    The National AIDS Convention in South Africa (NACOSA) in October 1992 was the first real attempt to address HIV/AIDS. In Soweto, government, the African National Congress, nongovernmental organizations, and organized industry and labor representatives worked for 2 days to develop a national plan of action, but it did not result in a united effort to fight AIDS. The highest HIV infection rates in South Africa are among the KwaZulu in Natal, yet the Inkatha Freedom Party did not attend NACOSA. This episode exemplifies the key obstacles for South Africa to prevent and control AIDS. Inequality of access to health care may explain why health workers did not diagnose the first AIDS case in blacks until 1985. Migrant labor, Bantu education, and uprooted communities affect the epidemiology of HIV infection. Further, political and social polarization between blacks and whites contributes to a mindset that AIDS is limited to the other race which only diminishes the personal and collective sense of susceptibility and the volition and aptitude to act. The Department of National Health and Population Development's voluntary register of anonymously reported cases of AIDS specifies 1517 cumulative AIDS cases (October 1992), but this number is low. Seroprevalence studies show between 400,000-450,000 HIV positive cases. Public hospitals cannot give AIDS patients AZT and DDI. Few communities provided community-based care. Not all hospitals honor confidentiality and patients' need for autonomy. Even though HIV testing is not mandatory, it is required sometimes, e.g., HIV testing of immigrants. AIDS Training, Information and Counselling Centers are in urban areas, but not in poor areas where the need is most acute. The government just recently developed in AIDS education package for schools, but too many people consider it improper, so it is not being used. The poor quality education provided blacks would make it useless anyhow. Lifting of the academic boycott will allow South African

  3. Digital approach to planning computer-guided surgery and immediate provisionalization in a partially edentulous patient.

    PubMed

    Arunyanak, Sirikarn P; Harris, Bryan T; Grant, Gerald T; Morton, Dean; Lin, Wei-Shao

    2016-07-01

    This report describes a digital approach for computer-guided surgery and immediate provisionalization in a partially edentulous patient. With diagnostic data obtained from cone-beam computed tomography and intraoral digital diagnostic scans, a digital pathway of virtual diagnostic waxing, a virtual prosthetically driven surgical plan, a computer-aided design and computer-aided manufacturing (CAD/CAM) surgical template, and implant-supported screw-retained interim restorations were realized with various open-architecture CAD/CAM systems. The optional CAD/CAM diagnostic casts with planned implant placement were also additively manufactured to facilitate preoperative inspection of the surgical template and customization of the CAD/CAM-fabricated interim restorations. PMID:26868961

  4. Low-cost Design and Manufacturing of Surgical Guides for Mandibular Reconstruction Using a Fibula

    PubMed Central

    Nakamura, Hiroko; Sowa, Yoshihiro; Nishino, Kenichi

    2016-01-01

    Background: Surgical cutting guides are used in mandibular reconstruction involving osteotomy of the mandible and fibula. Cutting guides produced using computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies have been reported recently. These guides aim to increase the benefits to patients by improving the accuracy, shortening the operating time, and correcting occlusion. However, the availability of these advanced technologies is limited in some regions of the world. To test whether we could produce low-cost surgical cutting guides, we made surgical guides and investigated their accuracy. Methods: Using free CAD software, we designed surgical cutting guides for the mandible and fibula and used these to perform virtual mandibular segmental osteotomies and fibula transplants in 12 model surgeries. The cutting guides were printed on a 3-dimensional (3D) printer. The model surgeries were performed using 3D mandibular models and cutting guides to check their accuracy. Deviations between the virtually simulated plan and the actual model surgery were investigated. Results: CAD and CAM technologies were used to design and 3D print the cutting guides and models. The guided surgeries were performed. The deviations were about 1.3 mm for mandibular osteotomy, less than 1 mm for fibular osteotomy, and within 2.4 mm for reconstructions of the mandible. Conclusions: Without using expensive software or products, we were able to design surgical cutting guides for the mandible and fibula and used these to perform virtual simulation of mandibular segmental osteotomy and fibular reconstruction. Model surgeries using 3D-printed surgical guides showed that the accuracy of reconstruction was within a 3-mm deviation. In circumstances where commercial CAD/CAM guides are not available, it may be possible to use CAD/CAM surgical guides in the clinic if doctors are willing to volunteer their time for the design and printing. PMID:27536484

  5. Three-dimensional liver model based on preoperative CT images as a tool to assist in surgical planning for hepatoblastoma in a child.

    PubMed

    Souzaki, Ryota; Kinoshita, Yoshiaki; Ieiri, Satoshi; Hayashida, Makoto; Koga, Yuhki; Shirabe, Ken; Hara, Toshiro; Maehara, Yoshihiko; Hashizume, Makoto; Taguchi, Tomoaki

    2015-06-01

    The patient is a 3-year-old female diagnosed with PRETEXT IV hepatoblastoma (HB). Although the tumor was decreased after the neoadjuvant chemotherapy, HB still located at the porta hepatis. The patient underwent extended left lobectomy successfully after surgical simulation using three-dimensional (3D) printing liver model based on preoperative CT.

  6. AIDS (image)

    MedlinePlus

    AIDS (acquired immune deficiency syndrome) is caused by HIV (human immunodeficiency virus), and is a syndrome that ... life-threatening illnesses. There is no cure for AIDS, but treatment with antiviral medicine can suppress symptoms. ...

  7. Hearing Aids

    MedlinePlus

    ... more in both quiet and noisy situations. Hearing aids help people who have hearing loss from damage ... your doctor. There are different kinds of hearing aids. They differ by size, their placement on or ...

  8. AIDS in Malaysia.

    PubMed

    Singh, J; Che'Rus, S; Chong, S; Chong, Y K; Crofts, N

    1994-01-01

    The first people to be infected with HIV in Malaysia were mainly homosexual men with foreign connections. IV drug users, however, rapidly became the population group with the highest prevalence of HIV. Accurate, timely data are needed in order to responsibly describe the pattern of HIV infection and AIDS in any given setting. In Malaysia, however, there has been little systematic surveillance in population groups other than blood donors. This surveillance indicates the existence of a rapidly increasing rate of seropositivity among blood donors. Otherwise, many people are loathe to undergo voluntary HIV testing to determine their serostatus. Moreover, some people with STDs avoid contact with the health system and the potential for HIV testing. The extent to which AIDS cases are underreported or reported late is unknown. On the other hand, an estimated 10% of notified AIDS cases have been wrongly classified as such. The lack of hard data on HIV/AIDS in Malaysia makes it difficult to project the future course of the epidemic in the country. Since Malaysia shares a land border with Thailand and there is much sea-borne traffic between the two countries, it is highly possible that Malaysia will experience a significant epidemic of HIV infection similar to its neighbors. A National AIDS Committee was established April 1985 to develop responses to the HIV epidemic, while the National AIDS Program Manager of the Ministry of Health is responsible for controlling STDs. A national plan of action for the prevention and control of AIDS, drawn up in 1985 and revised in 1988, includes planning for the continued surveillance of HIV infection and AIDS through existing notification systems, and for screening and sentinel programs for IV drug users, prostitutes, and STD patients. Recent nongovernmental organization responses complement government efforts to prevent HIV and AIDS in Malaysia. PMID:7857575

  9. Hearing Aids

    MedlinePlus

    ... type and degree of loss. Are there different styles of hearing aids? Styles of hearing aids Source: NIH/NIDCD Behind-the- ... the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is ...

  10. Surgical management of laryngomalacia: update 2000

    NASA Astrophysics Data System (ADS)

    Shah, Udayan K.

    2000-05-01

    Laryngomalacia is the most common cause of inspiratory stridor in children. This disease of excess tissue collapse most often does not require surgical correction. Surgery when necessary is best performed with the aid of the carbon dioxide (CO2) laser, delivered through a mirrored-arm micromanipulator- controlled system, while the supraglottis is exposed using a bivalved laryngoscope. This paper reviews the details of surgical technique used for the safe alleviation of airway distress due to larnyngomalacia.

  11. Hearing Aid Tester

    NASA Technical Reports Server (NTRS)

    1978-01-01

    Hearing aids often develop malfunctions that are not detected by the wearer. This is particularly true when the wearers are school-age children. Studies of selected groups showed that from 30 to more than 50 percent of school children were not getting adequate benefit from their hearing aids because of unrecognized malfunctions, usually low or dead batteries. This can be serious because hearing impairment retards a child's educational progress. NASA technology incorporated in the Hearing Aid Malfunction Detection Unit (HAMDU), the device pictured, is expected to provide an effective countermeasure to the childrens' hearing aid problem. A patent license has been awarded to a minority-owned firm, Hopkins International Company, a subsidiary of H. H. Aerospace Design Co., Inc., Elmford, New York. The company plans early commercial availability of its version of the device.

  12. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation

    PubMed Central

    Lonic, Daniel; Pai, Betty Chien-Jung; Yamaguchi, Kazuaki; Chortrakarnkij, Peerasak; Lin, Hsiu-Hsia; Lo, Lun-Jou

    2016-01-01

    Background Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. Patients and Methods This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. Results 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. Conclusion Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is

  13. Quandaries in prescribing an emergency action plan and self-injectable epinephrine for first-aid management of anaphylaxis in the community.

    PubMed

    Sicherer, Scott H; Simons, F Estelle R

    2005-03-01

    Anaphylaxis often occurs in the community in the absence of a health care professional. Prompt administration of self-injectable epinephrine as first-aid treatment in the context of a personalized emergency action plan is the key to survival. There is little argument that physicians should prescribe self-injectable epinephrine for individuals who have already experienced anaphylaxis involving respiratory distress or shock triggered by allergens that might be encountered in the community. A quandary faced by physicians is that additional individuals with identified allergy who have no recognized prior history of anaphylaxis or who have a history of mild symptoms after exposure to a known trigger might also be at risk for subsequent life-threatening anaphylaxis and might also warrant prescription of self-injectable epinephrine. Prescribing for the latter individuals requires considerable clinical judgment and has led to controversy regarding possible overprescription or underprescription of self-injectable epinephrine. A second quandary for physicians occurs with regard to the advice they should give to at-risk individuals about actual use of their self-injectable epinephrine. It is difficult for health care professionals, let alone persons with no health care training, to predict whether anaphylaxis symptoms will occur in an at-risk individual after exposure to a known trigger. Moreover, at the onset of an acute allergic reaction, it is difficult to predict the symptoms that will ultimately develop. We examine these 2 common quandaries and provide examples of clinical scenarios and potential pitfalls in the management of persons identified as being at risk for anaphylaxis in the community. Additional studies of the recognition and treatment of anaphylaxis in the community are needed to develop comprehensive, evidence-based recommendations for its management in this setting.

  14. Accuracy of computer-aided template-guided oral implant placement: a prospective clinical study

    PubMed Central

    2014-01-01

    Purpose The aim of the present study was to evaluate the in vivo accuracy of flapless, computer-aided implant placement by comparing the three-dimensional (3D) position of planned and placed implants through an analysis of linear and angular deviations. Methods Implant position was virtually planned using 3D planning software based on the functional and aesthetic requirements of the final restorations. Computer-aided design/computer-assisted manufacture technology was used to transfer the virtual plan to the surgical environment. The 3D position of the planned and placed implants, in terms of the linear deviations of the implant head and apex and the angular deviations of the implant axis, was compared by overlapping the pre- and postoperative computed tomography scans using dedicated software. Results The comparison of 14 implants showed a mean linear deviation of the implant head of 0.56 mm (standard deviation [SD], 0.23), a mean linear deviation of the implant apex of 0.64 mm (SD, 0.29), and a mean angular deviation of the long axis of 2.42° (SD, 1.02). Conclusions In the present study, computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected. Therefore, accurate presurgical planning taking into account anatomical limitations and prosthetic demands is mandatory to ensure a predictable treatment, without incurring possible intra- and postoperative complications. Graphical Abstract PMID:25177520

  15. Misuse of statistics in surgical literature

    PubMed Central

    Ronna, Brenden; Robbins, Riann B.

    2016-01-01

    Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes. PMID:27621909

  16. Misuse of statistics in surgical literature.

    PubMed

    Thiese, Matthew S; Ronna, Brenden; Robbins, Riann B

    2016-08-01

    Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes.

  17. Misuse of statistics in surgical literature.

    PubMed

    Thiese, Matthew S; Ronna, Brenden; Robbins, Riann B

    2016-08-01

    Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes. PMID:27621909

  18. Misuse of statistics in surgical literature

    PubMed Central

    Ronna, Brenden; Robbins, Riann B.

    2016-01-01

    Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes.

  19. Computer assisted planning and custom-made surgical guide for malunited pronation deformity after first metatarsophalangeal joint arthrodesis in rheumatoid arthritis: a case report.

    PubMed

    Hirao, Makoto; Ikemoto, Sumika; Tsuboi, Hideki; Akita, Shosuke; Ohshima, Shiro; Saeki, Yukihiko; Yoshikawa, Hideki; Sugamoto, Kazuomi; Murase, Tsuyoshi; Hashimoto, Jun

    2014-01-01

    Arthrodesis of the first metatarsophalangeal (MTP-1) joint is a widely used procedure for the treatment of hallux valgus in patients with MTP-1 degeneration, severe or recurrent deformity, or inflammatory arthritis. In this case, ten years earlier, the patient's MTP-1 joint had been fused in a severe pronation deformity position. Subsequently, a laterally shifted tibial sesamoid and osseous rising of the phalanx base caused painful callosities. To correct the pronated deformity accurately, a custom-made surgical guide based on a three-dimensional computer tomography (3D-CT) simulation system was used. After correction of the deformity, the MTP-1 joint was again fused. Adequate correction was achieved, and the patient no longer complains of pain and can perform full weight-bearing on the forefoot. The difficulty and importance of placing the MTP-1 joint in an adequate rotational position in MTP-1 joint arthrodesis surgery were confirmed, as was the utility of 3D evaluation and a custom-made surgical guide for rotational adjustment between the metatarsal and the proximal phalanx. We believe that this system should be one of the indicators for adjusting the rotation, especially in revision MTP-1 joint fusion surgery.

  20. Latina women and AIDS.

    PubMed

    Worth, D; Rodriguez, R

    1987-01-01

    The incidence of AIDS in Latina women is over 11 times that of white women. Women account for 13% of all Latino AIDS deaths since 1980. This examination of the impact of AIDS on Latino women concentrates on Manhattan's Lower East Side. The AIDS deaths among Puerto Rican women in this neighborhood are predominantly intravenous drug abuse related. Latina women accounted for more than 1/2 of all female AIDS deaths on the Lower East Side during the 1980-1985 period. The age range is parallel with that in the rest of New York City, with the exception of a higher number of deaths on the Lower East Side in the age ranges of 15-19 and over 40. Serious obstacles exist to providing AIDS risk reduction information to Puerto Rican women and their partners. Latinos account for 11% of all US AIDS cases among gay and bisexual men. The cultural proscription against these sexual practices in the Puerto Rican community makes AIDS education related to such practices extremely difficult. Many of the female sex partners of these men are unaware of their bisexuality, and, therefore not aware that they are at risk of HIV infection. The Latina women most at risk are young, poor, and have low educational levels. Latina women seriously underutilize ongoing primary health care, family planning, prenatal or pediatric care. Attempts to reach Latina women with AIDS risk reduction education must also contend with issues such as cultural gender roles. Females tend to be dependent on males and defer to male decision making related to sexual practices. In formulating policy regarding services and education, it is essential to involve the leadership of the Latino community. PMID:12268416

  1. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

    PubMed Central

    Kimmel, Allison L.; Wang, Jichuan; Scott, Rachel; Briggs, Linda; Lyon, Maureen E.

    2016-01-01

    Although the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered Advance Care Planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18-month post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. PMID:26044463

  2. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    PubMed

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  3. Utility of PET/CT Imaging Performed Early After Surgical Resection in the Adjuvant Treatment Planning for Head and Neck Cancer

    SciTech Connect

    Shintani, Stephanie A.; Foote, Robert L. Lowe, Val J.; Brown, Paul D.; Garces, Yolanda I.; Kasperbauer, Jan L.

    2008-02-01

    Purpose: To evaluate the utility of positron emission tomography (PET)/computed tomography (CT) early after surgical resection and before postoperative adjuvant radiation therapy. Methods and Materials: We studied a prospective cohort of 91 consecutive patients referred for postoperative adjuvant radiation therapy after complete surgical resection. Tumor histologies included 62 squamous cell and 29 non-squamous cell cancers. Median time between surgery and postoperative PET/CT was 28 days (range, 13-75 days). Findings suspicious for persistent/recurrent cancer or distant metastasis were biopsied. Correlation was made with changes in patient care. Results: Based on PET/CT findings, 24 patients (26.4%) underwent biopsy of suspicious sites. Three patients with suspicious findings did not undergo biopsy because the abnormalities were not easily accessible. Eleven (45.8%) biopsies were positive for cancer. Treatment was changed for 14 (15.4%) patients (11 positive biopsy and 3 nonbiopsied patients) as a result. Treatment changes included abandonment of radiation therapy and switching to palliative chemotherapy or hospice care (4), increasing the radiation therapy dose (6), extending the radiation therapy treatment volume and increasing the dose (1), additional surgery (2), and adding palliative chemotherapy to palliative radiation therapy (1). Treatment for recurrent cancer and primary skin cancer were significant predictors of having a biopsy-proven, treatment-changing positive PET/CT (p < 0.03). Conclusions: Even with an expectedly high rate of false positive PET/CT scans in this early postoperative period, PET/CT changed patient management in a relatively large proportion of patients. PET/CT can be recommended in the postoperative, preradiation therapy setting with the understanding that treatment-altering PET/CT findings should be biopsied for confirmation.

  4. Early Discharge Planning and Improved Care Transitions: Pre-Admission Assessment for Readmission Risk in an Elective Orthopedic and Cardiovascular Surgical Population

    PubMed Central

    Mola, Ana; Rosenfeld, Peri; Ford, Shauna

    2016-01-01

    Background/Methods: Readmission prevention is a marker of patient care quality and requires comprehensive, early discharge planning for safe hospital transitions. Effectively performed, this process supports patient satisfaction, efficient resource utilization, and care integration. This study developed/tested the utility of a predictive early discharge risk assessment with 366 elective orthopedic/cardiovascular surgery patients. Quality improvement cycles were undertaken for the design and to inform analytic plan. An 8-item questionnaire, which includes patient self-reported health, was integrated into care managers’ telephonic pre-admission assessments during a 12-month period. Results: Regression models found the questionnaire to be predictive of readmission (p ≤ .005; R2 = .334) and length-of-stay (p ≤ .001; R2 = .314). Independent variables of “lives-alone” and “self-rated health” were statistically significant for increased readmission odds, as was “self-rated health” for increased length-of-stay. Quality measures, patient experience and increased rates of discharges-to-home further supported the benefit of embedding these questions into the pro-active planning process. Conclusion: The pilot discharge risk assessment was predictive of readmission risk and length-of-stay for elective orthopedic/cardiovascular patients. Given the usability of the questionnaire in advance of elective admissions, it can facilitate pro-active discharge planning essential for producing quality outcomes and addressing new reimbursement methodologies for continuum-based episodes of care.

  5. Early Discharge Planning and Improved Care Transitions: Pre-Admission Assessment for Readmission Risk in an Elective Orthopedic and Cardiovascular Surgical Population

    PubMed Central

    Mola, Ana; Rosenfeld, Peri; Ford, Shauna

    2016-01-01

    Background/Methods: Readmission prevention is a marker of patient care quality and requires comprehensive, early discharge planning for safe hospital transitions. Effectively performed, this process supports patient satisfaction, efficient resource utilization, and care integration. This study developed/tested the utility of a predictive early discharge risk assessment with 366 elective orthopedic/cardiovascular surgery patients. Quality improvement cycles were undertaken for the design and to inform analytic plan. An 8-item questionnaire, which includes patient self-reported health, was integrated into care managers’ telephonic pre-admission assessments during a 12-month period. Results: Regression models found the questionnaire to be predictive of readmission (p ≤ .005; R2 = .334) and length-of-stay (p ≤ .001; R2 = .314). Independent variables of “lives-alone” and “self-rated health” were statistically significant for increased readmission odds, as was “self-rated health” for increased length-of-stay. Quality measures, patient experience and increased rates of discharges-to-home further supported the benefit of embedding these questions into the pro-active planning process. Conclusion: The pilot discharge risk assessment was predictive of readmission risk and length-of-stay for elective orthopedic/cardiovascular patients. Given the usability of the questionnaire in advance of elective admissions, it can facilitate pro-active discharge planning essential for producing quality outcomes and addressing new reimbursement methodologies for continuum-based episodes of care. PMID:27616965

  6. Financial Aid.

    ERIC Educational Resources Information Center

    Graves, Mary A.

    This workbook assists college and vocational school bound American Indian students in determining their financial needs and in locating sources of financial aid. A checklist helps students assess the state of their knowledge of financial programs; a glossary defines terms pertinent to the realm of financial aid (i.e., graduate study programs,…

  7. Teaching AIDS.

    ERIC Educational Resources Information Center

    Tonks, Douglas

    This book presents a curriculum to educate students about the risk of AIDS and HIV infection. The opening chapters of the book presents a discussion of: how teachers can create an environment of support for an AIDS education program; the political and educational implications of winning principal, district, and parental support for an AIDS…

  8. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors

    PubMed Central

    Hou, Bob L.; Bhatia, Sanjay; Carpenter, Jeffrey S.

    2016-01-01

    For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., > 20 mm) of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52%) the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52%) the distances between the task-determined and anatomically determined hand areas were > 20 mm; and in 16 of 25 cases (i.e., 64%) the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities. PMID:27069871

  9. Hard and soft tissue surgical complications in dental implantology.

    PubMed

    Aziz, Shahid R

    2015-05-01

    This article discusses surgical complications associated with the placement of dental implants, specifically focusing on how they occur (etiology), as well as their management and prevention. Dental implant surgical complications can be classified into those of hard and soft tissues. In general, complications can be avoided with thorough preoperative treatment planning and proper surgical technique.

  10. Homemaker/Home Health Aide.

    ERIC Educational Resources Information Center

    Missouri Univ., Columbia. Instructional Materials Lab.

    This curriculum guide provides materials for a five-unit home health aide course. Each unit contains 4 to 36 lesson plans. Unit topics and representative lesson plan topics are as follows: (1) introduction (ethical and legal responsibilities, time management, reporting and recording); (2) communication (techniques, meeting the public, therapeutic…

  11. Comparison of Cone Beam Computed Tomography, Orthopantomography with Direct Ridge Mapping for Pre-Surgical Planning to Place Implants in Cadaveric Mandibles: An Ex-Vivo Study

    PubMed Central

    Amarnath, G S; Kumar, Ullash; Hilal, Mohammed; Muddugangadhar, B C; Anshuraj, Kopal; Shruthi, C S

    2015-01-01

    Background: Implant treatment is today a common and most widely accepted prosthetic therapy worldwide. The quality and quantity of the bone available at the anticipated implant site is of prime importance. Accurate measurement of alveolar bone and adjacent anatomic structures are of paramount importance in implant insertion. Proper pre-surgical assessment requires precise radiographic visualization of anatomic structures and pathologic conditions. However, the concern for radiation exposure has also grown. Materials and Methods: A total of 15 partially or completely edentulous human cadaveric mandibles were used which were further subdivided into three further groups for cone-beam computed tomography (CBCT), orthopantomography (OPG), and direct measurements (DM). Mandibles were prepared for each sample and subjected to radiographs according to the respective techniques, and radiographic measurements were done using the appropriate software. The cadaveric mandibles were then sectioned, and the actual measurements were done using a digital vernier caliper. Results: Analysis of variance test revealed that there was no significant difference among the three different measurements techniques. Conclusion: A sizable portion of the CBCT measurements with respect to width showed slight overestimation when compared to DMs. There were no statistically significant differences found between CBCT, OPG, and DM when height was taken into consideration. PMID:26225103

  12. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

    The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

  13. Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy.

    PubMed

    Wagner, Arne; Wanschitz, Felix; Birkfellner, Wolfgang; Zauza, Konstantin; Klug, Clemens; Schicho, Kurt; Kainberger, Franz; Czerny, Christian; Bergmann, Helmar; Ewers, Rolf

    2003-06-01

    The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.

  14. Hearing Aid

    MedlinePlus

    ... and Food and Drug Administration Staff FDA permits marketing of new laser-based hearing aid with potential ... feeds Follow FDA on Twitter Follow FDA on Facebook View FDA videos on YouTube View FDA photos ...

  15. Computer aided production engineering

    SciTech Connect

    Not Available

    1986-01-01

    This book presents the following contents: CIM in avionics; computer analysis of product designs for robot assembly; a simulation decision mould for manpower forecast and its application; development of flexible manufacturing system; advances in microcomputer applications in CAD/CAM; an automated interface between CAD and process planning; CAM and computer vision; low friction pneumatic actuators for accurate robot control; robot assembly of printed circuit boards; information systems design for computer integrated manufacture; and a CAD engineering language to aid manufacture.

  16. 20 CFR 416.121 - Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance... application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part... financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in...

  17. 20 CFR 416.121 - Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance... application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part... financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in...

  18. 20 CFR 416.121 - Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance... application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part... financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in...

  19. 20 CFR 416.121 - Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance... application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part... financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in...

  20. 20 CFR 416.121 - Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance... application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part... financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in...

  1. AIDS lymphomas.

    PubMed

    Middleton, G W; Lau, R K

    1992-01-01

    Chronically immunosuppressed individuals are susceptible to lymphoreticular tumors. Up to 15% of patients with congenital deficiencies such as ataxia=telangiectasia may develop malignancies, mainly high-grade B cell non=Hodgkin's lymphomas (NHLs). AIDS lymphomas are comprised of NHLs including Burkitt's lymphoma (BL) and primary cerebral lymphomas (PCLs). Almost 3% of all AIDS patients (2824 of 97,258 cases) developed NHL. Epstein-Barr virus (EBV) as a co-factor in AIDS lymphomagenesis has been studied: in 12 cases of 24 AIDS lymphomas EBV by DNA in situ hybridization was found. In an analysis of 6 primary cerebral lymphomas, .5 were positive for EBV DNA by Southern blotting. In Burkitt's lymphoma the characteristic genetic alteration affects the c-myc oncogene. In 1/3 of BL p53 mutations were found but none in the 43 NHLs suggesting that p53 mutations and c-myc activation act synergistically in the pathogenesis of these tumors. Cytotoxic agents dideoxyinosine, dideoxycytosine, and zidovudine may cause secondary neoplasia. 8 of 55 AIDS patients under zidovudine treatment developed high-grade lymphoma 23.8 months subsequently; recently doses were reduced. PCL was found in 21 of 90 patients. A 5.2 months survival was associated with combined treatment with cyclophosphamide, Oncovin (vincristine), methotrexate, etoposide, and cytosine arabinoside compared with 11.3 months with chemotherapy. Colony-stimulating factors (CSFs) alleviate drug-induced myelotoxicity and zidovudine-induced neutropenia, however, l8 of 11 patients receiving granulocyte-macrophage CSF developed hematological toxicity. Interleukine-2 produced by T-helper cells enhancing tumor cells cytotoxicity has been used in AIDS-associated cryptosporidial diarrhea and in 4 patients with AIDS lymphoma with modest response, but its stimulation of the HIV-infected substrate may increase viral proliferation.

  2. Surgical Travellers: Tapestry to Bayeux

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2014-01-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  3. Confronting AIDS.

    PubMed

    Squire, L

    1998-03-01

    By 2020, HIV/AIDS will be the leading infectious killer of young and middle-aged adults in the developing world. Past gains in life expectancy are already being eroded in some countries. Millions of lives can, however, be saved if developing country governments, the international community, and nongovernmental organizations act now. Although more than 11 million people have already died of AIDS, 2.3 billion people live in developing countries in which the disease has not yet spread beyond certain risk groups. If the spread of HIV is checked, the quality of care available to people who are infected with HIV will probably be better than it would be in the context of a full-blown AIDS epidemic. However, while governments need to respond urgently to HIV/AIDS, using resources to help people with AIDS will reduce the resources available for other investments, such as child education, providing safe drinking water, and building roads. Economics can help governments set priorities as they decide how best to allocate their available resources. Externalities, public goods, and redistribution are discussed. All countries will need to use some combination of preventive and coping measures. PMID:12293445

  4. HIV/AIDS Researchers Interaction with Schoolteachers: A Key to Combat AIDS among Brazilian Adolescents

    ERIC Educational Resources Information Center

    Kashima, Simone; de Castro, Fabiola Attie; de Castro Amarante, Maria Fernanda; Barbieri, Marisa Ramos; Covas, Dimas Tadeu

    2008-01-01

    Considering the fact that information on HIV/AIDS is a strategy for disease control, this project was planned to provide comprehensive information about HIV infection and AIDS to schoolteachers and their students. Previous analysis of adolescent students' knowledge of HIV/AIDS showed that they still have doubts about transmission, diagnosis, and…

  5. A Comprehensive Computer Package for Ambulatory Surgical Facilities

    PubMed Central

    Kessler, Robert R.

    1980-01-01

    Ambulatory surgical centers are a cost effective alternative to hospital surgery. Their increasing popularity has contributed to heavy case loads, an accumulation of vast amounts of medical and financial data and economic pressures to maintain a tight control over “cash flow”. Computerization is now a necessity to aid ambulatory surgical centers to maintain their competitive edge. An on-line system is especially necessary as it allows interactive scheduling of surgical cases, immediate access to financial data and rapid gathering of medical and statistical information. This paper describes the significant features of the computer package in use at the Salt Lake Surgical Center, which processes 500 cases per month.

  6. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  7. U.S. Department of Education Federal Student Aid Annual Report, 2005

    ERIC Educational Resources Information Center

    US Department of Education, 2005

    2005-01-01

    This annual report summarizes Federal Student Aid's Fiscal Year (FY) 2005 performance activities and achievements. Federal Student Aid's annual performance initiatives are based on two strategic planning documents, the "Five-Year Plan" and the "Annual Performance Plan." Federal Student Aid's "Five-Year Plan," issued in annual editions, is a…

  8. A constitution for AIDS.

    PubMed

    Koshy, L M

    1996-01-15

    The Indian Health Organization projected the number of deaths per day due to AIDS by the year 2000 at 10,000. An interdisciplinary international conference was held in New Delhi to draft an international law governing the issues related to AIDS. Human freedom and public health policies are the most affected by this disease. In the absence of an international AIDS law, judicial verdicts set precedents and could have serious ramifications. A participant from the John Marshall Law School, Chicago, suggested that instead of making new laws, the existing ones from the colonial past should be repealed. This includes Section 377 of the Indian Penal Code, which provides criminal sanctions against those who indulge in unnatural relations with man, woman, or animal. Penalizing homosexuality will only perpetuate clandestine relations and spread the virus into their families. Another participant seconded this motion stating that even a sex worker must be protected from abuse and indignity. The National AIDS Control Organization responded to the criticism that the government had not utilized all the World Bank funds allocated for anti-AIDS projects. The trends of the epidemic were the most important indicators not just the numbers. In Manipur and Mizoram, infection was almost entirely due to injecting drug use. The Saheli project undertaken in the red-light areas of Bombay encompassed brothel owners and prostitutes, which could be replicated in other areas. Because existing government policies were focusing on prevention, there was no protection of an HIV-infected individual's privacy, one participant from Madras stated. The confidentiality issue was also echoed by a US participant. The New Delhi Declaration and Action Plan on HIV/AIDS was also discussed. It forbids discrimination in employment, education, housing, health care, social security, travel, and marital and reproductive rights. Providing sterile needles and ensuring the safety of the blood supply were other concerns

  9. Classroom Aids

    ERIC Educational Resources Information Center

    Science Activities: Classroom Projects and Curriculum Ideas, 2007

    2007-01-01

    This article describes 6 aids for science instruction, including (1) the use of fudge to represent lava; (2) the "Living by Chemistry" program, designed to make high school chemistry more accessible to a diverse pool of students without sacrificing content; (3) NOAA and NSTA's online coral reef teaching tool, a new web-based "science toolbox" for…

  10. Dietitian Aide.

    ERIC Educational Resources Information Center

    Texas Tech. Univ., Lubbock. School of Home Economics.

    This course of study for the dietitian aide is one of a series available for use by teacher-coordinators and students in Grade 11 and 12 home economics cooperative education programs. Based on job analysis interviews with health care facilities personnel, this course was prepared by teachers and Instructional Materials Center staff, field-tested,…

  11. Surgical laser use in implantology and endodontics.

    PubMed

    Parker, S

    2007-04-14

    The use of surgical lasers has been advocated to aid in the placement and second stage recovery of dental implants, together with soft tissue contouring. In addition, laser use has been suggested as an aid in decontamination of the implant surface in cases of peri-implantitis. In endodontics, the association of laser energy with dentine hypersensitivity, bacteriocidal action and pulp-capping, has led to a growing number of reports as to its beneficial use, together with claims of morphological changes in the canal wall, to enhance endodontic treatment success.

  12. An Improved Stereotactic System For CT Aided Neurosurgery

    NASA Astrophysics Data System (ADS)

    Rhodes, Michael L.; Glenn, William V., Jr.; Azzawi, Yu-Ming; Howland, Robert S.

    1982-11-01

    Several computed tomography (CT) aided stereotactic systems have been introduced during the last five years for precise placement of neurosurgical instruments. Using digital CT image data that is transformed to a patient-frame coordinate system surgery can be simulated, planned and executed with sub-millimeter precision. This paper introduces a second generation stereotactic system that improves on speed, image resolution, accuracy and patient comfort of past and current systems. The system described here is designed for surgical procedures conducted entirely in the CT suite. Geometric resolution of this system is presented, test procedures are described and phantom results are discussed. An application to percutaneous knee surgery is briefly mentioned. At this writing patient data is not yet available.

  13. Surgical skin-marking techniques.

    PubMed

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.

  14. Surgical skin-marking techniques.

    PubMed

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged. PMID:2434965

  15. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  16. AIDS in India: constructive chaos?

    PubMed

    Chatterjee, A

    1991-08-01

    Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.

  17. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning – anxiety, depression, quality of life

    PubMed Central

    Lyon, Maureen E; Garvie, Patricia A; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J; McCarter, Robert

    2010-01-01

    Purpose To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention. Patients and methods We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76). Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC) received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation). Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©); psychological adjustment (Beck Depression, Anxiety Inventories); quality of life (PedsQL™); and HIV symptoms (General Health Self-Assessment). Results Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001). Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018) and emotional (P = 0.029) quality of life at 3 months, compared with controls. Conclusions Participating in advance care planning did not unduly distress HIV+ adolescents. PMID:22096382

  18. Surgical research IV.

    PubMed

    Toledo-Pereyra, Luis H

    2010-08-01

    Harvey W. Cushing (1869-1939) is the only surgeon represented in Surgical Research IV and one of the most accomplished American contributors to surgical research in general and to neurological and endocrine surgery research in particular. Other surgical research leaders of the 19th and 20th centuries who preceded Harvey Cushing have been introduced before. First, we highlighted the "importance of medical and surgical research" as the basic elements in the advancement of medicine and surgery could be considered as Surgical Research I. Second, in Surgical Research II, we presented William Beaumont, Samuel Gross, and William Halsted as the most important participants of the first wave of American surgical researchers. Next, in Surgical Research III, we considered surgeon researchers who moved ahead in the field of surgery with their research initiatives at the time, including John B. Murphy, the Mayo Brothers William J. and Charles H. Mayo, and George W. Crile. With Harvey Cushing, we enter an era of surgical research associated with neurosurgery and endocrine surgery as part of Surgical Research IV. PMID:20690841

  19. Directory of IEC Assistance. Sources and Types of Aid Available for the Information, Education, Communication Components of Population/Family Planning Programs.

    ERIC Educational Resources Information Center

    Hawaii Univ., Honolulu. East-West Center.

    This directory is intended as a source of information on the types and sources of assistance available to support the information, education, communication (IEC) components of population/family planning programs in developing countries. Forty international agencies are identified as involved in supporting the IEC components of population/family…

  20. HIV/AIDS Basics

    MedlinePlus

    ... Enter ZIP code or city Follow Act Against AIDS Act Against AIDS @talkHIV Act Against AIDS Get Email Updates on AAA Anonymous Feedback HIV/AIDS Media Infographics Syndicated Content Podcasts Slide Sets HIV/ ...

  1. NIH support of Centers for AIDS Research and Department of Health Collaborative Public Health Research: advancing CDC's Enhanced Comprehensive HIV Prevention Planning project.

    PubMed

    Greenberg, Alan E; Purcell, David W; Gordon, Christopher M; Flores, Stephen; Grossman, Cynthia; Fisher, Holly H; Barasky, Rebecca J

    2013-11-01

    The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department–supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS.

  2. Supramalleolar Osteotomy: Indications and Surgical Techniques.

    PubMed

    Mulhern, Jennifer L; Protzman, Nicole M; Brigido, Stephen A; Deol, Premjit Pete S

    2015-07-01

    Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.

  3. Osteotomy and osteosynthesis in complex segmental genioplasty with double surgical guide

    PubMed Central

    Assis, Adriano; Olate, Sergio; Asprino, Luciana; de Moraes, Márcio

    2014-01-01

    Chin osteotomy is used in esthetic and functional procedure; genioplasty shows different surgical options as lineal osteotomy, curved osteotomy, segmental osteotomy and others for different conditions of the face. This communication shows the use of two surgical guides used in a patient with extremely facial asymmetry; the surgical plan was realized in a stereolithographic biomodel. The first surgical guide was used for osteotomy and the second surgical guide was used for putting the plate, previously bent, and for segmented osteotomy in the planned position on the biomodel; this technique showed adequate adaptation and security in this extremely asymmetric case. The potential use of this surgical guide was discussed. PMID:24995074

  4. Educating Brazilian workers about AIDS.

    PubMed

    1991-12-01

    This article contains a the script for a slide-tape presentation entitled Working Against AIDS, a presentation developed by the Brazil Family Planning Association (BEMFAM) which is designed to debunk common misconceptions about the disease. This audio-visual, which targets Brazilian workers, can be used during talks, seminars, and meetings. A discussion of the issues involved usually follows the presentation of Working Against AIDS. The presentation contains 30 illustrated slides (these are included in the article). The presentation begins by explaining that much of the information concerning AIDS is prejudicial and misleading. The next few slides point out some of the common misconceptions about AIDS, such as claims denying the existence of the disease, or suggestions that only homosexuals and prostitutes are at risk. The presentation then goes on to explain the ways in which the virus can and cannot be transmitted. Then it discusses how the virus destroys the body's natural defenses and explains the ensuing symptoms. Slides 14 and 15 point out that no cure yet exists for AIDS, making prevention essential. Slides 16-23 explain what actions are considered to be high risk and which ones do not entail risk. Noting that AIDS can be prevented, slide 24 says that the disease should not present an obstacle to spontaneous manifestations of human relations. The next slide explains that condoms should always be used when having sex with someone who could be infected with AIDS. Finally slides 26-30 demonstrate the proper way to use and dispose of a condom.

  5. "Aid to Thought"--Just Simulate It!

    ERIC Educational Resources Information Center

    Kinczkowski, Linda; Cardon, Phillip; Speelman, Pamela

    2015-01-01

    This paper provides examples of Aid-to-Thought uses in urban decision making, classroom laboratory planning, and in a ship antiaircraft defense system. Aid-to-Thought modeling and simulations are tools students can use effectively in a STEM classroom while meeting Standards for Technological Literacy Benchmarks O and R. These projects prepare…

  6. The Rising Institutional Cost of Student Aid.

    ERIC Educational Resources Information Center

    Green, Kenneth C.

    1988-01-01

    Since 1980 a growing share of student aid costs has passed from government to institutions. The shift is directly tied to changes in the eligibility guidelines governing federal aid programs, and is severely affecting families' efforts to plan for college costs and institutions' ability to make important infrastructure expenditures. (MSE)

  7. Talus fractures: surgical principles.

    PubMed

    Rush, Shannon M; Jennings, Meagan; Hamilton, Graham A

    2009-01-01

    Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries. PMID:19121756

  8. Surgical research in Canada: synopsis of a consensus conference

    PubMed Central

    Warnock, Garth L.; Tator, Charles H.

    1998-01-01

    Canadian surgical research requires careful nurturing if it is to flourish in tomorrow’s environment. A consensus conference organized by the Research Development Committee of the Canadian Association of Surgical Chairs has addressed a number of issues to promote Canadian surgical research. This synopsis is a summary of the proceedings of that conference. It reflects on the meaning of surgical science, elements of establishing a successful research program, leadership in surgical science, identification of talented trainees, and the means to make the most of opportunities for funding. The information contained in the synopsis should not only assist departments of surgery and surgical specialty societies but should challenge them to set goals and innovative approaches to plan for strong surgical research in a changing environment. PMID:9711162

  9. Surgical ethics and the challenge of surgical innovation.

    PubMed

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  10. Bone Anchored Hearing Aid

    PubMed Central

    2002-01-01

    conditions were successfully treated with antibiotics, and only 1% to 2% required surgical revision. Less than 1% required removal of the fixture. Other complications included failure to osseointegrate and loss of fixture and/or abutment due to trauma or infection. Effectiveness Studies showed that BAHAs were implanted in people who have conduction or mixed hearing loss, congenital atresia or suppurative otitis media who were not candidates for surgical repair, and who cannot use conventional bone conduction hearing aids. The need for BAHA is not age- related. Objective audiometric measures and subjective patient satisfaction surveys showed that BAHA significantly improved the unaided and aided free field and sound field thresholds as well as speech discrimination in quiet and in noise for former users of conventional bone conduction hearing aids. The outcomes were ambiguous for former users of air conduction hearing aids. BAHA has been shown to reduce the frequency of ear infection and reduce the discharge particularly among patients with suppurative otitis media. Patients have reported that BAHA improved their quality of life. Reported benefits were improved speech intelligibility, better sound comfort, less pressure on the head, less skin irritation, greater cosmetic acceptance and increase in confidence. Main reported shortcomings were wind noise, feedback and difficulty in using the telephone. Experts and the BAHA manufacturer recommended that recipients of a BAHA implant be at least 5 years old. Challenges associated with the implantation of BAHA in pediatric patients include thin bone, soft bone, higher rates of fixture loss due to trauma, psychological problems, and higher revision rates due to rapid bone growth. The overall outcomes are comparable to adult BAHA. The benefits of pediatric BAHA (e.g. on speech development) appear to outweigh the disadvantages. Screening according to strict eligibility criteria, preoperative counselling, close monitoring by a physician

  11. Cone-beam computed tomography as a surgical guide to impacted anterior teeth

    PubMed Central

    Jeremias, Fabiano; Fragelli, Camila Maria Bullio; Mastrantonio, Simone Di Salvo; dos Santos-Pinto, Lourdes; dos Santos-Pinto, Ary; Pansani, Cyneu Aguiar

    2016-01-01

    Surgical procedure for removal of impacted teeth is a challenge for clinicians as it involves accuracy in the diagnosis and localization of the dental elements. The cone-beam computed tomography (CBCT), compared to the conventional radiography, has a greater potential to provide complementary information because of its three-dimensional (3D) images, reducing the possibility of failures in surgical procedures. Two 10-year-old boys presented with aesthetic issues associated with the juxtaposition of ectopic teeth with the permanent ones. Both two-dimensional and 3D preoperative radiographic diagnostic sets were produced. The occlusal and panoramic radiographs were not enough for proper localization of impacted incisors. Thus, the CBCT was used as a surgical guide. After 2 years of longitudinal following, no lesion was recorded, and the orthodontic treatment has proven successful. In all cases, CBCT contributed to both diagnosis and correct localization of supernumerary teeth, aiding the professional in the treatment planning, and consequently in the clinical success. The surgeries were completely safe, avoiding damage in noble structures, and providing a better recovering of the patients. PMID:26962322

  12. Cone-beam computed tomography as a surgical guide to impacted anterior teeth.

    PubMed

    Jeremias, Fabiano; Fragelli, Camila Maria Bullio; Mastrantonio, Simone Di Salvo; Dos Santos-Pinto, Lourdes; Dos Santos-Pinto, Ary; Pansani, Cyneu Aguiar

    2016-01-01

    Surgical procedure for removal of impacted teeth is a challenge for clinicians as it involves accuracy in the diagnosis and localization of the dental elements. The cone-beam computed tomography (CBCT), compared to the conventional radiography, has a greater potential to provide complementary information because of its three-dimensional (3D) images, reducing the possibility of failures in surgical procedures. Two 10-year-old boys presented with aesthetic issues associated with the juxtaposition of ectopic teeth with the permanent ones. Both two-dimensional and 3D preoperative radiographic diagnostic sets were produced. The occlusal and panoramic radiographs were not enough for proper localization of impacted incisors. Thus, the CBCT was used as a surgical guide. After 2 years of longitudinal following, no lesion was recorded, and the orthodontic treatment has proven successful. In all cases, CBCT contributed to both diagnosis and correct localization of supernumerary teeth, aiding the professional in the treatment planning, and consequently in the clinical success. The surgeries were completely safe, avoiding damage in noble structures, and providing a better recovering of the patients.

  13. Hearing Aids

    MedlinePlus

    ... Fitness Diseases & Conditions Infections Q&A School & Jobs Drugs & Alcohol Staying Safe Recipes En Español Making a Change – Your Personal Plan Hot Topics Meningitis Choosing Your Mood Prescription Drug Abuse Healthy School Lunch Planner How Can I ...

  14. Brand Aid

    ERIC Educational Resources Information Center

    Drozdowski, Mark J.

    2007-01-01

    Planning is a critical step to take before launching a capital campaign, if marketing materials are to cater to all potential donors and reinforce the institution's brand--which defines what the institution is and what it does, and is shaped by what people think of it. Here, the author discusses the importance of maintaining and conveying a…

  15. Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: a literature review.

    PubMed

    Lin, Hsiu-Hsia; Lo, Lun-Jou

    2015-04-01

    By incorporating three-dimensional (3D) imaging and computer-aided design and manufacturing techniques, 3D computer-assisted technology has been applied widely to provide accurate guidance for assessment and treatment planning in clinical practice. This technology has recently been used in orthognathic surgery to improve surgical planning and outcome. The modality will gradually become popular. This study reviewed the literature concerning the use of computer-assisted techniques in orthognathic surgery including surgical planning, simulation, intraoperative translation of the virtual surgery, and postoperative evaluation. A Medline, PubMed, ProQuest, and ScienceDirect search was performed to find relevant articles with regard to 3D computer-assisted orthognathic surgery in the past 10 years. A total of 460 articles were revealed, out of which 174 were publications addressed the topic of this study. The purpose of this article is to present an overview of the state-of-art methods for 3D computer-assisted technology in orthognathic surgery. From the review we can conclude that the use of computer-assisted technique in orthognathic surgery provides the benefit of optimal functional and aesthetic results, patient satisfaction, precise translation of the treatment plan, and facilitating intraoperative manipulation.

  16. Reprieve for Thailand's AIDS campaign.

    PubMed

    Clements, A

    1992-07-25

    A promilitary coalition began to govern Thailand in March 1992. It reduced the budget for the original proposed national AIDS awareness campaign from 30 million British pounds to almost 15 million British pounds. The Ministry of Health professed that the campaign had exaggerated the problem of AIDS in Thailand and had damaged tourism. Yet prodemocracy demonstrations in Bangkok in which troops killed many protesters restored the politicians who started the AIDS campaign to power in May 1992. There were to remain in power until new elections in September 1992. In July, the Minister of Health, Mechai Viravaidya, said he would step down if the government did not completely restore the 30 million British pounds for the AIDS campaign. It then increased the budget to almost that amount. Mr. Viravaidya initiated Thailand's open policy on the AIDS crisis and was known as Mr. Condom. He claimed that at the present HIV prevalence rate, Thailand may have between 2-4 million HIV infected people by 2000. If the country would take on anti-AIDS efforts now, however, they could cut the spread of HIV by 75%. As of mid-1992, about 400,000 people living in Thailand were HIV positive. The AIDS campaign planned to sue the mass media to inform people about AIDS especially those in universities and schools and high risk occupational groups. The increasing number of construction workers in Bangkok and existing sex workers were a high risk occupational group. At the 2nd national seminar of AIDS, the Minister of Health reproached tourists who come to Thailand for its sex industry. He said that Thailand does not need the 1 billion British pounds they bring to Thailand annually, and Thais do not want their homeland to be referred to as the sex capital.

  17. Reprieve for Thailand's AIDS campaign.

    PubMed

    Clements, A

    1992-07-25

    A promilitary coalition began to govern Thailand in March 1992. It reduced the budget for the original proposed national AIDS awareness campaign from 30 million British pounds to almost 15 million British pounds. The Ministry of Health professed that the campaign had exaggerated the problem of AIDS in Thailand and had damaged tourism. Yet prodemocracy demonstrations in Bangkok in which troops killed many protesters restored the politicians who started the AIDS campaign to power in May 1992. There were to remain in power until new elections in September 1992. In July, the Minister of Health, Mechai Viravaidya, said he would step down if the government did not completely restore the 30 million British pounds for the AIDS campaign. It then increased the budget to almost that amount. Mr. Viravaidya initiated Thailand's open policy on the AIDS crisis and was known as Mr. Condom. He claimed that at the present HIV prevalence rate, Thailand may have between 2-4 million HIV infected people by 2000. If the country would take on anti-AIDS efforts now, however, they could cut the spread of HIV by 75%. As of mid-1992, about 400,000 people living in Thailand were HIV positive. The AIDS campaign planned to sue the mass media to inform people about AIDS especially those in universities and schools and high risk occupational groups. The increasing number of construction workers in Bangkok and existing sex workers were a high risk occupational group. At the 2nd national seminar of AIDS, the Minister of Health reproached tourists who come to Thailand for its sex industry. He said that Thailand does not need the 1 billion British pounds they bring to Thailand annually, and Thais do not want their homeland to be referred to as the sex capital. PMID:1392821

  18. Manufacturing Aids

    NASA Technical Reports Server (NTRS)

    1989-01-01

    During a research program, MMTC/Textron invented a computer-aided automatic robotic system for spraying hot plasma onto a turbine blade. The need to control the thickness of the plasma deposit led to the development of advanced optical gaging techniques to monitor and control plasma spray build-up on blade surfaces. The techniques led to computerized optical gages for inspecting aircraft, industrial turbine blades, etc. MMTC offers 10 standard commercial robotic gages. The system also generates two dimensional profiles for assessing status and specifying repairs to the electromechanical cathodes used to make the parts. It is capable of accuracies to a ten-thousandth of an inch. An expanded product line is currently marketed. The gages offer multiple improvements in quality control and significant savings.

  19. New comprehensive surgical curriculum of pre-graduate surgical education

    PubMed Central

    Łaski, Dariusz; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; Śledziński, Zbigniew

    2013-01-01

    training aids should be utilized in training of every surgical skill, not only laparoscopy. This form of training, associated with the component of competition, enables good and stable results to be achieved, as well as high satisfaction of trainees. PMID:24130633

  20. MRI of Perianal Fistulas: Bridging the radiologic-surgical divide

    PubMed Central

    Gage, Kenneth L.; Deshmukh, Swati; Macura, Katarzyna J.; Kamel, Ihab R.; Zaheer, Atif

    2013-01-01

    Perianal fistula is a clinical entity with multiple surgical treatment options. Recently, magnetic resonance imaging (MRI) has emerged as an important imaging modality in the management of perianal fistulas. It provides accurate description of the fistula within the anal canal in relation to the sphincter complex and other pelvic floor structures as well as the associated complications such as abscess. By understanding the surgical viewpoint, the appearance of perianal fistulas, associated complications, and post-treatment findings of commonly used surgical interventions can more accurately be interpreted to aid clinicians. The objective of the article is to review MRI indications and findings, radiological versus surgical classification schemes, and surgical treatment options for perianal fistulas. PMID:23242265

  1. Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties

    PubMed Central

    Matar, Wadih Y.; Trottier, Daniel C.; Balaa, Fady; Fairful-Smith, Robin; Moroz, Paul

    2012-01-01

    Background Many low- and middle-income countries (LMICs) lack basic surgical resources, resulting in avoidable disability and mortality. Recently, residents in surgical training programs have shown increasing interest in overseas elective experiences to assist surgical programs in LMICs. The purpose of this study was to survey Canadian surgical residents about their interest in international volunteerism. Methods We sent a web-based survey to all general and orthopedic surgery residents enrolled in surgical training programs in Canada. The survey assessed residents’ interests, attitudes and motivations, and perceived barriers and aids with respect to international volunteerism. Results In all, 361 residents completed the survey for a response rate of 38.0%. Half of the respondents indicated that the availability of an international surgery elective would have positively influenced their selection of a residency program. Excluding the 18 residents who had volunteered during residency, 63.8% of the remaining residents confirmed an interest in international volunteering with “contributing to an important cause,” “teaching” and “tourism/cultural enhancement” as the leading reasons for their interest. Perceived barriers included “lack of financial support” and “lack of available organized opportunities.” All (100%) respondents who had done an international elective during residency confirmed that they would pursue such work in the future. Conclusion Administrators of Canadian surgical programs should be aware of strong resident interest in global health care and accordingly develop opportunities by encouraging faculty mentorships and resources for global health teaching. PMID:22854155

  2. Surgical simulation in orthopaedic skills training.

    PubMed

    Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

    2012-07-01

    Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated. PMID:22751160

  3. 23 CFR 470.107 - Federal-aid highway systems.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Federal-aid highway systems. 470.107 Section 470.107 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH HIGHWAY SYSTEMS Federal-aid Highway Systems § 470.107 Federal-aid highway systems. (a) Interstate System. (1) The Dwight...

  4. 23 CFR 470.107 - Federal-aid highway systems.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Federal-aid highway systems. 470.107 Section 470.107 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH HIGHWAY SYSTEMS Federal-aid Highway Systems § 470.107 Federal-aid highway systems. (a) Interstate System. (1) The Dwight...

  5. 23 CFR 470.107 - Federal-aid highway systems.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 23 Highways 1 2012-04-01 2012-04-01 false Federal-aid highway systems. 470.107 Section 470.107 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH HIGHWAY SYSTEMS Federal-aid Highway Systems § 470.107 Federal-aid highway systems. (a) Interstate System. (1) The Dwight...

  6. 23 CFR 470.107 - Federal-aid highway systems.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Federal-aid highway systems. 470.107 Section 470.107 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH HIGHWAY SYSTEMS Federal-aid Highway Systems § 470.107 Federal-aid highway systems. (a) Interstate System. (1) The Dwight...

  7. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  8. Surgical progress: surgical management of infective endocarditis.

    PubMed Central

    Mills, S A

    1982-01-01

    Infective endocarditis of bacterial or fungal origin may arise in either the left or the right heart and can involve both natural and prosthetic valves. The diagnosis is based primarily upon clinical criteria and positive blood cultures, but serial electrocardiograms, fluoroscopy, and two-dimensional echocardiograms may also be helpful. The initial treatment should consist of antibiotic therapy and is itself often adequate in effecting cure. However, careful observation during antibiotic treatment is mandatory, since the development of congestive heart failure due to valvular obstruction or destruction can be an indication for surgical intervention. Other surgical indications include a failure to respond to antibiotic therapy, pulmonary or systemic emboli, evidence of abscess involving the valvular ring (particularly prevalent with prosthetic valve endocarditis), Brucella infection, and the onset of conduction disturbances. The goals of surgical treatment are removal of infective tissue, restoration of valve function, and correction of associated mechanical disorders. The results are surprisingly good, especially for a condition of this severity. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:7065743

  9. Crawling Aid

    NASA Technical Reports Server (NTRS)

    1982-01-01

    The Institute for the Achievement of Human Potential developed a device known as the Vehicle for Initial Crawling (VIC); the acronym is a tribute to the crawler's inventor, Hubert "Vic" Vykukal; is an effective crawling aid. The VIC is used by brain injured children who are unable to crawl due to the problems of weight-bearing and friction, caused by gravity. It is a rounded plywood frame large enough to support the child's torso, leaving arms and legs free to move. On its underside are three aluminum discs through which air is pumped to create an air-bearing surface that has less friction than a film of oil. Upper side contains the connection to the air supply and a pair of straps which restrain the child and cause the device to move with him. VIC is used with the intent to recreate the normal neurological connection between brain and muscles. Over repetitive use of the device the child develops his arm and leg muscles as well as coordination. Children are given alternating therapy, with and without the VIC until eventually the device is no longer needed.

  10. Stereolithography in oral implantology: a comparison of surgical guides.

    PubMed

    Sammartino, Gilberto; Della Valle, Antonio; Marenzi, Gaetano; Gerbino, Salvatore; Martorelli, Massimo; di Lauro, Alessandro Espedito; di Lauro, Francesco

    2004-06-01

    This article presents the use of stereolithography in oral implantology. Stereolithography is a new technology that can produce physical models by selectively solidifying an ultraviolet-sensitive liquid resin using a laser beam, reproducing the true maxillary and mandibular anatomic dimensions. With these models, it is possible to fabricate surgical guides that can place the implants in vivo in the same places and same directions as those in the planned computer simulation. A 70-year-old woman, in good health, with severe mandibular bone atrophy was rehabilitated with an over-denture supported by 2 Branemark implants. Two different surgical planning methods were considered: 1) the construction of a surgical guide evaluating clinical aspects, and 2) the surgical guide produced by stereolithographic study. The accuracy of surgical planning can reduce the problems related to bone density and dimensions. Furthermore, the stereolithographic study assured the clinicians of a superior location of fixtures in bone. Surgical planning based on stereolithographic technique is a safe procedure and has many advantages. This technologic advance has biologic and therapeutic benefits because it simplifies anatomic surgical management for improved implant placement.

  11. Surgical Treatments for Fibroids

    MedlinePlus

    ... Clinical Trials Resources and Publications Surgical Treatments for Fibroids Skip sharing on social media links Share this: ... If you have moderate or severe symptoms of fibroids, surgery may be the best treatment for you. ...

  12. American Pediatric Surgical Association

    MedlinePlus

    ... Us Login The Hendren Project Resources Research Continuing Education Residents / Fellows Membership About APSA American Pediatric Surgical Association One Parkview Plaza, Suite 800 Oakbrook Terrace, IL 60181 USA Phone: +1-847-686-2237 Fax: +1-847- ...

  13. Guide to Surgical Specialists

    MedlinePlus

    ... may also deal with the liver, urinary, and female reproductive systems if they are involved with primary intestinal disease. ... The focus for this specialty is on the female reproductive system, including performing surgical procedures, managing the care of ...

  14. Hernia Surgical Mesh Implants

    MedlinePlus

    ... Surgical Clinics of North America; 83(5):1045-51, v-vi. 2 . http://www.facs.org/public_ ... FDA Contact FDA Browse by Product Area Product Areas back Food Drugs Medical Devices Radiation-Emitting Products ...

  15. Urogynecologic Surgical Mesh Implants

    MedlinePlus

    ... Boston Scientific's urogynecologic surgical mesh may contain counterfeit raw material. We are examining these allegations to determine any ... are currently not aware that the alleged counterfeit raw material contributes to adverse events associated with these products. ...

  16. Disruptive visions: surgical education.

    PubMed

    Satava, R M

    2004-05-01

    Technological change, decreased financial support for medical education, and social oversight (in the form of the "To Err Is Human" report, HIPPA, and reduced work hours) are forcing a rethinking of the traditional model of surgical education to improve patient safety. New approaches to evaluating surgical competence, such as objective assessment, in combination with new technologies, such as the Internet and surgical simulators, provide the tools to effect a revolution in surgical education and training. Competency based upon quantifiable criteria measures must replace the traditional subjective assessment. The implementation requires accurately defining the elements of training, establishing new quantifiable metrics, stringently measuring performance against criterion, and reporting outcomes throughout the career of a surgeon.

  17. HIV-AIDS Connection

    MedlinePlus

    ... Marketing Share this: Main Content Area The HIV-AIDS Connection AIDS was first recognized in 1981 and ... is there overwhelming scientific consensus that HIV causes AIDS? Before HIV infection became widespread in the human ...

  18. Heart attack first aid

    MedlinePlus

    First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest ... of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 ...

  19. Splinter, First Aid

    MedlinePlus

    ... and rashes clinical tools newsletter | contact Share | Splinter, First Aid A A A First Aid for Splinter: View ... wet, it makes the area prone to infection. First Aid Guide Self-care measures to remove a splinter ...

  20. Surgical correction of brachymetatarsia.

    PubMed

    Bartolomei, F J

    1990-02-01

    Brachymetatarsia describes the condition of an abnormally short metatarsal. Although the condition has been recorded since antiquity, surgical options to correct the deformity have been available for only two decades. Most published procedures involve metaphyseal lengthening with autogenous grafts from different donor sites. The author discusses one such surgical technique. In addition, the author proposes specific criteria for the objective diagnosis of brachymetatarsia. PMID:2406417

  1. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  2. Laparoscopic adrenalectomy: Surgical techniques

    PubMed Central

    Mellon, Matthew J.; Sethi, Amanjot; Sundaram, Chandru P.

    2008-01-01

    Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This article reviews the surgical techniques for the laparoscopic adrenalectomy. PMID:19468527

  3. Computer-Assisted Technique for Surgical Tooth Extraction

    PubMed Central

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. PMID:27127510

  4. Computer-Assisted Technique for Surgical Tooth Extraction.

    PubMed

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. PMID:27127510

  5. Conceptual Spawning Habitat Model to Aid in ESA Recovery Plans for Snake River Fall Chinook Salmon, 2002-2003 Annual Report.

    SciTech Connect

    Geist, David

    2005-09-01

    The goal of this project is to develop a spawning habitat model that can be used to determine the physical habitat factors that are necessary to define the production potential for fall chinook salmon that spawn in large mainstem rivers like the Columbia River's Hanford Reach and Snake River. This project addresses RPA 155 in the NMFS 2000 Biological Opinion: Action 155: BPA, working with BOR, the Corps, EPA, and USGS, shall develop a program to: (1) Identify mainstem habitat sampling reaches, survey conditions, describe cause-and-effect relationships, and identify research needs; (2) Develop improvement plans for all mainstem reaches; and (3) Initiate improvements in three mainstem reaches. During FY 2003 we continued to collect and analyze information on fall chinook salmon spawning habitat characteristics in the Hanford Reach that will be used to address RPA 155, i.e., items 1-3 above. For example, in FY 2003: (1) We continued to survey spawning habitat in the Hanford Reach and develop a 2-dimensional hydraulic and habitat model that will be capable of predicting suitability of fall chinook salmon habitat in the Hanford Reach; (2) Monitor how hydro operations altered the physical and chemical characteristics of the river and the hyporheic zone within fall chinook salmon spawning areas in the Hanford Reach; (3) Published a paper on the impacts of the Columbia River hydroelectric system on main-stem habitats of fall chinook salmon (Dauble et al. 2003). This paper was made possible with data collected on this project; (4) Continued to analyze data collected in previous years that will ultimately be used to identify cause-and-effect relationships and identify research needs that will assist managers in the improvement of fall chinook habitat quality in main-stem reaches. During FY 2004 we plan to: (1) Complete preliminary reporting and submit papers based on the results of the project through FY 2004. Although we have proposed additional analysis of data be

  6. Ergogenic aids.

    PubMed

    Coyle, E F

    1984-07-01

    The catabolism of bodily fuels provides the energy for muscular work. Work output can be limited by the size of fuel reserves, the rate of their catabolism, the build-up of by-products, or the neurologic activation of muscle. A substance that favorably affects a step that is normally limiting, and thus increases work output, can be considered an ergogenic aid. The maximal amount of muscular force generated during brief contractions can be acutely increased during hypnosis and with the ingestion of a placebo or psychomotor stimulant. This effect is most obvious in subjects under laboratory conditions and is less evident in athletes who are highly motivated prior to competition. Fatigue is associated with acidosis in the working musculature when attempts are made to maximize work output during a 4 to 15-minute period. Sodium bicarbonate ingestion may act to buffer the acid produced, provided that blood flow to the muscle is adequate. Prolonged intense exercise can be maintained for approximately two hours before carbohydrate stores become depleted. Carbohydrate feedings delay fatigue during prolonged exercise, especially in subjects who display a decline in blood glucose during exercise in the fasting state. Caffeine ingestion prior to an endurance bout has been reported to allow an individual to exercise somewhat more intensely than he or she would otherwise. Its effect may be mediated by augmenting fat metabolism or by altering the perception of effort. Amphetamines may act in a similar manner. Water ingestion during prolonged exercise that results in dehydration and hyperthermia can offset fluid losses and allow an individual to better maintain work output while substantially reducing the risk of heat-related injuries. PMID:6100848

  7. Severe stricturing Crohn's disease of the duodenum: A case report and review of surgical options

    PubMed Central

    Racz, Jennifer M.; Davies, Ward

    2012-01-01

    INTRODUCTION Duodenal Crohn's disease is a rare clinical entity that occurs in 0.5–4.0% of patients with Crohn's disease. A unique case of Crohn's disease of the upper gastrointestinal tract characterized by multiple strictures within the duodenum and jejunum is described in our review. PRESENTATION OF CASE A 41-year-old male presented with a 2-month history of intermittent, crampy abdominal pain accompanied by nausea, bilious emesis, early satiety, anorexia and weight loss. Physical examination revealed fullness in the epigastric region. Imaging demonstrated strictures in the proximal and distal duodenum with dilatation of the intervening segments. There was also gross dilatation of the proximal jejunum, which was followed by a 9 cm strictured segment. There was no evidence of acute Crohn's disease. Although a Whipple's resection was initially considered as a form of operative intervention given the extent of disease within the duodenum, the discovery of unexpected disease intra-operatively presented a surgical dilemma. In this case, strictureplasty, surgical resection and bypass were used to treat the patient. DISCUSSION Diffuse stricturing of the proximal gastrointestinal tract is a rare manifestation of Crohn's disease. Although imaging can aid in surgical planning, intra-operative decision-making to deal with unexpected findings will remain an important aspect of the management of this entity. CONCLUSION The fundamental goal of the surgical management of strictures secondary to Crohn's disease is to relieve obstruction while maximizing bowel conservation. A variety of operative techniques are currently described for the management of duodenal Crohn's disease and are reviewed in this case report. PMID:22503915

  8. [Surgical laboratory in pregraduate medicine.

    PubMed

    Tapia-Jurado, Jesús

    2011-01-01

    Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient.

  9. [Surgical laboratory in pregraduate medicine.

    PubMed

    Tapia-Jurado, Jesús

    2011-01-01

    Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient. PMID:21477522

  10. Application of surgical navigation in styloidectomy for treating Eagle’s syndrome

    PubMed Central

    Dou, Geng; Zhang, Yu; Zong, Chunlin; Chen, Yuanli; Guo, Yuxuan; Tian, Lei

    2016-01-01

    Purpose The present study aimed to evaluate the feasibility, accuracy, and clinical effect of intraoperative navigation for resection of elongated styloid process (ESP) in Eagle’s syndrome. Patients and methods Twelve patients with Eagle’s syndrome with clinically and radiologically established diagnoses of ESP were included in this study. Preoperatively, all patients accepted three-dimensional computed tomography scan, and their skulls’ digital imaging and communications in medicine data were inputed into the navigation system workstation to make a virtual surgical plan in advance. During surgery, the intraoperative navigation was performed to excise the ESP accurately for both intraoral (without tonsillectomy) and extraoral approaches following the virtual plan. Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN). A simple visual analog scale questionnaire was also used to assess patients’ satisfaction and the surgery effect after 3 months. Results In total, 17 SPs from 12 patients were precisely resected by intraoral parapharyngeal approach and small cervical approach with the aid of SN. No severe complications occurred in any patients. The length of resected SPs was 21.93±14.26 mm. The average amount of bleeding and duration of operation were 22.50±8.54 mL and 40.35±11.81 minutes, respectively, which were all less than with traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients’ symptoms were improved greatly, and two patients had some improvement. Conclusion The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and

  11. An AIDS campaign in Brazil.

    PubMed

    Janoff, D

    1987-01-01

    The Acquired Immune Deficiency Syndrome (AIDS) distribution program in Brazil, spearheaded by the National Division of Sanitary Surveillance in Ports, Airports, and Borders, was part of the government's massive education campaign to prevent the transmission of HIV-AIDS in Brazil. Beginning in February 1987, the climate was sufficiently favorable to operate a coordinated information campaign during the Carnival celebration, and tourists arriving in the cities of Brazil for the annual Carnival celebration were handed an educational brochure in Portugese, Spanish, English, and French. Yet, beyond reaching the tourist populations, it is particularly important to reach large portions of the Brazilian population. Planners of the national AIDS campaign intend to use television, radio, and all major newspapers in their effort to cover the country. Initial television coverage is comprised of short informational messages directed at high-risk groups. There also are plans to use radio and the print media in order to reach a wider audience. It is estimated that US $6 million will be needed to adequately meet the costs of AIDS prevention and medical care, but due to extreme budget constraints, only $45,000 has been earmarked for ongoing AIDS activities at this time. PMID:12281284

  12. Surgical treatment of snoring & obstructive sleep apnoea.

    PubMed

    Ephros, Hillel D; Madani, Mansoor; Yalamanchili, Sumitra C

    2010-02-01

    Obstructive sleep apnoea (OSA) syndrome is a potentially serious disorder affecting millions of people around the world. Many of these individuals are undiagnosed while those who are diagnosed, often exhibit poor compliance with nightly use of continuous positive airway pressure (CPAP), a very effective nonsurgical treatment. Various surgical procedures have been proposed to manage and, in some cases, treat OSA. In this article we review methods used to assess the sites of obstruction and a number of surgical procedures designed to address OSA. Effective surgical management of OSA depends upon developing a complete database and determining different levels of obstruction, which may include nasal, nasopharyngeal, oropharyngeal, and hypopharyngeal/retrolingual, or a combination of these sites. A systematic approach to clinical evaluation, treatment planning and surgical management is recommended and is likely to result in more predictable outcomes. Surgical treatment may involve various procedures that are performed in different stages depending on the patient's sites of obstruction. The most commonly performed procedures include nasal reconstruction, uvulopalatopharyngoplasty (UPPP), advancement genioplasty, mandibular osteotomy with genioglossus advancement, and hyoid myotomy and suspension. In more severe cases, maxillomandibular advancement (MMA) with advancement genioplasty may be indicated. Even after appropriate surgical treatment, some patients may demonstrate continued obstruction with associated symptoms. Published indications for surgical treatment include an elevated respiratory disturbance index (RDI) with excessive daytime somnolence (EDS), oxygen desaturations below 90 per cent, medical co-morbidities including hypertension and arrhythmias, anatomic abnormalities of the upper airway and failure of medical treatment. The success of surgery in OSA is generally measured by achieving a (RDI) of less than 5, improvement of oxygen nadir to 90 per cent or

  13. A Novel Surgical Template Design in Staged Dental Implant Rehabilitations

    PubMed Central

    Patras, Michael; Martin, William; Sykaras, Nikitas

    2012-01-01

    ABSTRACT Background The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning. Methods This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts. Results This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes. Conclusions Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery. PMID:24422012

  14. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  15. [Electoro-surgical device].

    PubMed

    Matsumura, Yuji

    2009-07-01

    Electro-surgical device is an essential instrument for bloodless surgery after the 1st introduction by Harvey Cushing in 1926. Basal mechanisms of electric scalpels (monopolar and bipolar), current waveforms (cut, coagulation and blend), high-frequency currents and electrical shocks were commented. After 1990s, several new electro-surgical devices such as argon beam coagulator, bipolar scissors and vessel sealing system (LigaSure) were developed and introduced in chest surgery. Argon beam coagulator is useful in sealing and hemostasis of bleeding from chest walls after extrapleural dissections. Bipolar scissors can seal small vessels less than diameter 2 mm and is useful in mediastinal lymphnode dissections. Vessel sealing system is able to seal and cut vessels up to diameter 7 mm. LigaSure V is the most suitable instrument for thymic vein handling in thoracoscopic thymectomy. Clinical applications of these new surgical devices in chest surgery are discussed. PMID:20715684

  16. Computer Navigation-aided Resection of Sacral Chordomas

    PubMed Central

    Yang, Yong-Kun; Chan, Chung-Ming; Zhang, Qing; Xu, Hai-Rong; Niu, Xiao-Hui

    2016-01-01

    Background: Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods: Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35–84 years old). Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18–84 months). Results: Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7%) exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19–30). Conclusions: Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill. PMID:26830986

  17. The Master Hearing Aid

    PubMed Central

    Curran, James R.

    2013-01-01

    As early as the 1930s the term Master Hearing Aid (MHA) described a device used in the fitting of hearing aids. In their original form, the MHA was a desktop system that allowed for simulated or actual adjustment of hearing aid components that resulted in a changed hearing aid response. Over the years the MHA saw many embodiments and contributed to a number of rationales for the fitting of hearing aids. During these same years, the MHA was viewed by many as an inappropriate means of demonstrating hearing aids; the audio quality of the desktop systems was often superior to the hearing aids themselves. These opinions and the evolution of the MHA have molded the modern perception of hearing aids and the techniques used in the fitting of hearing aids. This article reports on a history of the MHA and its influence on the fitting of hearing aids. PMID:23686682

  18. Singapore's conservative attitude toward AIDS discussed.

    PubMed

    1999-01-01

    871 of Singapore's 3.1 million people have been diagnosed with HIV since 1985. 90% of these people are male and more than 70% of them report that they were infected through unprotected heterosexual sex. In the context of a growing number of people with AIDS, the government of Singapore plans to begin promoting condom use rather than rely simply upon campaigns stressing the need to remain sexually faithful to one partner. The government plans to increase awareness of HIV/AIDS at the grassroots, and gradually include condom use in public campaigns which now focus upon avoiding casual sex. At Singapore's first national AIDS conference, participants shared studies which showed that although a majority of Singaporeans know that HIV/AIDS is largely transmitted through sex or the sharing of injection equipment in IV drug use, up to 40% worry that they can become infected in other ways, such as from a diseased person sneezing or coughing upon them. PMID:12294479

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

    PubMed Central

    POZZI, A.; GARGARI, M.; BARLATTANI, A.

    2008-01-01

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

  20. Surgical prosthetic treatment

    PubMed Central

    Carulli, Christian; Matassi, Fabrizio; Civinini, Roberto; Villano, Marco; Innocenti, Massimo

    2010-01-01

    Fragility fractures typically occur in elderly patients related principally to osteoporosis. A significative percentage of these fractures have to be treated surgically but comorbilities are often present, and need to be grossly stabilized before surgery. However, there is for these fractures a high rate of morbidity and mortality at short-term. Moreover, patients affected by a fragility fracture are at risk for another fragility fracture later in life. The Authors present an overview of the main patterns of proximal femoral fractures, underlining the peculiar features and choices of surgical treatment, and relating to specific indications and results of each treatment. PMID:22461289

  1. [Pulmonary Echinococcosis: Surgical Aspects].

    PubMed

    Eichhorn, M E; Hoffmann, H; Dienemann, H

    2015-10-01

    Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach. PMID:26351761

  2. MDT lung cancer care: input from the Surgical Oncologist.

    PubMed

    Kidane, Biniam; Toyooka, Shinichi; Yasufuku, Kazuhiro

    2015-10-01

    Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

  3. Surgical wound care - open

    MedlinePlus

    Surgical incision care; Open wound care ... your wound again with sutures, you need to care for it at home, since it may take ... Your health care provider will tell you how often to change your dressing . To prepare for the dressing change: Clean your ...

  4. Surgical treatment of constipation.

    PubMed

    Błachut, K; Bednarz, W; Paradowski, L

    2004-01-01

    Constipation is a common symptom in clinical practice. Definition of constipation includes abnormal bowel frequency, difficulty during defecation and abnormal stool consistency. There are many classifications of constipation based on constipation etiology (constipation in healthy people caused by life style, constipation as a symptom of digestive tract diseases, secondary constipation in the course of systemic disorders or associated with drugs) and/or constipation mechanisms (functional, mechanical). The numerous disorders leading to constipation make often diagnostic management difficult and complicated. Treatment of constipation includes dietary and behavioral approaches, pharmacologic therapy and in selected patient surgical treatment. Surgical treatment is recommended in young patients with severe slow transit constipation refractory to conservative treatment. Confirmation of indication to surgical treatment requires studies of colonic and anorectal function (colonic transit studies, anorectal manometry, studies of defecation). Preferred surgical technique is colectomy with ileorectal anastomosis. Authors reported good results and patient satisfaction in 50-100 percent of cases. Postoperative complications include intestinal obstruction, abdominal pain, flatulence, diarrhea. PMID:15631313

  5. Ancient Egyptian surgical heritage.

    PubMed

    Saber, Aly

    2010-12-01

    Egyptian medicine influenced the medicine of neighboring cultures, including the culture of ancient Greece. From Greece, its influence spread onward, thereby affecting Western civilization significantly. The oldest extant Egyptian medical texts are six papyri: The Edwin Smith Surgical Papyrus and the Ebers Medical Papyrus are famous. PMID:21208098

  6. Risk analysis. HIV / AIDS country profile: Senegal.

    PubMed

    1996-12-01

    Since the first acquired immunodeficiency syndrome (AIDS) case was confirmed in 1986, Senegal has conducted an aggressive prevention campaign. Senegal's National AIDS Committee has noted the contributions of poverty and migration to the spread of AIDS. By June 1994, 1297 AIDS cases had been reported and an estimated 500,000 people (1.4% of the population) were infected with human immunodeficiency virus (HIV)-1 and 2. The highest rate of HIV infection (14%) exists among commercial sex workers. At present, HIV/AIDS cases are concentrated in Dakar, Kaolack, the Matam region, and Ziguinchor; however, the growing importance of inter-regional trading is expected to spread HIV to the smaller towns and rural areas. Also salient is the recent devaluation by 50% of the CFA franc, which has reduced the public sector workforce and led many poor urban residents into commercial sex work. CFA devaluation has made Senegal attractive to tourists and business visitors--another factor responsible for growth of the legalized commercial sex industry. Although sex workers are instructed in condom use and tested annually for HIV, only 850 of the 2000 registered sex workers have reported for check-ups, and the majority of prostitutes are unregistered. Senegal's AIDS Plan for 1994-98 focuses on care of AIDS patients, pressures placed on family structures by HIV, and AIDS-related erosions in the status of women. Each health service region has its own local plan for AIDS/HIV and sexually transmitted diseases, supervised by a regional committee. Public education has involved outreach to religious leaders, promotion of affordable condoms, and distribution of over 75,000 leaflets to key target populations. About US $16 million of the $25,688,875-budget HIV/AIDS program for 1994-98 was pledged by external donors.

  7. The impact of external donor support through the U.S. President’s Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004–2011

    PubMed Central

    Pitman, John P.; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J.; Basavaraju, Sridhar V.; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A.; Lowrance, David W.; Sibinga, Cees Th. Smit

    2015-01-01

    Background External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004–2011, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. Material and methods A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004–2009) and the 2 years in which PEPFAR support began to decline (2010–2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Results Between 2004–2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. Discussion PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are

  8. Novel Uses of Video to Accelerate the Surgical Learning Curve.

    PubMed

    Ibrahim, Andrew M; Varban, Oliver A; Dimick, Justin B

    2016-04-01

    Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementoring. Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.

  9. [Thiel's method of embalming and its usefulness in surgical assessments].

    PubMed

    Okada, Ryuhei; Tsunoda, Atsunobu; Momiyama, Naoko; Kishine, Naomi; Kitamura, Ken; Kishimoto, Seiji; Akita, Keiichi

    2012-08-01

    When we assess anatomical problems and the safety and effectiveness for performing a difficult surgical procedure or planning novel surgical approaches, preoperative human dissections are very helpful. However, embalming with the conventional formaldehyde method makes the soft tissue of the cadaver harder than that of a living body. Therefore, the cadaver embalmed with conventional formaldehyde is not appropriate for dissections when assess surgical approaches. Thiel's method is a novel embalming technique, first reported by W. Theil in 1992. This method can preserve color and softness of the cadaver without risk of infections. We have used cadavers embalmed with Thiel's method for preoperative assessments and have confirmed the usefulness of this method especially for the prevention of complications or in assessing surgical approaches. The cadaver embalmed with this method has several advantages over other embalming methods and it might be also useful for the developments of new surgical devices or evaluation of a surgeon's skill.

  10. [ATPF / CE project: AIDS prevention in the workplace].

    PubMed

    1995-01-01

    The Tunisian Family Planning Association initiated a widespread activity relative to the prevention of AIDS that targets young professionals, both those that are employed and those in professional training. The activity aimed to sensitize young professionals to AIDS prevention and to promote condom use. Planned activities include 30 educational meetings on AIDS prevention in professional environments. More specifically, there will be 10 meetings in each of three regions: Sfax, Sbeitla, and Kef. Each meeting will have 40 participants. Association volunteers in collaboration with the Tunisian Association for AIDS Control will enliven the meetings. These meetings are scheduled to take place in June 1995 in Sfax.

  11. IPAA supply and demand committee aids planning

    SciTech Connect

    Wells, B.A.

    1995-12-01

    Among the competitive disadvantages many independent oil and gas producers face with their larger counterparts is the lack of staff to prepare forecasts about the U.S. petroleum industry. Accurate forecasting requires a collective effort from a variety of experts that often proves very costly. This report describes the activities of the IPAA concerned with forecasting issues and activities.

  12. Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

    PubMed

    Parwani, Simran R; Parwani, Rajkumar N

    2014-01-01

    Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

  13. Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

    PubMed

    Parwani, Simran R; Parwani, Rajkumar N

    2014-01-01

    Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth. PMID:25369395

  14. Addressing the burden of post-conflict surgical disease - strategies from the North Caucasus.

    PubMed

    Lunze, Karsten; Lunze, Fatima I

    2011-01-01

    The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients. Credible, sustained partnerships and needs assessments beyond the immediate phases after a disaster are essential to facilitate a meaningful transition from humanitarian aid to capacity building exceeding existing insufficient standards. Psychosocial impacts of disaster might constitute a barrier to care and need to be assessed when responding to the burden of surgical disease in conflict or post-conflict settings. Involving local citizen groups in the planning process can be useful to identify and access vulnerable populations. Integration of our strategy into broader efforts might strengthen the local health system through management and leadership.

  15. A new AS-display as part of the MIRO lightweight robot for surgical applications

    NASA Astrophysics Data System (ADS)

    Grossmann, Christoph M.

    2010-02-01

    The DLR MIRO is the second generation of versatile robot arms for surgical applications, developed at the Institute for Robotics and Mechatronics at Deutsche Zentrum für Luft- und Raumfahrt (DLR) in Oberpfaffenhofen, Germany. With its low weight of 10 kg and dimensions similar to those of the human arm, the MIRO robot can assist the surgeon directly at the operating table where space is scarce. The planned scope of applications of this robot arm ranges from guiding a laser unit for the precise separation of bone tissue in orthopedics to positioning holes for bone screws, robot assisted endoscope guidance and on to the multi-robot concept for endoscopic minimally invasive surgery. A stereo-endoscope delivers two full HD video streams that can even be augmented with information, e.g vectors indicating the forces that act on the surgical tool at any given moment. SeeFront's new autostereoscopic 3D display SF 2223, being a part of the MIRO assembly, will let the surgeon view the stereo video stream in excellent quality, in real time and without the need for any viewing aids. The presentation is meant to provide an insight into the principles at the basis of the SeeFront 3D technology and how they allow the creation of autostereoscopic display solutions ranging from smallest "stamp-sized" displays to 30" desktop versions, which all provide comfortable freedom of movement for the viewer along with excellent 3D image quality.

  16. Answering the AIDS denialists: is AIDS real?

    PubMed

    Mirken, B

    2000-12-01

    This article looks at theories that say AIDS does not exist, or is not a new disease but only a collection of old ones--and explains some of the history behind earlier changes in the official definition of AIDS in the U.S., changes which caused some public confusion. PMID:12171004

  17. AIDS education reaches Pacific atolls.

    PubMed

    1994-01-01

    The Republic of Kiribati consists of 33 islands and 69,000 inhabitants dispersed over a large area of the Central Pacific. It includes the former Gilbert Islands, which were linked as British colonies with the Ellice Islands until the latter declared themselves independent as Tuvalu. Kiribati became independent from Britain in 1979 and joined WHO [the World Health Organization] in 1984. Launched in 1988, the national AIDS program is now implementing its second medium-term plan. As part of this plan, the program recently held its first AIDS awareness workshop for hotel workers, health care workers and youth. The workshop was held on Kiritimati, the world's largest atoll. Also known as Christmas Island, the atoll of 2650 inhabitants has excellent bird-watching and fishing opportunities, which have drawn growing numbers of tourists in recent years. Although neither of the two HIV infections identified in Kiribati by March 1994 were on Kiritimati, the prevalence of other sexually transmitted diseases there has been on the rise. Meeting in a traditional thatched building, the workshop participants proved eager to learn about HIV and STDs [sexually transmitted diseases]. They received instruction in prevention skills, including a demonstration of proper condom use led by the national AIDS coordinator. At the close of the workshop, condoms were provided to hotel staff for distribution.

  18. Surgical Approaches to the Nasal Cavity and Sinuses.

    PubMed

    Weeden, Alyssa Marie; Degner, Daniel Alvin

    2016-07-01

    The nasal cavity and sinuses may be exposed primarily via a dorsal or ventral surgical approach. Surgical planning involves the use of advanced imaging, such as computed tomography or MRI. Surgical treatment of lesions of the nasal cavity usually is limited to benign lesions or can also be used in combination with adjunctive therapy, such as radiation therapy. Extreme caution must be exercised with a dorsal approach to the nasal cavity to avoid complications of inadvertent penetration into the brain case. Gentle tissue handling and careful closure of the mucoperiosteum must be exercised following a ventral approach to minimize the risk of oronasal fistula formation. PMID:27217006

  19. Facial skeletal growth and timing of surgical intervention.

    PubMed

    Reid, Russell R

    2007-07-01

    Various forces and factors influence the development and maturation of the craniofacial skeleton. These encompass genetic and micro- and macro-environmental factors whose intricacies and interplay must be understood, recognized, and respected in the surgical planning and treatment of maxillofacial deformities. The theories of and experimentation with such factors, which dictate the timing of surgical intervention, are the focus of this article. The common procedures that make up the surgical armamentarium of the maxillofacial surgeon are catalogued in the setting of this developmental timeline.

  20. Regenerative treatments to enhance orthopedic surgical outcome.

    PubMed

    Murrell, William D; Anz, Adam W; Badsha, Humeira; Bennett, William F; Boykin, Robert E; Caplan, Arnold I

    2015-04-01

    In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair.

  1. Brachymetatarsia. A new surgical approach.

    PubMed

    Martin, D E; Kalish, S R

    1991-01-01

    Although most practitioners are familiar with brachymetatarsia, it is a relatively uncommon clinical entity presenting for surgical correction. Traditional methods of surgical correction have been successful for the most part; however, a number of potentially devastating complications exist with these procedures. The authors present a review of the deformity, including the historical surgical techniques, and introduce a new surgical approach that minimizes the risk of complication. PMID:1993972

  2. [Initial management of advanced ovarian cancer: What radiological, pathological and surgical information are important for optimal therapeutic strategy?].

    PubMed

    Heudel, Pierre-Etienne; Selle, Frédéric; Morice, Philippe; Rouzier, Roman; Taieb, Sophie; Devouassoux-Shisheboran, Mojgan; Genestie, Catherine; Balleyguier, Corinne; Ray-Coquard, Isabelle

    2015-09-01

    Because the majority of patients present advanced disease at diagnosis, the management of epithelial ovarian cancer needs specialist multidisciplinary teamwork. Expertise in surgery, chemotherapy, imaging and histopathology is essential to achieve optimum outcomes. Computed tomography scans are routinely used to determine the extent of disease and to aid in surgical planning. The histologic classification is crucial to plan the best therapeutic strategy and to define the prognosis of disease. Pathological prognostic factors, such as degree of differentiation, FIGO-stage, and histological type have to be described. This report is fundamental to assessing prognosis and selection of appropriate treatment strategy. An adequate staging procedure is an extensive staging by an experienced gynecological oncologist, exploring the entire upper abdomen, and the pelvic and para-aortic lymph node regions to define the Peritoneal Cancer Index (PCI). The final assessment is the completeness of cytoreduction (CC) score, which is an assessment of residual disease after a maximal surgical effort. Initial management of advanced ovarian cancer is best provided by a specialist multidisciplinary team, including a radiologist, a pathologist, a gynecologic oncologist and a medical oncologist.

  3. Surgical management of presbyopia

    PubMed Central

    Torricelli, André AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

    2012-01-01

    Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages. PMID:23055664

  4. Spacecraft surgical scrub system

    NASA Technical Reports Server (NTRS)

    Abbate, M.

    1980-01-01

    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  5. Postthrombotic Syndrome: Surgical Possibilities

    PubMed Central

    Khanna, Ajay K.; Singh, Shivanshu

    2012-01-01

    Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves. PMID:22084674

  6. How HIV Causes AIDS

    MedlinePlus

    ... Share this: Main Content Area How HIV Causes AIDS HIV destroys CD4 positive (CD4+) T cells, which ... and disease, ultimately resulting in the development of AIDS. Most people who are infected with HIV can ...

  7. AIDS Myths and Misunderstandings

    MedlinePlus

    ... 21, 2014 Select a Language: Fact Sheet 158 AIDS Myths and Misunderstandings WHY ARE THERE SO MANY ... support this belief. Myth: Current medications can cure AIDS. It’s no big deal if you get infected. ...

  8. HIV/AIDS

    MedlinePlus

    ... at risk for serious infections and certain cancers. AIDS stands for acquired immunodeficiency syndrome. It is the final stage of infection with HIV. Not everyone with HIV develops AIDS. HIV most often spreads through unprotected sex with ...

  9. Students with AIDS.

    ERIC Educational Resources Information Center

    Broadwell, Cathy Allen; Strope, John L., Jr.

    1989-01-01

    Addresses the law as it pertains to Acquired Immune Deficiency Syndrome (AIDS) in public elementary and secondary schools. Section 504 of the Rehabilitation Act of 1973 has been used successfully in the majority of the AIDS cases discussed. (MLF)

  10. Unconsciousness - first aid

    MedlinePlus

    Loss of consciousness - first aid; Coma - first aid; Mental status change; Altered mental status ... person is unconscious and: Does not return to consciousness quickly (within a minute) Has fallen down or ...

  11. Frostbite, First Aid

    MedlinePlus

    ... and rashes clinical tools newsletter | contact Share | Frostbite, First Aid A A A Severe frostbite can result in ... became frozen). Frostbite is often associated with hypothermia. First Aid Guide In the case of mild frostbite, the ...

  12. Heat Exhaustion, First Aid

    MedlinePlus

    ... rashes clinical tools newsletter | contact Share | Heat Exhaustion, First Aid A A A Heat exhaustion signs and symptoms ... specific to the other stages of heat illness. First Aid Guide Use a combination of the following measures ...

  13. Heat Cramps, First Aid

    MedlinePlus

    ... rashes clinical tools newsletter | contact Share | Heat Cramps, First Aid A A A Heat cramp signs and symptoms ... if later stages of heat illness are suspected. First Aid Guide Use a combination of the following measures, ...

  14. Heatstroke, First Aid

    MedlinePlus

    ... and rashes clinical tools newsletter | contact Share | Heatstroke, First Aid A A A Heatstroke signs and symptoms can ... specific to the earlier stages of heat illness. First Aid Guide When heatstroke is suspected, seek emergency medical ...

  15. Bruises, First Aid

    MedlinePlus

    ... and rashes clinical tools newsletter | contact Share | Bruises, First Aid A A A Bruises lighten and change color ... Bruises can be a sign of internal bleeding. First Aid Guide If there is external bleeding in addition ...

  16. Tick Bites, First Aid

    MedlinePlus

    ... rashes clinical tools newsletter | contact Share | Tick Bites, First Aid A A A It is important to inspect ... temporary paralysis in their host (called tick paralysis). First Aid Guide To remove an embedded tick: Wash your ...

  17. First Aid: Influenza (Flu)

    MedlinePlus

    ... to Know About Zika & Pregnancy First Aid: The Flu KidsHealth > For Parents > First Aid: The Flu Print ... tiredness What to Do If Your Child Has Flu Symptoms: Call your doctor. Encourage rest. Keep your ...

  18. Hepatic surgical anatomy.

    PubMed

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros

    2004-04-01

    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  19. Surgical lessons from the lake.

    PubMed

    Kothari, Shanu N

    2014-12-01

    After circumnavigating Lake Michigan during a sabbatical in the summer of 2011, the lessons learned from this experience and the surgical parallels between boating and life as a surgeon will be discussed. Topics will include the use of surgical checklists, teamwork and communication, leadership, and surgical mentorship. PMID:25440476

  20. Guideline implementation: Surgical attire.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  1. Robotic surgical training.

    PubMed

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey. PMID:23528718

  2. Robotic surgical training.

    PubMed

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.

  3. Louis Pasteur surgical revolution.

    PubMed

    Toledo-Pereyra, Luis H

    2009-01-01

    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  4. Hearing-aid tester

    NASA Technical Reports Server (NTRS)

    Kessinger, R.; Polhemus, J. T.; Waring, J. G.

    1977-01-01

    Hearing aids are automatically checked by circuit that applies half-second test signal every thirty minutes. If hearing-aid output is distorted, too small, or if battery is too low, a warning lamp is activated. Test circuit is incorporated directly into hearing-aid package.

  5. HIV and AIDS

    MedlinePlus

    ... I Help a Friend Who Cuts? HIV and AIDS KidsHealth > For Teens > HIV and AIDS Print A A A Text Size What's in ... in human history. HIV causes a condition called acquired immunodeficiency syndrome — better known as AIDS . HIV destroys a type ...

  6. Designing State Aid Formulas

    ERIC Educational Resources Information Center

    Zhao, Bo; Bradbury, Katharine

    2009-01-01

    This paper designs a new equalization-aid formula based on fiscal gaps of local communities. When states are in transition to a new local aid formula, the issue of whether and how to hold existing aid harmless poses a challenge. The authors show that some previous studies and the formulas derived from them give differential weights to existing and…

  7. AIDS Education Curriculum Guide.

    ERIC Educational Resources Information Center

    Horry County Board of Education, Conway, SC.

    This curriculum guide was developed, based on sound principles of human growth and development, to present the most recently available information on AIDS (Acquired Immune Deficiency Syndrome). The curriculum presents information on the known facts about AIDS and the AIDS virus infection. It also addresses the potential for adolescents and adults…

  8. First Aid: Rashes

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Rashes KidsHealth > For Parents > First Aid: Rashes Print A A A Text Size Rashes ... For Kids For Parents MORE ON THIS TOPIC First Aid: Skin Infections Poison Ivy Erythema Multiforme Hives (Urticaria) ...

  9. First Aid: Burns

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Burns KidsHealth > For Parents > First Aid: Burns Print A A A Text Size Scald ... THIS TOPIC Kitchen: Household Safety Checklist Fireworks Safety First Aid: Sunburn Firesetting Fire Safety Burns Household Safety: Preventing ...

  10. First Aid: Croup

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Croup KidsHealth > For Parents > First Aid: Croup Print A A A Text Size Croup ... For Kids For Parents MORE ON THIS TOPIC First Aid: Coughing X-Ray Exam: Neck Why Is Hand ...

  11. First Aid: Falls

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Falls KidsHealth > For Parents > First Aid: Falls Print A A A Text Size en ... Floors, Doors & Windows, Furniture, Stairways: Household Safety Checklist First Aid: Broken Bones Head Injuries Preventing Children's Sports Injuries ...

  12. First Aid: Choking

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Choking KidsHealth > For Parents > First Aid: Choking Print A A A Text Size Choking ... usually are taught as part of any basic first-aid course. Reviewed by: Steven Dowshen, MD Date reviewed: ...

  13. First Aid: Dehydration

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Dehydration KidsHealth > For Parents > First Aid: Dehydration Print A A A Text Size Dehydration ... MORE ON THIS TOPIC Summer Safety Heat Illness First Aid: Heat Illness Sun Safety Dehydration Diarrhea Vomiting Word! ...

  14. First Aid: Animal Bites

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy First Aid: Animal Bites KidsHealth > For Parents > First Aid: Animal Bites Print A A A Text Size ... For Kids For Parents MORE ON THIS TOPIC First Aid & Safety Center Infections That Pets Carry Dealing With ...

  15. Space Derived Health Aids (AID, Heart Monitor)

    NASA Technical Reports Server (NTRS)

    1981-01-01

    CPI's spinoff from miniaturized pace circuitry is the new heart-assist device, the AID implantable automatic pulse generator. AID pulse generator monitors the heart continuously, recognizes onset of fibrillation, then administers a corrective electrical shock. A mini- computer, a power source, and two electrodes which sense heart activity are included in the unit. An associated system was also developed. It includes an external recorder to be worn by AID patients and a physician's console to display the data stored by the recorder. System provides a record of fibrillation occurrences and the ensuing defibrillation.

  16. Arab nations: attitudes to AIDS.

    PubMed

    Kandela, P

    1993-04-01

    In the Arab world the number of people infected with HIV is uncertain, but official figures underreport the disease, even in Lebanon where public information is credible. The Ministry of Health figure of 130 recorded cases of AIDS since 1984 has been disputed by doctors, who also disclosed that a recent traffic-accident victim acquired HIV after a blood transfusion in a large Beirut hospital. In Marrakesh the blood bank releases figures on proportions of HIV-positive cases among blood donors only under special permission from the Ministry of Health. However, public health, education material is being produced in Morocco in a joint venture between the Pasteur Foundation and the Moroccan Association against AIDS. In Tunisia disputable figures released in January 1993 state that there are only 350 known cases of AIDS. In Jordan a Ministry of Health ruling mandates graduates of foreign medical schools seeking appointments at government hospitals to undergo pre-employment tests for HIV. In the United Arab Emirates and Saudi Arabia similar rules apply to foreign medical workers, and those found to be HIV-positive are deported. The chairman of the Egyptian Medical Association disclosed that his association is testing doctors regularly to ensure their safety. Doctors found to be HIV-positive should be isolated from society with suitable medical care. A specialist at Abasa Fever Hospital has proposed the establishment of an AIDS colony for all infected persons and a national screening program for all Egyptians. Aswan district is to institute a pilot scheme of annual HIV testing for all hotel employees because of their contact with foreigners. According to WHO figures, Egypt's AIDS rate is not high, and the HIV seropositivity rate among blood donors was 1 in 110,254 in 1991. More health education is being carried out in Egypt than in any other Arab country except Lebanon, and the availability of condoms for family planning purposes helps in the protection against HIV

  17. Rhinoplasty: surface aesthetics and surgical techniques.

    PubMed

    Çakir, Bariş; Doğan, Teoman; Öreroğlu, Ali Riza; Daniel, Rollin K

    2013-03-01

    Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights, with specific proportions and breakpoints. Our evaluation of the nasal surface aesthetics is achieved using the concept of geometric polygons as aesthetic subunits, both to define the existing deformity and the aesthetic goals. Surgical techniques have been developed and modified to achieve the desired surface appearance, and those are detailed in this article. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operative plan to achieve specific goals, and to select the appropriate operative technique. These aesthetic concepts and surgical techniques were used in 257 consecutive rhinoplasties performed in the past 3 years by the principal author (B.Ç.).

  18. BEMFAM delivers AIDS alert.

    PubMed

    1993-05-01

    The Sociedade Civil Bem-Estar Familiar (BEMFAM) of Brazil developed a project using integrated communication strategies to alert prostitutes and their clients about the risks of contracting HIV. The project specifically promoted condom use and was conducted within the context of BEMFAM's Integrated Family Planning Program. Villa Mimoza, a prostitution zone in the Estacio neighborhood of Rio de Janeiro, was the site of the intervention. This neighborhood harbors 44 houses of prostitution where an estimated 500 female prostitutes receive clients. An agreement was reached with the Association of Prostitutes of the State of Rio de Janeiro whereby it would help mobilize local women, merchants, brothel owners, and clients. Initial needs were assessed by BEMFAM and AIDSCOM through questionnaires and focus groups. It was subsequently resolved that radio programs, counter displays of educational materials in brothels, and posters in brothel rooms would be the most effective channels through which to carry integrated, effective messages to the community. Final evaluation found a change in attitude and an awareness of the importance of measures to prevent AIDS along with a prevalent increase in condom use.

  19. Hearing Aid Assembly

    NASA Technical Reports Server (NTRS)

    Grugel, Richard N. (Inventor)

    2002-01-01

    Progress in hearing aids has come a long way. Yet despite such progress hearing aids are not the perfect answer to many hearing problems. Some adult ears cannot accommodate tightly fitting hearing aids. Mouth movements such as chewing, talking, and athletic or other active endeavors also lead to loosely fitting ear molds. It is well accepted that loosely fitting hearing aids are the cause of feedback noise. Since feedback noise is the most common complaint of hearing aid wearers it has been the subject of various patents. Herein a hearing aid assembly is provided eliminating feedback noise. The assembly includes the combination of a hearing aid with a headset developed to constrict feedback noise.

  20. HIV, AIDS, and the Future

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV, AIDS, and the Future Past Issues / Summer 2009 Table ... and your loved ones from HIV/AIDS. The AIDS Memorial Quilt In 1987, a total of 1, ...