Subacromial spacer for Tears Affecting Rotator cuff Tendons : a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS)

Background A balloon spacer is a relatively simple addition to an arthroscopic debridement procedure for irreparable rotator cuff tears. Objective To evaluate the clinical and cost-effectiveness of a subacromial balloon spacer for individuals undergoing arthroscopic debridement for irreparable rotator cuff tears. Design A multicentre participant-and assessor-blinded randomised controlled trial comparing arthroscopic debridement with the InSpace® (Stryker, Kalamazoo, MI, USA) balloon to arthroscopic debridement alone, using a novel adaptive design. Pretrial simulations informed stopping boundaries for two interim analyses, using outcome data from early and late time points

Lead-DBS v3.0: Mapping Deep Brain Stimulation Effects to Local Anatomy and Global Networks.

Following its introduction in 2014 and with support of a broad international community, the open-source toolbox Lead-DBS has evolved into a comprehensive neuroimaging platform dedicated to localizing, reconstructing, and visualizing electrodes implanted in the human brain, in the context of deep brain stimulation (DBS) and epilepsy monitoring. Expanding clinical indications for DBS, increasing availability of related research tools, and a growing community of clinician-scientist researchers, however, have led to an ongoing need to maintain, update, and standardize the codebase of Lead-DBS. Major development efforts of the platform in recent years have now yielded an end-to-end solution for DBS-based neuroimaging analysis allowing comprehensive image preprocessing, lead localization, stimulation volume modeling, and statistical analysis within a single tool. The aim of the present manuscript is to introduce fundamental additions to the Lead-DBS pipeline including a deformation warpfield editor and novel algorithms for electrode localization. Furthermore, we introduce a total of three comprehensive tools to map DBS effects to local, tract- and brain network-levels. These updates are demonstrated using a single patient example (for subject-level analysis), as well as a retrospective cohort of 51 Parkinson's disease patients who underwent DBS of the subthalamic nucleus (for group-level analysis). Their applicability is further demonstrated by comparing the various methodological choices and the amount of explained variance in clinical outcomes across analysis streams. Finally, based on an increasing need to standardize folder and file naming specifications across research groups in neuroscience, we introduce the brain imaging data structure (BIDS) derivative standard for Lead-DBS. Thus, this multi-institutional collaborative effort represents an important stage in the evolution of a comprehensive, open-source pipeline for DBS imaging and connectomics

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

The characterization of feces and urine: a review of the literature to inform advanced treatment technology

The safe disposal of human excreta is of paramount importance for the health and welfare of populations living in low income countries as well as the prevention of pollution to the surrounding environment. On-site sanitation (OSS) systems are the most numerous means of treating excreta in low income countries, these facilities aim at treating human waste at source and can provide a hygienic and affordable method of waste disposal. However, current OSS systems need improvement and require further research and development. Development of OSS facilities that treat excreta at, or close to, its source require knowledge of the waste stream entering the system. Data regarding the generation rate and the chemical and physical composition of fresh feces and urine was collected from the medical literature as well as the treatability sector. The data were summarized and statistical analysis was used to quantify the major factors that were a significant cause of variability. The impact of this data on biological processes, thermal processes, physical separators, and chemical processes was then assessed. Results showed that the median fecal wet mass production was 128 g/cap/day, with a median dry mass of 29 g/cap/day. Fecal output in healthy individuals was 1.20 defecations per 24 hr period and the main factor affecting fecal mass was the fiber intake of the population. Fecal wet mass values were increased by a factor of 2 in low income countries (high fiber intakes) in comparison to values found in high income countries (low fiber intakes). Feces had a median pH of 6.64 and were composed of 74.6% water. Bacterial biomass is the major component (25–54% of dry solids) of the organic fraction of the feces. Undigested carbohydrate, fiber, protein, and fat comprise the remainder and the amounts depend on diet and diarrhea prevalence in the population. The inorganic component of the feces is primarily undigested dietary elements that also depend on dietary supply. Median urine generation rates were 1.42 L/cap/day with a dry solids content of 59 g/cap/day. Variation in the volume and composition of urine is caused by differences in physical exertion, environmental conditions, as well as water, salt, and high protein intakes. Urine has a pH 6.2 and contains the largest fractions of nitrogen, phosphorus, and potassium released from the body. The urinary excretion of nitrogen was significant (10.98 g/cap/day) with urea the most predominant constituent making up over 50% of total organic solids. The dietary intake of food and fluid is the major cause of variation in both the fecal and urine composition and these variables should always be considered if the generation rate, physical, and chemical composition of feces and urine is to be accurately predicted

Protocol for a randomised controlled trial of subacromial spacers for tears affecting rotator cuff tendons : a randomised, efficient, adaptive clinical trial in surgery (START:REACTS)

Introduction: Shoulder pain due to irreparable rotator cuff tears can cause substantial disability, but treatment options are limited. A balloon spacer is a relatively simple addition to a standard arthroscopic debridement procedure, but it is costly and there is no current randomised trial evidence to support its use. This trial will evaluate the clinical and cost-effectiveness of a subacromial balloon spacer for individuals undergoing arthroscopic debridement for irreparable rotator cuff tears. New surgical procedures can provide substantial benefit to patients. Good quality randomised controlled trials (RCTs) are needed, but trials in surgery are typically long and expensive, exposing patients to risk and the healthcare system to substantial costs. One way to improve the efficiency of trials is with an adaptive sample size. Such methods are well established in drug trials but have rarely, if ever, been used in surgical trials. Methods and analysis: Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS) is a participant and assessor blinded, adaptive, multicentre RCT comparing arthroscopic debridement with the InSpace balloon (Stryker, USA) to arthroscopic debridement alone for people with a symptomatic irreparable rotator cuff tear. It uses a group sequential adaptive design where interim analyses are performed using all of the 3, 6 and 12-month data that are available at each time point. A maximum of 221 participants will be randomised (1:1 ratio), this will provide 90% power (at the 5% level) for a 6 point difference in the primary outcome; the Oxford Shoulder Score at 12 months. A substudy will use deltoid-active MRI scans in 56 participants to assess the function of the balloon. Analysis will be on an intention-to-treat basis and reported according to principles established in the Consolidated Standards of Reporting Trials statement. Ethics and dissemination: NRES number 18/WM/0025. The results will be disseminated via peer-reviewed publications, presentations at conferences, lay summaries and social media. Trial registration number: ISRCTN1782559

Commons-oriented information syntheses : a model for user-driven design and creation activities

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2008.Includes bibliographical references (p. 173-195).The phenomenon of user-driven creation activities has recently emerged and is quickly expanding, especially on the Web. A growing number of people participate in online activities, where they generate content by themselves, freely share their creations, and combine one another's creations in order to synthesize new material. Similar activities also occur in the area of product development, as people design products for themselves and share their designs for others to reuse or build upon. The phenomenon shows that under some special circumstances, typically passive users can become active creators. Also, under such circumstances, creation activities are not just isolated do-it-yourself activities of an individual; instead, people build on one another's creations and further share their own. Recognizing the positive potential of user-driven design, this work endeavored to understand the underlying drivers of open source creation and essential environmental elements. The most important element is the commons, or shared resources, of the communities where the activities take place. A model of commons-oriented information syntheses was formulated. The model provides a unifying description of user-driven creation activities and, more importantly, serves as a general prescription for how to construct a circumstance to recreate the phenomenon for desired applications. Key aspects of the model include: that, in this particular form of information synthesis, the processes of information creating, participating in a community, and sharing of information take place integrally; that the three processes revolve around the commons; and that people consider the prospective benefits and costs of all three processes when they decide on whether or not to engage in a synthesis activity. This understanding can be employed to build circumstances under which the phenomenon can be recreated.(cont.) The ability to recreate the phenomenon of user-driven creation activities can be beneficial in many areas, including design and knowledge transfer. In the design area, the understanding can be used to build an environment that induces and fosters open-source design. With such environment, people can design things for themselves by reusing, remixing, and building on designs shared by others. They can also freely make available their own designs, which can continue to evolve through a series of building-on processes by others. In the knowledge transfer area, the understanding can be a key to constructing an environment that not only supports transfer of knowledge, but also enables people to further generate knowledge by building on what they receive, particularly when the transferred knowledge is in meta-forms such simulation models. Possible applications include: engineering education (where students can connect models of fundamental topics in various ways to create simulations of complex systems and learn from them), sustainable development (where citizens can integrate models of potential environmental remedies to figure out which solution mix will be the most effective in their situations), and academic communities (where researchers can share and allow their colleagues to reuse or build on simulation models from which the results they publish in journal papers are derived). A prototypical online environment was designed and implemented, employing the essential elements outlined in the model. Hosting a commons of environmental and energy-related simulation models, the environment functions as an open-source design environment for alternative energy systems and a public platform for generative transfers of environmental knowledge. Anyone can freely access the commons, build on them to synthesize new simulation models, and further share their synthesized models as new commons.by Sittha Sukkasi.Ph.D

Grid-based semantic integration of heterogeneous data resources: Implementation on a HealthGrid

This thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel University.The semantic integration of geographically distributed and heterogeneous data resources still remains a key challenge in Grid infrastructures. Today's mainstream Grid technologies hold the promise to meet this challenge in a systematic manner, making data applications more scalable and manageable. The thesis conducts a thorough investigation of the problem, the state of the art, and the related technologies, and proposes an Architecture for Semantic Integration of Data Sources (ASIDS) addressing the semantic heterogeneity issue. It defines a simple mechanism for the interoperability of heterogeneous data sources in order to extract or discover information regardless of their different semantics. The constituent technologies of this architecture include Globus Toolkit (GT4) and OGSA-DAI (Open Grid Service Architecture Data Integration and Access) alongside other web services technologies such as XML (Extensive Markup Language). To show this, the ASIDS architecture was implemented and tested in a realistic setting by building an exemplar application prototype on a HealthGrid (pilot implementation). The study followed an empirical research methodology and was informed by extensive literature surveys and a critical analysis of the relevant technologies and their synergies. The two literature reviews, together with the analysis of the technology background, have provided a good overview of the current Grid and HealthGrid landscape, produced some valuable taxonomies, explored new paths by integrating technologies, and more importantly illuminated the problem and guided the research process towards a promising solution. Yet the primary contribution of this research is an approach that uses contemporary Grid technologies for integrating heterogeneous data resources that have semantically different. data fields (attributes). It has been practically demonstrated (using a prototype HealthGrid) that discovery in semantically integrated distributed data sources can be feasible by using mainstream Grid technologies, which have been shown to have some Significant advantages over non-Grid based approaches

A systematized approach for reduction of medical appointment waiting list

Paper aims: This work aims to develop a systematized approach for the reduction of medical appointment waiting lists, proposing an optimization decision-making model followed by continuous people engagement towards a systematic approach for waiting list problem-solving. Originality: There are several studies related to waiting lists in healthcare contexts, however, the present study presents an innovative approach for waiting list problem-solving by proposing prescriptive decision-making models followed by continuous improvement and people engagement. Research method: A research approach with the following phases was developed: system analysis, problem quantification, and development of an optimization model. After these phases, the model was applied, and the results were analysed, as contributions to a systematized model. Main findings: The model was applied to the screening waiting list for orthopaedics appointments followed by the fundamental involvement of medical doctors, which made it possible to implement the optimal solution generated by the model, resulting in a reduction of 90% by 56 days in waiting time for the screening process. Implications for theory and practice: This model contributes for theory and for practice as a way to deal with different scenarios for waiting list reduction in the upcoming days during and after the pandemic.This work was supported by projects UIDB/00319/2020 and POCI-01-0145-FEDER-030299, from Fundação para a Ciência e Tecnologia (FCT), Portugal