Image-Guided Abdominal Surgery and Therapy Delivery

ABSTRACT Image-Guided Surgery has become the standard of care in intracranial neurosurgery providing more exact resections while minimizing damage to healthy tissue. Moving that process to abdominal organs presents additional challenges in the form of image segmentation, image to physical space registration, organ motion and deformation. In this paper, we present methodologies and results for addressing these challenges in two specific organs: the liver and the kidney

A Transdisciplinary Emergent Approach for Systems and Interventions (EASI)

In modeling human behavior and social structures several factors can emerge over time this can be attributed to the availability of new data, increased complexity, changes to the organizational structure, interventions, introduction of innovative technology or services and due to improved knowledge and treatments. We hypothesize a new class of emergent decision support systems that continually evolve to account for this Causal Drift . In this work, we illustrate the application of the Emergent Approach to Systems and Intervention (EASI™) methodology with the example of Community Intervention Activity Model (CIAM) to reduce the rate of diabetic hospitalization at the local/ county level. A key contribution of this work is the design of an efficient theoretically informed emergent data collection system. A second key contribution of this work is that it offers practitioners a methodology to systematically determine data that needs to be collected and then model the collected data. Thus EASI™ methodology supports the efficient capture of data that has utility in decision making. To ensure applicability of this work publicly available Behavioral Risk Factor Surveillance System (BRFSS) and Social Vulnerability Index (SVI) data sets have been utilized. The EASI™ method has four significant advantages: a) the prediction is based on theoretically informed causal structure; this allows it to be used as a basis for evaluation of interventions as opposed to deep learning and other machine-based structure learning methods which are susceptible to spurious associations, b) existing data is utilized to evaluate clinical relevance of predictions, c) leveraging high dimensional synthetic observational health data to model health objectives, and d) provides guidance on transformation of system from the emergent basis to the new emergent system as new knowledge is gained. The dissertation proposes, implements, and evaluates the EASI™ methodology as applied to a CAIM for the reduction in diabetic hospitalizations

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Effectiveness of therapeutic play in terms of anxiety and behavioral response among hospitalized preschool children in masonic hospital at Coimbatore

Children, especially younger ones, typically fear being separated from their parents during medical visits. This fear may be heightened when the child finds themselves in the strange environment of a treatment room surrounded by unfamiliar people and facing a possibly painful experience. Loss of autonomy and control may cause the young child a great deal of anxiety. Therapeutic play may help to reduce children stress. This play can help prepare children to face upcoming events, or it can provide catharsis by allowing children to express feelings and to reconcile, both cognitively and emotionally, painful or frightening events. Study was done to assess the effectiveness of therapeutic play in terms of anxiety and behavioral response among hospitalized preschool children in Masonic hospital at Coimbatore. The conceptual framework of the study was based on the modified Widenbach’s Selphing art of clinical nursing. The study design was one group pretest post test pre experimental design – non probability purposive sampling technique was used to select 60 samples for the study. The demographics variables are collected and pretest was conducted on the first day by using anxiety rating scale and behavioral response rating scale to assess the level of anxiety and behavioral response level. Immediately after the pretest therapeutic play was given for 30 minutes for the hospitalized preschool children. The therapeutic play was given for 2 times perday, on the next day assess the post test. The data gathered were analyzed employing descriptive and inferential statistics. There is significant difference between pretest and posttest anxiety score (‘t’ value = 18.9) and behavioral response (‘t’ value = 29.66). The result showed that therapeutic play to reduced anxiety and improved behavioral response among hospitalized preschool children

Introducing clinical audit into veterinary practice.

This project has been designed to increase our understanding of the clinical audit process, as it applies to veterinary practice in the UK, and to facilitate its introduction in a manner that brings maximum benefit to all stakeholders. It examines the medical scenario to define the process and glean any relevant information. It then takes the form of an action research project that examines in depth the introduction of the audit process into a small animal practice in outer NW London, including its impact upon the standard of clinical care supplied to its patients, and the sociological effect upon the working environment. The provisional conclusions reached in this way have then been triangulated with the findings of a focus group of veterinarians that are actively involved in the subject, and a broader questionnaire of veterinary practitioners and support staff. The research was able to highlight the key obstacles to introducing clinical audit into a veterinary practice, the benefits that can be achieved when its introduction has been successfully achieved, and how those benefits may ameliorate the time and expense involved. In particular, clinical audit was found to be an effective tool for improving client concordance with the recommended treatment regime for the animals in their care, and thus able to improve both patient welfare and practice income. The sociological changes that are needed to put clinical audit into place successfully, encouraging the development of an integrated team of highly motivated reflective practitioners working within a no-blame practice culture, can bring many additional benefits. This work has taken place at a time when various pressures, such as the RCVS Practice Standards Scheme, and an increased public demand for professional accountability have focused interest in the subject. The author has been leading the way in increasing public awareness of the process, encouraging further research, and ensuring that clinical audit is incorporated into the new modular postgraduate CertAVP designed to develop the learning and skills of the practicing vets of the future

Engineering a 3D ultrasound system for image-guided vascular modelling

Atherosclerosis is often diagnosed using an ultrasound (US) examination in the carotid and femoral arteries and the abdominal aorta. A decision to operate requires two measures of disease severity: the degree of stenosis measured using B-mode US; and the blood flow patterns in the artery measured using spectral Doppler US. However other biomechanical factors such as wall shear stress (WSS) and areas of flow recirculation are also important in disease development and rupture. These are estimated using an image-guided modelling approach, where a three-dimensional computational mesh of the artery is simulated. To generate a patient-specific arterial 3D computational mesh, a 3D ultrasound (3DUS) system was developed. This system uses a standard clinical US scanner with an optical position sensor to measure the position of the transducer; a video capture card to record video images from the scanner; and a PC running Stradwin software to reconstruct 3DUS data. The system was characterised using an industry-standard set of calibration phantoms, giving a reconstruction accuracy of ± 0.17 mm with a 12MHz linear array transducer. Artery movements from pulsatile flow were reduced using a retrospective gating technique. The effect of pressure applied to the transducer moving and deforming the artery was reduced using an image-based rigid registration technique. The artery lumen found on each 3DUS image was segmented using a semi-automatic segmentation technique known as ShIRT (the Sheffield Image Registration Toolkit). Arterial scans from healthy volunteers and patients with diagnosed arterial disease were segmented using the technique. The accuracy of the semi-automatic technique was assessed by comparing it to manual segmentation of each artery using a set of segmentation metrics. The mean accuracy of the semi-automatic technique ranged from 85% to 99% and depended on the quality of the images and the complexity of the shape of the lumen. Patient-specific 3D computational artery meshes were created using ShIRT. An idealised mesh was created using key features of the segmented 3DUS scan. This was registered and deformed to the rest of the segmented dataset, producing a mesh that represents the shape of the artery. Meshes created using ShIRT were compared to meshes created using the Rhino solid modelling package. ShIRT produced smoother meshes; Rhino reproduced the shape of arterial disease more accurately. The use of 3DUS with image-guided modelling has the potential to be an effective tool in the diagnosis of atherosclerosis. Simulations using these data reflect in vivo studies of wall shear stress and recirculation in diseased arteries and are comparable with results in the literature created using MRI and other 3DUS systems