Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

Background: The insertion of bolt external ventricular drains (EVD) on the intensive care unit (ICU) has enabled rapid cranial cerebrospinal fluid (CSF) diversion. However, bolt EVDs tend to be perceived as a more challenging technique, particularly when dealing with small ventricles or when there is midline shift distorting the ventricular morphology. Furthermore, if neuronavigation guidance is felt to be necessary, this usually assumes a transfer to an operating theatre. In this technical note, we describe the use of electromagnetic neuronavigation for bolt EVD insertion on the ICU and assess the protocol’s feasibility and accuracy. / Methods: Case series of neuronavigation-assisted bolt EVD insertion in ICU setting, using Medtronic Flat Emitter for StealthStation EM. / Results: Neuronavigation-guided bolt EVDs were placed at the bedside in n = 5 patients on ICU. Their widest frontal ventricular horn diameter in the coronal plane ranged from 11 to 20 mm. No procedural complications were encountered. Post-procedural CT confirmed the optimal placement of the EVDs. / Conclusions: Electromagnetic neuronavigation is feasible at the ICU bedside and can assist the insertion of bolt EVDs in this setting. The preference for a bolt EVD to be inserted in ICU—as is standard practice at this unit—should not prohibit patients from benefitting from image guidance if required

Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions

INTRODUCTION: Microsurgery for the clipping of intracranial aneurysms remains a technically challenging and high-risk area of neurosurgery. We aimed to describe the technical challenges of aneurysm surgery, and the scope for technological innovations to overcome these barriers from the perspective of practising neurovascular surgeons. MATERIALS AND METHODS: Consultant neurovascular surgeons and members of the British Neurovascular Group (BNVG) were electronically invited to participate in an online survey regarding surgery for both ruptured and unruptured aneurysms. The free text survey asked three questions: what do they consider to be the principal technical barriers to aneurysm clipping? What technological advances have previously contributed to improving the safety and efficacy of aneurysm clipping? What technological advances do they anticipate improving the safety and efficacy of aneurysm clipping in the future? A qualitative synthesis of responses was performed using multi-rater emergent thematic analysis. RESULTS: The most significant reported historical advances in aneurysm surgery fell into five themes: (1) optimising clip placement, (2) minimising brain retraction, (3) tissue handling, (4) visualisation and orientation, and (5) management of intraoperative rupture. The most frequently reported innovation by far was indocyanine green angiography (84% of respondents). The three most commonly cited future advances were hybrid surgical and endovascular techniques, advances in intraoperative imaging, and patient-specific simulation and planning. CONCLUSIONS: While some surgeons perceive that the rate of innovation in aneurysm clipping has been dwarfed in recent years by endovascular techniques, surgeons surveyed highlighted a broad range of future technologies that have the potential to continue to improve the safety of aneurysm surgery in the future

Gate-controlled Guiding of Electrons in Graphene

Ballistic semiconductor structures have allowed the realization of optics-like phenomena in electronics, including magnetic focusing and lensing. An extension that appears unique to graphene is to use both n and p carrier types to create electronic analogs of optical devices having both positive and negative indices of refraction. Here, we use gate-controlled density with both p and n carrier types to demonstrate the analog of the fiber-optic guiding in graphene. Two basic effects are investigated: (1) bipolar p-n junction guiding, based on the principle of angle-selective transmission though the graphene p-n interface, and (2) unipolar fiber-optic guiding, using total internal reflection controlled by carrier density. Modulation of guiding efficiency through gating is demonstrated and compared to numerical simulations, which indicates that interface roughness limits guiding performance, with few-nanometer effective roughness extracted. The development of p-n and fiber-optic guiding in graphene may lead to electrically reconfigurable wiring in high-mobility devices.Comment: supplementary materal at http://marcuslab.harvard.edu/papers/OG_SI.pd

Body mass index, physical activity, and dietary behaviors among members of an urban community fitness center: a questionnaire survey

<p>Abstract</p> <p>Background</p> <p>Development of effective behavioral interventions to promote weight control and physical activity among diverse, underserved populations is a public health priority. Community focused wellness organizations, such as YMCAs, could provide a unique channel with which to reach such populations. This study assessed health behaviors and related characteristics of members of an urban YMCA facility.</p> <p>Methods</p> <p>We surveyed 135 randomly selected members of an urban YMCA facility in Massachusetts to examine self-reported (1) physical activity, (2) dietary behaviors, (3) body mass index, and (4) correlates of behavior change among short-term (i.e., one year or less) and long-term (i.e., more than one year) members. Chi-square tests were used to assess bivariate associations between variables, and multivariate linear regression models were fit to examine correlates of health behaviors and weight status.</p> <p>Results</p> <p>Eighty-nine percent of short-term and 94% of long-term members reported meeting current physical activity recommendations. Only 24% of short-term and 19% of long-term members met fruit and vegetable consumption recommendations, however, and more than half were overweight or obese. Length of membership was not significantly related to weight status, dietary behaviors, or physical activity. Most respondents were interested in changing health behaviors, in the preparation stage of change, and had high levels of self-efficacy to change behaviors. Short-term members had less education (p = 0.02), lower household incomes (p = 0.02), and were less likely to identify as white (p = 0.005) than long-term members. In multivariate models, females had lower BMI than males (p = 0.003) and reported less physical activity (p = 0.008). Physical activity was also inversely associated with age (p = 0.0004) and education (p = 0.02).</p> <p>Conclusion</p> <p>Rates of overweight/obesity and fruit and vegetable consumption suggested that there is a need for a weight control intervention among members of an urban community YMCA. Membership in such a community wellness facility alone might not be sufficient to help members maintain a healthy weight. The data indicate that YMCA members are interested in making changes in their dietary and physical activity behaviors. Targeting newer YMCA members might be an effective way of reaching underserved populations. These data will help inform the development of a weight control intervention tailored to this setting.</p

Using technology to deliver cancer follow-up : a systematic review

Peer reviewedPublisher PD

Characterizing eve: Analysing cybercrime actors in a large underground forum

Underground forums contain many thousands of active users, but the vast majority will be involved, at most, in minor levels of deviance. The number who engage in serious criminal activity is small. That being said, underground forums have played a significant role in several recent high-profile cybercrime activities. In this work we apply data science approaches to understand criminal pathways and characterize key actors related to illegal activity in one of the largest and longest- running underground forums. We combine the results of a logistic regression model with k-means clustering and social network analysis, verifying the findings using topic analysis. We identify variables relating to forum activity that predict the likelihood a user will become an actor of interest to law enforcement, and would therefore benefit the most from intervention. This work provides the first step towards identifying ways to deter the involvement of young people away from a career in cybercrime.Alan Turing Institut

Higher-Spin Interactions: four-point functions and beyond

In this work we construct an infinite class of four-point functions for massless higher-spin fields in flat space that are consistent with the gauge symmetry. In the Lagrangian picture, these reflect themselves in a peculiar non-local nature of the corresponding non-abelian higher-spin couplings implied by the Noether procedure that starts from the fourth order. We also comment on the nature of the colored spin-2 excitation present both in the open string spectrum and in the Vasiliev system, highlighting how some aspects of String Theory appear to reflect key properties of Field Theory that go beyond its low energy limit. A generalization of these results to n-point functions, fermions and mixed-symmetry fields is also addressed.Comment: 66 pages, 10 figures, 1 table, LaTex. Several statements clarified. Final version to appear in JHE