A smart digital health platform to enable monitoring of quality of life and frailty in older patients with cancer: a mixed-methods, feasibility study protocol

Objectives: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. Data Sources: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. Conclusion: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. Implications for Nursing Practice: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate “big data” sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care

Methodology for the estimation of aggregate materials influence on the mix design of restoration mortars

The effect of aggregates grading and particle size distribution on the composition of restoration mortars has long been recognised. Aggregates are granular materials that occupy significant volume of the mortar matrix (usually more than 60%). Aggregates properties significantly affect the workability of fresh mortar and the strength, durability and density of hardened mortar. Moreover, the particle size distribution of an aggregate material is critical for the performance of the end mixture.In terms of restoration interventions on historical buildings, the aggregate materials employed for the design of proper restoration mortars should take into consideration the nature and the grading properties of the aggregates already applied in the authentic mortars.Taking into account that through the centuries historic mortars have proved to be well compatible with the historic structural units and long lasting under severe mechanical and environmental loads, mix design of restoration mortars should be approached on the basis of historic materials simulation. However, due to the overcoming industrial production, traditional materials and techniques have been replaced by cement technology, resulting to the loss of traditional building practice. A number of recent restoration interventions have caused significant failures and damage accelerations to the historic building materials and structural units. Therefore, there is a demand for proper restoration mortars and building materials compatible to the original structures.Special research should be followed on the selection of raw materials for the production of suitable restoration mortars. Binder and aggregates are the raw materials of which a mortar mixture consists on its basis. The present work focuses on a thorough investigation on aggregate materials, through mathematical and statistical examination of their grading, by extracting crucial parameters and factors that correspond to the characteristics of grading curves. The experimental works took place at the Materials Laboratory of National Technical University of Athens and at the Directorate for Technical Research and Restoration of the Ministry of Culture, Greece. They concern a thorough investigation of the parameters characterizing gradings of aggregate materials which determine the necessary proportions of raw materials for the mix design of workable restoration mortars. Grading of aggregates contribute significantly to the final behaviour of mortars. A combined evaluation of the mathematical and statistical data obtained permitted a standard method of analysing and integrating various aggregate materials and their properties. The gradation curves extracted from the typical gradation analysis that was performed on a significant number of various aggregates were plotted on graphs where areas of certain void content were determined. These areas correspond to certain proportions of binding materials that should be occupied in the mortar matrix released from the aggregates, which contribute essentially to the final mix design of restoration mortars.Moreover, restoration mortars with certain proportions of binding material and aggregates, as they derive from the study of grading curves, were evaluated regarding their strength development and microstructural parameters obtained through time. For this purpose certain mortar mixes were tested in the laboratory. Further investigation on various mortar mixes would prove the effectiveness of a good grading curve on the behaviour of restoration mortars using various types of binding materials and aggregates.Η επίδραση της κοκκομετρίας των αδρανών υλικών και της κατανομής του μεγέθους των κόκκων τους είναι ιδιαιτέρως σημαντική στη σύνθεση κονιαμάτων αποκατάστασης.Τα αδρανή είναι κοκκώδη υλικά που καταλαμβάνουν σημαντικό ποσοστό στη μήτρα ενός κονιάματος (συνήθως άνω του 60%). Οι ιδιότητές τους επηρεάζουν σημαντικά την συμπεριφορά των κονιαμάτων και συγκεκριμένα, μεταξύ άλλων, την εργασιμότητα των νωπών μιγμάτων, αλλά και την αντοχή, την συνεκτικότητα και την ανθεκτικότητα του σκληρυμένου κονιάματος.Η κατανομή μεγέθους κόκκων ενός αδρανούς υλικού είναι κρίσιμος παράγοντας για την συμπεριφορά του τελικού προϊόντος.Στο γενικότερο πλαίσιο των επεμβάσεων αποκατάστασης σε ιστορικές τοιχοποιίες, τα αδρανή υλικά που χρησιμοποιούνται για τον σχεδιασμό κατάλληλων κονιαμάτων αποκατάστασης θα πρέπει να συμβαδίζουν κατά το δυνατόν με τις απαιτήσεις της φύσης και της κοκκομετρίας του πλέγματος των αδρανών που αναγνωρίζονται στα αυθεντικά κονιάματα ιστορικών τοιχοποιϊών.Λαμβάνοντας υπόψη ότι, στο πέρασμα των χρόνων, τα αυθεντικά κονιάματα έχουν επιδείξει αξιοσημείωτη συμπεριφορά και ανθεκτικότητα σε μηχανικές καταπονήσεις και περιβαλλοντικά φορτία, η Μελέτη Σχεδιασμού (Mix Design) κονιαμάτων αποκατάστασης θα πρέπει να προσεγγιστεί υπό το πρίσμα της προσομοίωσης των αυθεντικών υλικών.Ωστόσο, λόγω της σημαντικής διαφοροποίησης μέσω της βιομηχανικής παραγωγής των δομικών υλικών και της εξάλειψης των παραδοσιακών τεχνικών, καθώς και της ευρείας εφαρμογής τσιμεντιτικών υλικών σε επεμβάσεις αποκατάστασης, έχουν προκληθεί σημαντικές αστοχίες και φθορές στα αυθεντικά δομικά υλικά, επιβεβαιώνοντας την ακαταλληλότητα των υλικών με βάση το τσιμέντο.Επομένως, είναι αναγκαίος ο σχεδιασμός κατάλληλων κονιαμάτων αποκατάστασης συμβατών προς τα αυθεντικά δομικά υλικά.Η επιλογή των πρώτων υλών για την παρασκευή κατάλληλων κονιαμάτων αποκατάστασης χρήζει ιδιαίτερης μελέτης. Ως πρώτες ύλες νοούνται η κονία και τα αδρανή από τα οποία αποτελείται στη βάση του ένα κονίαμα.Η παρούσα εργασία επικεντρώνεται στη διερεύνηση του ρόλου των αδρανών στα κονιάματα αποκατάστασης και συγκεκριμένα στην παραμετροποίηση των κοκκομετρικών αναλύσεων αδρανών υλικών μέσω χαρακτηριστικών κρίσιμων παραμέτρων που προκύπτουν από την μαθηματική και στατιστική επεξεργασία των δεδομένων των κοκκομετρικών αναλύσεων.Η κοκκομετρία των αδρανών επηρεάζει σημαντικά την τελική συμπεριφορά του κονιάματος ως προς τις προσλαμβανόμενες μηχανικές αντοχές και την μικροδομή του. Μια συνδυασμένη εκτίμηση των μαθηματικών και στατιστικών δεδομένων που προκύπτουν από την επεξεργασία των κοκκομετρικών καμπυλών των αδρανών επιτρέπει τον καθορισμό συγκεκριμένης μεθοδολογίας ανάλυσης και διερεύνησης των χαρακτηριστικών τους.Οι κοκκομετρικές καμπύλες που προέκυψαν από την κοκκομετρική ανάλυση συγκεκριμένων αδρανών υλικών παρατέθηκαν σε ημιλογαριθμικά διαγράμματα κατανομής όπου καθορίστηκαν περιοχές που αντιστοιχούν σε συγκεκριμένο ποσοστό όγκου κενών αδρανών (%voids) και κατά συνέπεια σε συγκεκριμένο ποσοστό κονίας που απαιτείται για την πλήρωση των κενών όγκων στο πλέγμα του κονιάματος. Η παραπάνω παράμετρος (%voids) είναι καθοριστική στον σχεδιασμό κονιαμάτων αποκατάστασης.Επιπλέον, εξετάστηκαν στο εργαστήριο και παρουσιάζονται ενδεικτικά συνθέσεις κονιαμάτων αποκατάστασης με συγκεκριμένα ποσοστά ανάμιξης κονίας και αδρανών, όπως αυτά προέκυψαν από την διερεύνηση των κοκκομετρικών καμπυλών των αδρανών υλικών. Τα κονιάματα εξετάστηκαν ως προς την εξέλιξη των μηχανικών αντοχών και της μικροδομής τους στο χρόνο. Περαιτέρω διερεύνηση διαφόρων μιγμάτων κονιαμάτων με χρήση διαφορετικών τύπων συνδετικών κονιών αλλά και αδρανών υλικών θα διεύρυνε την συγκεκριμένη έρευνα που πιστοποιεί την σημαντική επίδραση της κοκκομετρικής κατανομής των αδρανών υλικών στην τελική συμπεριφορά των κονιαμάτων αποκατάσταση

Exploring the neurosurgical anatomy of the human insula: a combined and comparative anatomic-radiologic study

The human insula constitutes the invaginated portion of the cerebral cortex and is less well understood than other cortical areas because of its hidden location. Our purpose was to study the neurosurgical anatomy of the human insula via a combined and comparative study of its gross and imaging anatomy. We totally studied the anatomy of 148 normal insulae in anatomic specimens and radiologic images. We evaluated the number of all insular gyri (short and long), we statistically analyzed our results, and we made comparisons among hemispheres and gender. We also compared the two studies. Finally, we searched in the literature to make comparisons with other authors and to add our experience to the today existing knowledge of the insular anatomy. We found a significantly greater value of the insular gyri number for males, potential underestimation of the real insular gyri number by MRI and that the classic insular gyri pattern can rarely be absent. The middle short insular gyrus can be indistinguishable more likely on MRIs than during surgery, the long insular gyri are less curved than the short gyri, and finally, the insular perforating vessels usually originate at the inferior insular part. Deep knowledge of the gross, imaging, and surgical anatomy of the insula is of paramount importance for neurosurgeons dealing with disorders in this area. The male insula is larger (increased gyri pattern) than the female. Moreover, the classic insular gyri pattern can rarely be absent, probably as a normal anatomic variation

Stereotactic Anatomy of the Human Subthalamic Nucleus: Providing Coordinates for Accurate Electrode Placement

Background and Study Aims Stereotactic targeting of the subthalamic nucleus (STN) for insertion of deep brain stimulation (DBS) electrodes became popular in the last two decades. We present a study focused on the detailed stereotactic anatomy of the STN with respect to its targeting. Material and Methods We used cerebral magnetic resonance (MR) images from 26 patients (50 STNs) for the imaging study. The material of the anatomical study consisted of 24 cerebral hemispheres (24 STNs) from 16 normal human brains. We measured and analyzed the X, X’, Y, Y’, and Z, Z’ stereotactic coordinates of the STN at specific clinically important transverse, coronal, and sagittal planes. Results The STN extended almost 1.5 mm more lateral and almost 1 mm more posterior in patients < 60 years of age. The Y coordinate was more posterior and the X coordinate more lateral on MRI than in anatomical specimens. The left STN was located more lateral than the right STN. Analyzing our data we found a standard coronal zone 1.1 mmwide (zone T), a standard coronal plane (thus providing the most accurate Y target coordinate, plane M), and a standard transverse area (area C) for accurate right STN targeting. Conclusions Our study offers new insights into the stereotactic anatomy of the human STN. These data should be taken into account if performing STN DBS

Absent falx cerebelli: report of a rare case

The falx cerebelli is a small crescentic fold of dura mater below the tentorium cerebelli, which projects forward into the posterior cerebellar notch. Its base is directed upwards and attached to the posterior part of the inferior surface of the tentorium cerebelli in the midline; its posterior margin is attached to the internal occipital crest and contains the occipital sinus; the apex frequently dividing into two small folds which disappear at the sides of the foramen magnum. The material of our neuroanatomic study consisted of formalin-embalmed cadavers that we had in the dissection room of our Department from cadaver donors for students education. We report a case of absence of this dura mater structure from a 91-year-old female cadaver. To our knowledge, this is the first report of absent falx cerebelli in a normal human brain. The review of the literature revealed a few reports of its multiplication

Eagle's Syndrome: A Review of the Literature

Eagle’s syndrome represents symptoms brought on by compression of regional structures by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. Watt Eagle described it for the first time in 1937, dividing it into two subtypes: the “classic syndrome” and the “stylocarotid artery syndrome.” Many theories have been put forth regarding its pathogenesis. Depending on the underlying pathogenetic mechanism and the anatomical structures compressed or irritated by the styloid process, symptoms vary greatly, ranging from cervicofacial pain to cerebral ischemia. The syndrome generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings. Palpation of the styloid process in the tonsillar fossa and infiltration with anesthesia are also used in making the diagnosis. The treatment is primarily surgical; however, some conservative treatments have also been used. The current literature on Eagle’s syndrome is reviewed, highlighting its often underestimated frequency and its clinical importance. Clin. Anat. 22:545-558, 2009. (C) 2009 Wiley-Liss, Inc