Multiparametric quantification of volcanic hazards for eruption forecasting and communication

When a volcano enters a period of unrest it is necessary to assess the threat an eruption will pose. This requires the integration of multiparametric data sets. I present two examples of how different data sets with different levels of uncertainty can be combined to better constrain volcanic hazards, and also how well this information is currently being communicated. Firstly, I develop a new database of plinian eruption characteristics and use it to inform a Bayesian Belief Network that calculates the probability of an eruption becoming plinian in style. I show that the presence of an excess gas phase is one of the key factors. Secondly, I integrate geologic field studies with pyroclastic flow and ash fall modeling to improve hazard assessment at Gede volcano, Indonesia. I use this new set of data to produce an event tree for future activity at Gede. Finally, I perform an analysis of the issuance of volcano alert levels worldwide. I find that current success rates of alert issuance are low and suggest that increasing monitoring networks to an optimal level is likely to improve this.​Doctor of Philosophy (ASE

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT):a systematic review and meta-analysis

BACKGROUND: Optimising filter life and performance efficiency in continuous renal replacement therapy has been a focus of considerable recent research. Larger high quality studies have predominantly focussed on optimal anticoagulation however CRRT is complex and filter life is also affected by vascular access, circuit and management factors. We performed a systematic search of the literature to identify and quantify the effect of vascular access, circuit and patient factors that affect filter life and presented the results as a meta-analysis. METHODS: A systematic review and meta-analysis was performed by searching Pubmed (MEDLINE) and Ovid EMBASE libraries from inception to 29(th) February 2016 for all studies with a comparator or independent variable relating to CRRT circuits and reporting filter life. Included studies documented filter life in hours with a comparator other than anti-coagulation intervention. All studies comparing anticoagulation interventions were searched for regression or hazard models pertaining to other sources of variation in filter life. RESULTS: Eight hundred nineteen abstracts were identified of which 364 were selected for full text analysis. 24 presented data on patient modifiers of circuit life, 14 on vascular access modifiers and 34 on circuit related factors. Risk of bias was high and findings are hypothesis generating. Ranking of vascular access site by filter longevity favours: tunnelled semi-permanent catheters, femoral, internal jugular and subclavian last. There is inconsistency in the difference reported between femoral and jugular catheters. Amongst published literature, modality of CRRT consistently favoured continuous veno-venous haemodiafiltration (CVVHD-F) with an associated 44% lower failure rate compared to CVVH. There was a trend favouring higher blood flow rates. There is insufficient data to determine advantages of haemofilter membranes. Patient factors associated with a statistically significant worsening of filter life included mechanical ventilation, elevated SOFA or LOD score, elevations in ionized calcium, elevated platelet count, red cell transfusion, platelet factor 4 (PF-4) antibodies, and elevated fibrinogen. Majority of studies are observational or report circuit factors in sub-analysis. Risk of bias is high and findings require targeted investigations to confirm. CONCLUSION: The interaction of patient, pathology, anticoagulation, vascular access, circuit and staff factors contribute to CRRT filter life. There remains an ambiguity from published data as to which site and side should be the first choice for vascular access placement and what interaction this has with patient factors and timing. Early consideration of tunnelled semi-permanent access may provide optimal filter life if longer periods of CRRT are anticipated. There remains an absence of robust evidence outside of anti-coagulation strategies despite over 20 years of therapy delivery however trends favour CVVHD-F over CVVH

The 1985 Ohio Thrift Crisis, the FSLIC's Solvency, and Rate Contagion for Retail CDs.

This paper uses both an ARIMA transfer-function intervention model and a panel data analysis to examine the effect of the Ohio deposit insurance crisis in 1985 on the pricing of six-month retail certificates of deposit (CDs) for federally-insured Ohio banks and savings and loans. Adjusting for pricing reactions due to changes in market rates, the authors find a significant, unanticipated rise in CD-rate premiums on the initial event week of the crisis that continued for approximately seven weeks. Consistent with a contingent insurance guarantee hypothesis, rate premiums are found to be risk based. Copyright 1992 by American Finance Association.

An analysis of the issuance of volcanic alert levels during volcanic crises

Volcano Alert Levels (VALs) are used by volcanologists to quickly and simply inform local populations and government authorities of the level of volcanic unrest and eruption likelihood. Most VALs do not explicitly forecast volcanic activity but, in many instances they play an important role in informing decisions: defining exclusion zones and issuing evacuation alerts. We have performed an analysis on VALs (194 eruptions, 60 volcanoes) to assess how well they reflect unrest before eruption and what other variables might control them. We have also looked at VALs in cases where there was an increase in alert level but no eruption, these we term 'Unrest without eruption' (UwE). We have analyzed our results in the context of eruption and volcano type, instrumentation, eruption recurrence, and the population within 30 km. We found that, 19% of the VALs issued between 1990 and 2013 for events that ended with eruption accurately reflect the hazard before eruption. This increases to ~30% if we only consider eruptions with a VEI ≥ 3. VALs of eruptions from closed-vent volcanoes are more appropriately issued than those from open-vents. These two observations likely reflect the longer and stronger unrest signals associated with large eruptions from closed vents. More appropriate VAL issuance is also found in volcanoes with monitoring networks that are moderately-well equipped (3-4 seismometers, GPS and gas monitoring). There is also a better correlation between VALs and eruptions with higher population density. We see over time (1990 to 2013) that there was an increase in the proportion of `UwE’ alerts to other alerts, suggesting increasing willingness to use VALs well before an eruption is certain. The number of accurate VALs increases from 19% to 55% if we consider all UwE alerts to be appropriate. This higher `success’ rate for all alerts (with or without eruption) is improving over time, but still not optimal. We suggest that the low global accuracy of the issuance of VALs could be improved by having more monitoring networks equipped to a medium level, but also by using probabilistic hazard management during volcanic crisis.NRF (Natl Research Foundation, S’pore)ASTAR (Agency for Sci., Tech. and Research, S’pore)Published versio

MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: Technical case report

Laser interstitial thermal therapy (LITT) is increasingly used as a surgical option for the treatment of epilepsy. Placement of the laser fibers relies on stereotactic navigation with cranial fixation pins. In addition, the laser fiber is stabilized in the cranium during the ablation using a cranial bolt that assumes maturity of the skull. Therefore, younger infants (\u3c 2 years of age) have traditionally not been considered as candidates for LITT. However, LITT is an appealing option for patients with familial epilepsy syndromes, such as tuberous sclerosis complex (TSC), due to the multiplicity of lesions and the likely need for multiple procedures. A 4-month-old infant with TSC presented with refractory focal seizures despite receiving escalating doses of 5 antiepileptic medications. Electrographic and clinical seizures occurred numerous times daily. Noninvasive evaluations, including MRI, magnetoencephalography, scalp EEG, and SPECT, localized the ictal onset to a left frontal cortical tuber in the premotor area. In this paper, the authors report a novel technique to overcome the challenges of performing LITT in an infant with an immature skull by repurposing the Navigus biopsy skull mount for stereotactic placement of a laser fiber using electromagnetic-based navigation. The patient underwent successful ablation of the tuber and remained seizure free 4 months postoperatively. To the authors\u27 knowledge, this is the youngest reported patient to undergo LITT. A safe method is described to perform LITT in an infant using commonly available tools without dedicated instrumentation beyond standard stereotactic navigation, a biopsy platform, and the Visualase system

Novel Soft Haptic Biofeedback—Pilot Study on Postural Balance and Proprioception\u3csup\u3e†\u3c/sup\u3e

Sensory feedback is critical in proprioception and balance to orchestrate muscles to perform targeted motion(s). Biofeedback plays a significant role in substituting such sensory data when sensory functions of an individual are reduced or lost such as neurological disorders including stroke causing loss of sensory and motor functions requires compensation of both motor and sensory functions. Biofeedback substitution can be in the form of several means: mechanical, electrical, chemical and/or combination. This study proposes a soft monolithic haptic biofeedback device prototyped and pilot tests were conducted with healthy participants that balance and proprioception of the wearer were improved with applied mechanical stimuli on the lower limb(s). The soft monolithic haptic biofeedback device has been developed and manufactured using fused deposition modelling (FDM) that employs soft and flexible materials with low elastic moduli. Experimental results of the pilot tests show that the soft haptic device can effectively improve the balance of the wearer as much as can provide substitute proprioceptive feedback which are critical elements in robotic rehabilitation

Neoadjuvant Chemotherapy with Laser Interstitial Thermal Therapy in Central Nervous System Neuroblastoma: Illustrative Case and Literature Review

Primitive neuroectodermal tumors of the central nervous system, or CNS neuroblastoma, are rare neoplasms in children. Recently, methylation profiling enabled the discovery of four distinct entities of these tumors. The current treatment paradigm involves surgical resection followed by chemotherapy and radiation. However, upfront surgical resection carries high surgical morbidity in this patient population due to their young age, tumor vascularity, and often deep location in the brain. We report a case of CNS neuroblastoma that can be successfully treated with neoadjuvant chemotherapy followed by minimally invasive laser interstitial thermal therapy and radiation. The patient has complete treatment with no evidence of recurrence at one year follow-up. This case illustrates a potential paradigm shift in the treatment of these rare tumors can be treated using minimally invasive surgical approach to achieve a favorable outcome