BlueGame - A bluetooth enabled multi-player and multi-platform game: An experience report

Computer games on mobile devices including cellular phones or handheld computers have become a fast expanding industry due to the recent advance in hardware and software supports. Most large mobile game and handheld vendors mainly focus on improving the interactivity and visual effects of, commonly single-user, mobile games. In this project, we carefully designed and then implemented an interactive multi-player action game, namely the BlueGame, transferrable between different computing platforms supported by the Bluetooth wireless technology. In addition to individual user's convenience to continue the multi-player game, our BlueGame prototype highlighted certain shortcomings of the existing Bluetooth technology, and more importantly our valuable experience gained for future wireless game development. ©2006 IEEE.published_or_final_versio

Functional MRI of visual responses in the late stage of neonatal hypoxic-ischemic encephalopathy

Animal Models of Ischemia: Characterization - Poster presentationThis study employs blood oxygenation level-dependent functional MRI to evaluate the visual responses in the rat superior colliculi 2 months after neonatal hypoxic-ischemic encephalopathy. Results showed a smaller BOLD signal amplitude increase in the contralateral superior colliculus of the HIE group in the stimulation period than in the normal group upon either side of eye stimulation. Our results constitute the first fMRI report in evaluating the visual responses of the rat superior colliculus upon neonatal HI insults. These can be potentially useful in establishing the links between the changes related to the visual sensory development after neonatal injury.published_or_final_versionThe 17th Scientific Meeting & Exhibition of the International Society of Magnetic Resonance in Medicine (ISMRM), Honolulu, HI., 18-24 April 2009. In Proceedings of ISMRM 17th Scientific Meeting & Exhibition, 2009, p. 327

Functional MRI of visual development in rat superior colliculus

fMRI Applications & Animal Models - Poster presentationThis study aimed to use visual stimulation in rats to determine age-related visual development from the time of eyelid opening to adulthood. By studying BOLD-fMRI measurements of rat superior colliculus, we demonstrated that the regional BOLD visual response in these animals undergoes a systematic increase in amplitude with age especially during the 3rd postnatal week.published_or_final_versionThe 17th Scientific Meeting & Exhibition of the International Society of Magnetic Resonance in Medicine (ISMRM), Honolulu, HI., 18-24 April 2009. In Proceedings of ISMRM 17th Scientific Meeting & Exhibition, 2009, p. 371

Diffusion-weighted balanced SSFP (DW-bSSFP): a new approach to diffusion tensor imaging

Posters - Diffusion MRI: No. 4003Although DW-EPI offers high acquisition speed, it generally suffers from low spatial resolution and geometric distortion. SSFP is a possible alternative to perform diffusion imaging with higher resolution and with no distortion artifacts that is inherent in EPI. In this study, we modified the balanced SSFP sequence by adding a pair of bipolar diffusion sensitizing gradients. The diffusion effect in bSSFP sequence with a pair of bipolar diffusion gradients was formulated and DW-bSSFP experiment was performed on in vivo rat brain at 7T.postprin

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Functional MRI of substantia nigra upon visual flash illumination

Posters - Animal fMRI: No. 3542In the mammalian midbrain, increasing evidence suggested a direct projection from the superior colliculus (SC) to the substantia nigra (SN), yet their functional characteristics remain largely unknown. This study explores the capability of blood oxygenation level–dependent (BOLD) fMRI to detect simultaneous activations in SC and SN upon visual flash illumination in order to understand the basic visual properties and hemodynamic responses in this functional connection. Upon monocular stimulation, activations were found predominantly in the contralateral SC and SN, whereas upon binocular stimulation activations were observed in SC and SN of both hemispheres. Significantly lower BOLD percent changes were also observed in the SN of both groups than SC before reaching similar peak heights after stimulation. The current results of having the same visual event initiating afferent inputs to both SC and SN could have important implications for interpreting the responses to biologically salient sensory events in relation to novelty, intensity or reward within the SC-SN connection

Functional MRI study of the visual system development in rodent model

Session T2.5 - Neuroimaging: T2.5.4The 4th World Congress on Bioengineering (WACBE 2009), Hong Kong, 26-29 July 2009. In Proceedings of the 4th WACBE World Congress on Bioengineering, 2009, p. 10