Single incision for oncologic breast conserving surgery and sentinel node biopsy in early stage breast cancer: A minimally invasive approach.

Introduction Breast conserving surgery (BCS) has a postoperative morbidity up to 30%. We report the feasibility of a single-incision approach for tumor excision and axillary sentinel node biopsy (SNB) sampling intended to minimize patient morbidity and complications. Materials and methods A tertiary surgical oncology single surgeon database was retrospectively reviewed for all patients undergoing BCS and SNB between January 2013 and December 2015. The single-incision approach used a single breast incision to resect the tumor and the Lymphazurin-tagged SNB. The multi-incision group used a breast incision and a separate axillary incision. Results The single-incision approach was associated with shorter operative time (56 vs 64 minutes, P = 0.026). Sentinel node retrieval was achieved in 100% in both groups. The single-incision technique was used primarily in the upper outer quadrant (N = 41, 85.4%), but was also selectively applied in other quadrants (N = 5). There was no significant difference in complication rates between the two procedures (P = 0.425), and there were no instances of conversion from single-incision to standard BCS-SNB. Conclusions Minimally invasive breast conserving surgery is feasible for patients with early breast cancer located in the upper outer quadrants. This technique may reduce postoperative morbidity and improved cosmetic result

Agile development of a virtual reality cognitive assessment

In recent years user-centered design, participatory design and agile development have seen much popularity in the field of software development. More specifically, applying these methods to user groups with cognitive and motor disabilities has been the topic of numerous publications. However, neuropsychological assessment and training require special consideration to include therapists and brain-injured patients into the development cycle. Application goals, development tools and communication between all stakeholders are interdependent and outlined in a framework that promotes elements of agile development. The framework is introduced by example of a virtual reality cognitive assessment for patients with traumatic brain injuries. The assessment has seen a total of 20 iterations over the course of nine months including changes in task content, task difficulty, user interaction and data collection. The framework and development of the cognitive assessment are discussed.Peer Reviewe

Psychophysiology to Assess Impact of Varying Levels of Simulation Fidelity in a Threat Environment

There are many virtual environments found in the serious game community that simulate real world scenarios. There is a broad range of fidelity and experimental controls among these serious games. An important component to most evaluations is the extent to which level of fidelity impacts the persons immersed in the serious game. While a great deal of virtual environment and serious game research has assessed the subjective state or feeling of the participant (e.g., the participant’s sense of presence) through the use of questionnaires, the current study examines participant experience by examining psychophysiological responses of participants to their surroundings. The primary goal in this study was evaluative: will a virtual environment with arousing contents result in increased sensory arousal if it is presented in a highly immersive configuration? A secondary goal of this study was to investigate the utility of our environment to offer varying levels of stimulus threat to impact the user’s experience of the virtual environment. Increased simulation fidelity in an arousing environment resulted in faster heart rates and increased startle eyeblink amplitudes, suggesting that higher fidelity scenarios had great efficacy related to sensory arousal

IceCube Science

We discuss the status of the kilometer-scale neutrino detector IceCube and its low energy upgrade Deep Core and review its scientific potential for particle physics. We subsequently appraise IceCube's potential for revealing the enigmatic sources of cosmic rays. After all, this aspiration set the scale of the instrument. While only a smoking gun is missing for the case that the Galactic component of the cosmic ray spectrum originates in supernova remnants, the origin of the extragalactic component remains as inscrutable as ever. We speculate on the role of the nearby active galaxies Centaurus A and M87.Comment: 19 pages, 8 figures; Talk at Discrete 08, Valencia, Spai

Considering patient safety in autonomous e-mental health systems - detecting risk situations and referring patients back to human care

Background: Digital health interventions can fill gaps in mental healthcare provision. However, autonomous e-mental health (AEMH) systems also present challenges for effective risk management. To balance autonomy and safety, AEMH systems need to detect risk situations and act on these appropriately. One option is sending automatic alerts to carers, but such 'auto-referral' could lead to missed cases or false alerts. Requiring users to actively self-refer offers an alternative, but this can also be risky as it relies on their motivation to do so. This study set out with two objectives. Firstly, to develop guidelines for risk detection and auto-referral systems. Secondly, to understand how persuasive techniques, mediated by a virtual agent, can facilitate self-referral. Methods: In a formative phase, interviews with experts, alongside a literature review, were used to develop a risk detection protocol. Two referral protocols were developed - one involving auto-referral, the other motivating users to self-refer. This latter was tested via crowd-sourcing (n = 160). Participants were asked to imagine they had sleeping problems with differing severity and user stance on seeking help. They then chatted with a virtual agent, who either directly facilitated referral, tried to persuade the user, or accepted that they did not want help. After the conversation, participants rated their intention to self-refer, to chat with the agent again, and their feeling of being heard by the agent. Results: Whether the virtual agent facilitated, persuaded or accepted, influenced all of these measures. Users who were initially negative or doubtful about self-referral could be persuaded. For users who were initially positive about seeking human care, this persuasion did not affect their intentions, indicating that a simply facilitating referral without persuasion was sufficient. Conclusion: This paper presents a protocol that elucidates the steps and decisions involved in risk detection, something that is relevant for all types of AEMH systems. In the case of self-referral, our study shows that a virtual agent can increase users' intention to self-refer. Moreover, the strategy of the agent influenced the intentions of the user afterwards. This highlights the importance of a personalised approach to promote the user's access to appropriate care.Interactive Intelligenc

Catecholamine responses to virtual combat: implications for post-traumatic stress and dimensions of functioning

PTSD symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness

Magnetization dynamics with a spin-transfer torque

The magnetization reversal and dynamics of a spin valve pillar, whose lateral size is 64$\times$64 nm$^2$, are studied by using micromagnetic simulation in the presence of spin transfer torque. Spin torques display both characteristics of magnetic damping (or anti-damping) and of an effective magnetic field. For a steady-state current, both M-I and M-H hysteresis loops show unique features, including multiple jumps, unusual plateaus and precessional states. These states originate from the competition between the energy dissipation due to Gilbert damping and the energy accumulation due to the spin torque supplied by the spin current. The magnetic energy oscillates as a function of time even for a steady-state current. For a pulsed current, the minimum width and amplitude of the spin torque for achieving current-driven magnetization reversal are quantitatively determined. The spin torque also shows very interesting thermal activation that is fundamentally different from an ordinary damping effect.Comment: 15 figure

User-centered virtual environment design for virtual rehabilitation

<p>Abstract</p> <p>Background</p> <p>As physical and cognitive rehabilitation protocols utilizing virtual environments transition from single applications to comprehensive rehabilitation programs there is a need for a new design cycle methodology. Current human-computer interaction designs focus on usability without benchmarking technology within a user-in-the-loop design cycle. The field of virtual rehabilitation is unique in that determining the efficacy of this genre of computer-aided therapies requires prior knowledge of technology issues that may confound patient outcome measures. Benchmarking the technology (e.g., displays or data gloves) using healthy controls may provide a means of characterizing the "normal" performance range of the virtual rehabilitation system. This standard not only allows therapists to select appropriate technology for use with their patient populations, it also allows them to account for technology limitations when assessing treatment efficacy.</p> <p>Methods</p> <p>An overview of the proposed user-centered design cycle is given. Comparisons of two optical see-through head-worn displays provide an example of benchmarking techniques. Benchmarks were obtained using a novel vision test capable of measuring a user's stereoacuity while wearing different types of head-worn displays. Results from healthy participants who performed both virtual and real-world versions of the stereoacuity test are discussed with respect to virtual rehabilitation design.</p> <p>Results</p> <p>The user-centered design cycle argues for benchmarking to precede virtual environment construction, especially for therapeutic applications. Results from real-world testing illustrate the general limitations in stereoacuity attained when viewing content using a head-worn display. Further, the stereoacuity vision benchmark test highlights differences in user performance when utilizing a similar style of head-worn display. These results support the need for including benchmarks as a means of better understanding user outcomes, especially for patient populations.</p> <p>Conclusions</p> <p>The stereoacuity testing confirms that without benchmarking in the design cycle poor user performance could be misconstrued as resulting from the participant's injury state. Thus, a user-centered design cycle that includes benchmarking for the different sensory modalities is recommended for accurate interpretation of the efficacy of the virtual environment based rehabilitation programs.</p

The Discovery Potential of a Super B Factory

The Proceedings of the 2003 SLAC Workshops on flavor physics with a high luminosity asymmetric e+e- collider. The sensitivity of flavor physics to physics beyond the Standard Model is addressed in detail, in the context of the improvement of experimental measurements and theoretical calculations.Comment: 476 pages. Printed copies may be obtained by request to [email protected] . arXiv admin note: v2 appears to be identical to v

A virtual reality and retailing literature review: Current focus, underlying themes and future directions

This literature review reveals the current research focus, underlying themes and prominent research gaps in the Virtual Reality (VR) literature. 89 journal articles from the 22 years are thematically analysed in order to non-obvious reveal interconnections and themes, including research focus over time and underlying themes by research discipline. Over half of all papers focus on the need to understand the VR shopping consumer, yet no consensus exists as to what the optimal experience is or how to design effective v-Commerce stores. The most prominent research gaps are related to the unique HCI aspects in v-Commerce that influence shopping behaviours. The impact of this review is establishing the current challenges and future directions for academia in order to make v-Commerce a viable reality. Specifically, future research should focus on develop human factor theory in VR shop design (i.e. social dimension, eye-tracking etc.)