Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift

Determining the Contribution of Epidermal Cell Shape to Petal Wettability Using Isogenic Antirrhinum Lines

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Perfect periodic scheduling for three basic cycles

Periodic scheduling has many attractions for wireless telecommunications. It offers energy saving where equipment can be turned off between transmissions, and high-quality reception through the elimination of jitter, caused by irregularity of reception. However, perfect periodic schedules, in which each (of n) client is serviced at regular, prespecified intervals, are notoriously difficult to construct. The problem is known to be NP-hard even when service times are identical. This paper focuses on cases of up to three distinct periodicities, with unit service times. Our contribution is to derive a O (n 4) test for the existence of a feasible schedule, and a method of constructing a feasible schedule if one exists, for the given combination of client periodicities. We also indicate why schedules with a higher number of periodicities are unlikely to be useful in practice. This methodology can be used to support perfect periodic scheduling in a wide range in real world settings, including machine maintenance service, wireless mesh networks and various other telecommunication networks transmitting packet size data. © 2013 Springer Science+Business Media New York

I2N: image to nutrients, a sensor guided semi-automated tool for annotation of images for nutrition analysis of eating episodes

INTRODUCTION: Dietary assessment is important for understanding nutritional status. Traditional methods of monitoring food intake through self-report such as diet diaries, 24-hour dietary recall, and food frequency questionnaires may be subject to errors and can be time-consuming for the user. METHODS: This paper presents a semi-automatic dietary assessment tool we developed - a desktop application called Image to Nutrients (I2N) - to process sensor-detected eating events and images captured during these eating events by a wearable sensor. I2N has the capacity to offer multiple food and nutrient databases (e.g., USDA-SR, FNDDS, USDA Global Branded Food Products Database) for annotating eating episodes and food items. I2N estimates energy intake, nutritional content, and the amount consumed. The components of I2N are three-fold: 1) sensor-guided image review, 2) annotation of food images for nutritional analysis, and 3) access to multiple food databases. Two studies were used to evaluate the feasibility and usefulness of I2N: 1) a US-based study with 30 participants and a total of 60 days of data and 2) a Ghana-based study with 41 participants and a total of 41 days of data). RESULTS: In both studies, a total of 314 eating episodes were annotated using at least three food databases. Using I2N's sensor-guided image review, the number of images that needed to be reviewed was reduced by 93% and 85% for the two studies, respectively, compared to reviewing all the images. DISCUSSION: I2N is a unique tool that allows for simultaneous viewing of food images, sensor-guided image review, and access to multiple databases in one tool, making nutritional analysis of food images efficient. The tool is flexible, allowing for nutritional analysis of images if sensor signals aren't available

Crew Resource Management for Automated Teammates (CRM-A)

Crew Resource Management (CRM) is the application of human factors knowledge and skills to ensure that teams make effective use of all resources. This includes ensuring that pilots bring in opinions of other teammates and utilize their unique capabilities. CRM was originally developed 40 years ago in response to a number of airline accidents in which the crew was found to be at fault. The goal was to improve teamwork among airline cockpit crews. The notion of "team" was later expanded to include cabin crew and ground resources. CRM has also been adopted by other industries, most notably medicine. Automation research now finds itself faced with similar issues to those faced by aviation 40 years ago: how to create a more robust system by making full use of both the automation and its human operators. With advances in machine intelligence, processing speed and cheap and plentiful memory, automation has advanced to the point that it can and should be treated as a teammate to fully take advantage of its capabilities and contributions to the system. This area of research is known as Human-Autonomy Teaming (HAT). Research on HAT has identified reusable patterns that can be applied in a wide range of applications. These patterns include features such as bi-directional communication and working agreements. This paper will explore the synergies between CRM and HAT. We believe that HAT research has much to learn from CRM and that there are benefits to expanding CRM to cover automation

Decoherence-protected quantum gates for a hybrid solid-state spin register

Protecting the dynamics of coupled quantum systems from decoherence by the environment is a key challenge for solid-state quantum information processing. An idle qubit can be efficiently insulated from the outside world via dynamical decoupling, as has recently been demonstrated for individual solid-state qubits. However, protection of qubit coherence during a multi-qubit gate poses a non-trivial problem: in general the decoupling disrupts the inter-qubit dynamics, and hence conflicts with gate operation. This problem is particularly salient for hybrid systems, wherein different types of qubits evolve and decohere at vastly different rates. Here we present the integration of dynamical decoupling into quantum gates for a paradigmatic hybrid system, the electron-nuclear spin register. Our design harnesses the internal resonance in the coupled-spin system to resolve the conflict between gate operation and decoupling. We experimentally demonstrate these gates on a two-qubit register in diamond operating at room temperature. Quantum tomography reveals that the qubits involved in the gate operation are protected as accurately as idle qubits. We further illustrate the power of our design by executing Grover's quantum search algorithm, achieving fidelities above 90% even though the execution time exceeds the electron spin dephasing time by two orders of magnitude. Our results directly enable decoherence-protected interface gates between different types of promising solid-state qubits. Ultimately, quantum gates with integrated decoupling may enable reaching the accuracy threshold for fault-tolerant quantum information processing with solid-state devices.Comment: This is original submitted version of the paper. The revised and finalized version is in print, and is subjected to the embargo and other editorial restrictions of the Nature journa

Transient peak-strain matching partially recovers the age-impaired mechanoadaptive cortical bone response

Mechanoadaptation maintains bone mass and architecture; its failure underlies age-related decline in bone strength. It is unclear whether this is due to failure of osteocytes to sense strain, osteoblasts to form bone or insufficient mechanical stimulus. Mechanoadaptation can be restored to aged bone by surgical neurectomy, suggesting that changes in loading history can rescue mechanoadaptation. We use non-biased, whole-bone tibial analyses, along with characterisation of surface strains and ensuing mechanoadaptive responses in mice at a range of ages, to explore whether sufficient load magnitude can activate mechanoadaptation in aged bone. We find that younger mice adapt when imposed strains are lower than in mature and aged bone. Intriguingly, imposition of short-term, high magnitude loading effectively primes cortical but not trabecular bone of aged mice to respond. This response was regionally-matched to highest strains measured by digital image correlation and to osteocytic mechanoactivation. These data indicate that aged bone’s loading response can be partially recovered, non-invasively by transient, focal high strain regions. Our results indicate that old murine bone does respond to load when the loading is of sufficient magnitude, and bones’ age-related adaptation failure may be due to insufficient mechanical stimulus to trigger mechanoadaptation

Transoral laser microsurgery for laryngeal cancer: A primer and review of laser dosimetry

Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO2 laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained