Analyzing time attributes in temporal event sequences

Event data is present in a variety of domains such as electronic health records, daily living activities and web clickstream records. Current visualization methods to explore event data focus on discovering sequential patterns but present limitations when studying time attributes in event sequences. Time attributes are especially important when studying waiting times or lengths of visit in patient flow analysis. We propose a visual analytics methodology that allows the identification of trends and outliers in respect of duration and time of occurrence in event sequences. The proposed method presents event data using a single Sequential and Time Patterns overview. User-driven alignment by multiple events, sorting by sequence similarity and a novel visual encoding of events allows the comparison of time trends across and within sequences. The proposed visualization allows the derivation of findings that otherwise could not be obtained using traditional visualizations. The proposed methodology has been applied to a real-world dataset provided by Sheffield Teaching Hospitals NHS Foundation Trust, for which four classes of conclusions were derived

Direct estimation of wall shear stress from aneurysmal morphology: A statistical approach

Computational fluid dynamics (CFD) is a valuable tool for studying vascular diseases, but requires long computational time. To alleviate this issue, we propose a statistical framework to predict the aneurysmal wall shear stress patterns directly from the aneurysm shape. A database of 38 complex intracranial aneurysm shapes is used to generate aneurysm morphologies and CFD simulations. The shapes and wall shear stresses are then converted to clouds of hybrid points containing both types of information. These are subsequently used to train a joint statistical model implementing a mixture of principal component analyzers. Given a new aneurysmal shape, the trained joint model is firstly collapsed to a shape only model and used to initialize the missing shear stress values. The estimated hybrid point set is further refined by projection to the joint model space. We demonstrate that our predicted patterns can achieve significant similarities to the CFD-based results

The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs) is widely accepted. Computational fluid dynamics (CFD) is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT) Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4) which was 63% (range 0–100%) of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject

Flow complexity in open systems: interlacing complexity index based on mutual information

Flow complexity is related to a number of phenomena in science and engineering and has been approached from the perspective of chaotic dynamical systems, ergodic processes or mixing of fluids, just to name a few. To the best of our knowledge, all existing methods to quantify flow complexity are only valid for infinite time evolution, for closed systems or for mixing of two substances. We introduce an index of flow complexity coined interlacing complexity index (ICI), valid for a single-phase flow in an open system with inlet and outlet regions, involving finite times. ICI is based on Shannon’s mutual information (MI), and inspired by an analogy between inlet–outlet open flow systems and communication systems in communication theory. The roles of transmitter, receiver and communication channel are played, respectively, by the inlet, the outlet and the flow transport between them. A perfectly laminar flow in a straight tube can be compared to an ideal communication channel where the transmitted and received messages are identical and hence the MI between input and output is maximal. For more complex flows, generated by more intricate conditions or geometries, the ability to discriminate the outlet position by knowing the inlet position is decreased, reducing the corresponding MI. The behaviour of the ICI has been tested with numerical experiments on diverse flows cases. The results indicate that the ICI provides a sensitive complexity measure with intuitive interpretation in a diversity of conditions and in agreement with other observations, such as Dean vortices and subjective visual assessments. As a crucial component of the ICI formulation, we also introduce the natural distribution of streamlines and the natural distribution of world-lines, with invariance properties with respect to the cross-section used to parameterize them, valid for any type of mass-preserving flow

Heart rate reduction with ivabradine promotes shear stress-dependent anti-inflammatory mechanisms in arteries

Blood flow generates wall shear stress (WSS) which alters endothelial cell (EC) function. Low WSS promotes vascular inflammation and atherosclerosis whereas high uniform WSS is protective. Ivabradine decreases heart rate leading to altered haemodynamics. Besides its cardio-protective effects, ivabradine protects arteries from inflammation and atherosclerosis via unknown mechanisms. We hypothesised that ivabradine protects arteries by increasing WSS to reduce vascular inflammation. Hypercholesterolaemic mice were treated with ivabradine for seven weeks in drinking water or remained untreated as a control. En face immunostaining demonstrated that treatment with ivabradine reduced the expression of pro-inflammatory VCAM-1 (p<0.01) and enhanced the expression of anti-inflammatory eNOS (p<0.01) at the inner curvature of the aorta. We concluded that ivabradine alters EC physiology indirectly via modulation of flow because treatment with ivabradine had no effect in ligated carotid arteries in vivo, and did not influence the basal or TNFα-induced expression of inflammatory (VCAM-1, MCP-1) or protective (eNOS, HMOX1, KLF2, KLF4) genes in cultured EC. We therefore considered whether ivabradine can alter WSS which is a regulator of EC inflammatory activation. Computational fluid dynamics demonstrated that ivabradine treatment reduced heart rate by 20 % and enhanced WSS in the aorta. In conclusion, ivabradine treatment altered haemodynamics in the murine aorta by increasing the magnitude of shear stress. This was accompanied by induction of eNOS and suppression of VCAM-1, whereas ivabradine did not alter EC that could not respond to flow. Thus ivabradine protects arteries by altering local mechanical conditions to trigger an anti-inflammatory response

Modeling intracranial aneurysm stability and growth: An integrative mechanobiological framework for clinical cases

We present a novel patient-specific fluid-solid-growth framework to model the mechanobiological state of clinically detected intracranial aneurysms (IAs) and their evolution. The artery and IA sac are modeled as thick-walled, non-linear elastic fiber-reinforced composites. We represent the undulation distribution of collagen fibers: the adventitia of the healthy artery is modeled as a protective sheath whereas the aneurysm sac is modeled to bear load within physiological range of pressures. Initially, we assume the detected IA is stable and then consider two flow-related mechanisms to drive enlargement: (1) low wall shear stress; (2) dysfunctional endothelium which is associated with regions of high oscillatory flow. Localized collagen degradation and remodelling gives rise to formation of secondary blebs on the aneurysm dome. Restabilization of blebs is achieved by remodelling of the homeostatic collagen fiber stretch distribution. This integrative mechanobiological modelling workflow provides a step towards a personalized risk-assessment and treatment of clinically detected IAs

Robustness of common hemodynamic indicators with respect to numerical resolution in 38 middle cerebral artery aneurysms

Background: Using computational fluid dynamics (CFD) to compute the hemodynamics in cerebral aneurysms has received much attention in the last decade. The usability of these methods depends on the quality of the computations, highlighted in recent discussions. The purpose of this study is to investigate the convergence of common hemodynamic indicators with respect to numerical resolution. Methods: 38 middle cerebral artery bifurcation aneurysms were studied at two different resolutions (one comparable to most studies, and one finer). Relevant hemodynamic indicators were collected from two of the most cited studies, and were compared at the two refinements. In addition, correlation to rupture was investigated. Results: Most of the hemodynamic indicators were very well resolved at the coarser resolutions, correlating with the finest resolution with a correlation coefficient >0.95. The oscillatory shear index (OSI) had the lowest correlation coefficient of 0.83. A logarithmic Bland-Altman plot revealed noticeable variations in the proportion of the aneurysm under low shear, as well as in spatial and temporal gradients not captured by the correlation alone. Conclusion: Statistically, hemodynamic indicators agree well across the different resolutions studied here. However, there are clear outliers visible in several of the hemodynamic indicators, which suggests that special care should be taken when considering individual assessment

Gradeer : an open-source modular hybrid grader

Automated assessment has been shown to greatly simplify the process of assessing students' programs. However, manual assessment still offers benefits to both students and tutors. We introduce Gradeer, a hybrid assessment tool, which allows tutors to leverage the advantages of both automated and manual assessment. The tool features a modular design, allowing new grading functionality to be added. Gradeer directly assists manual grading, by automatically loading code inspectors, running students' programs, and allowing grading to be stopped and resumed in place at a later time. We used Gradeer to assess an end of year assignment for an introductory Java programming course, and found that its hybrid approach offers several benefits

How do coil configuration and packing density influence intra-aneurysmal hemodynamics?

Endovascular coiling is a well-established therapy for treating intracranial aneurysms. Nonetheless, postoperative hemodynamic changes induced by this therapy remain not fully understood. The purpose of this work is to assess the influence of coil configuration and packing density on intra-aneurysmal hemodynamicsThis work was partially supported within the CENIT program, as part of CDTEAM and cvREMOD projects funded by the Spanish CDTI and partly within the framework of the @neurIST Project (IST-2005-027703), which is cofinanced by the European Commission within the IST Program of the Sixth Framework Progra