Guidance in breast-conserving surgery: tumour localization versus identification

In breast-conserving surgery (BCS), the tumour is removed with the goal of preserving as much healthy breast tissue as possible. Breast conservation comes with a risk of positive resection margins, an independent predictor of ipsilateral tumour recurrence, necessitating reoperation1. Contemporary data from the UK Get it Right First Time1 suggest high average reoperation rates of around 19 %. Current tumour localization techniques can only guide surgeons to the tumour epicentre, but fail to provide identification of the boundary between tumour and normal tissue. Imaging techniques, such as intraoperative ultrasonography (IOUS), intraoperative MRI (iMRI) or fluorescence-guided surgery (FGS), enable visualization of the tumour in its entirety and may provide improved operative precision2–5

Energy Requirement of Control: Comments on Szilard's Engine and Maxwell's Demon

In mathematical physical analyses of Szilard's engine and Maxwell's demon, a general assumption (explicit or implicit) is that one can neglect the energy needed for relocating the piston in Szilard's engine and for driving the trap door in Maxwell's demon. If this basic assumption is wrong, then the conclusions of a vast literature on the implications of the Second Law of Thermodynamics and of Landauer's erasure theorem are incorrect too. Our analyses of the fundamental information physical aspects of various type of control within Szilard's engine and Maxwell's demon indicate that the entropy production due to the necessary generation of information yield much greater energy dissipation than the energy Szilard's engine is able to produce even if all sources of dissipation in the rest of these demons (due to measurement, decision, memory, etc) are neglected.Comment: New, simpler and more fundamental approach utilizing the physical meaning of control-information and the related entropy production. Criticism of recent experiments adde

Statistics of the dissipated energy in driven single-electron transitions

We analyze the distribution of heat generated in driven single-electron transitions and discuss the related non-equilibrium work theorems. In the adiabatic limit, the heat distribution is shown to become Gaussian, with the heat noise that, in spite of thermal fluctuations, vanishes together with the average dissipated energy. We show that the transitions satisfy Jarzynski equality for arbitrary drive and calculate the probability of the negative heat values. We also derive a general condition on the heat distribution that generalizes the Bochkov-Kuzovlev equality and connects it to the Jarzynski equality.Comment: 5 pages, 2 figure

Hamiltonian Derivations of the Generalized Jarzynski Equalities under Feedback Control

In the presence of feedback control by "Maxwell's demon," the second law of thermodynamics and the nonequilibrium equalities such as the Jarzynski equality need to be generalized. In this paper, we derive the generalized Jarzynski equalities for classical Hamiltonian dynamics based on the Liouville's theorem, which is the same approach as the original proof of the Jarzynski equality [Phys. Rev. Lett. 78, 2690 (1997)]. The obtained equalities lead to the generalizations of the second law of thermodynamics for the Hamiltonian systems in the presence of feedback control.Comment: Proceedings of "STATPHYS - Kolkata VII", November 26-30, 2010, Kolkata, Indi

Between Thought and Expression, a Magnetoencephalography Study of the "Tip-of-the-Tongue" Phenomenon

“Tip-of-the-tongue” (TOT) is the phenomenon associated with the inaccessibility of a known word from memory. It is universally experienced, increases in frequency with age, and is most common for proper nouns. It is a good model for the symptom of anomia experienced much more frequently by some aphasic patients following brain injury. Here, we induced the TOT state in older participants while they underwent brain scanning with magnetoencephalography to investigate the changes in oscillatory brain activity associated with failed retrieval of known words. Using confrontation naming of pictures of celebrities, we successfully induced the TOT state in 29% of trials and contrasted it with two other states: “Know” where the participants both correctly recognized the celebrity's face and retrieved their name and “Don't Know” when the participants did not recognize the celebrity. We wished to test Levelt's influential model of speech output by carrying out two analyses, one epoching the data to the point in time when the picture was displayed and the other looking back in time from when the participants first articulated their responses. Our main findings supported the components of Levelt's model, but not their serial activation over time as both semantic and motor areas were identified in both analyses. We also found enduring decreases in the alpha frequency band in the left ventral temporal region during the TOT state, suggesting ongoing semantic search. Finally, we identified reduced beta power in classical peri-sylvian language areas for the TOT condition, suggesting that brain regions that encode linguistic memories are also involved in their attempted retrieval

Linear Aerodynamic Loads on Cone-Cylinders at Mach Numbers from 0.7 to 2.0

Linear aerodynamic loads for cone-cylinder configurations in trisonic rang

From Wearable Sensors to Smart Implants – Towards Pervasive and Personalised Healthcare

<p>Objective: This article discusses the evolution of pervasive healthcare from its inception for activity recognition using wearable sensors to the future of sensing implant deployment and data processing. Methods: We provide an overview of some of the past milestones and recent developments, categorised into different generations of pervasive sensing applications for health monitoring. This is followed by a review on recent technological advances that have allowed unobtrusive continuous sensing combined with diverse technologies to reshape the clinical workflow for both acute and chronic disease management. We discuss the opportunities of pervasive health monitoring through data linkages with other health informatics systems including the mining of health records, clinical trial databases, multi-omics data integration and social media. Conclusion: Technical advances have supported the evolution of the pervasive health paradigm towards preventative, predictive, personalised and participatory medicine. Significance: The sensing technologies discussed in this paper and their future evolution will play a key role in realising the goal of sustainable healthcare systems.</p> <p> </p

Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery

Background: Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20–25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment. Methods: Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos. Results: A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40). Conclusions: The REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment