scholarly journals Clinical applications of OCTA in ocular oncology: pearls and pitfalls

2021 ◽  
Author(s):  
Marco Pellegrini ◽  
Giovanni Staurenghi ◽  
Chiara Preziosa
Keyword(s):  
Low Cost ◽  
Masking Effect ◽  
Wide Field ◽  
Imaging Tool ◽  
Intraocular Tumors ◽  
Malignant Lesions ◽  
Choroidal Vasculature ◽  
Media Opacities ◽  
Evaluation And Monitoring

Background: Optical Coherence Tomography Angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review we report the main applications and limits of the use of OCTA for the study of intraocular tumors. Summary: OCTA allows a rapid, safe, low-cost and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to tumor inner profile or thickness, poor penetration of laser into the lesion, masking effect from overlying fluid and media opacities and poor fixation. Key messages: The main applications of OCTA in ocular oncology consist in the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy allowing a detailed visualoization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.

scholarly journals I’m No Superman: fostering physician resilience through guided group discussion of Scrubs

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur Holtzclaw ◽  
Jack Ellis ◽  
Christopher Colombo
Keyword(s):  
Internal Medicine ◽  
Training Programs ◽  
Low Cost ◽  
Group Discussion ◽  
Well Being ◽  
Internal Medicine Residency ◽  
Resiliency Training ◽  
High Satisfaction ◽  
Burn Out

Abstract Background Almost half of trainees experience burnout during their career. Despite the Accreditation Council on Graduate Medical Education (ACGME) recommendation that training programs enact well-being curricula, there is no proven method of addressing this difficult topic. Methods We created a curriculum addressing physician resiliency and well-being, designed for an Internal Medicine Residency Program. This curriculum utilized episodes from a medical television series, Scrubs, to facilitate a monthly, 1-h faculty guided discussion group. We collected informal feedback and abbreviated Maslach Burnout Inventories (aMBI) monthly and conducted a formal focus group after 6 months to gauge its effectiveness. Results The curriculum was successfully conducted for 12 months with each session averaging 18–20 residents. Residents reported high satisfaction, stating it was more enjoyable and helpful than traditional resiliency training. 19 of 24 residents (79 %) completed a baseline aMBI, and 17 of 20 residents (85 %) who attended the most recent session completed the 6-month follow-up, showing a non-significant 1-point improvement in all subsets of the aMBI. Conclusions This novel, low-cost, easily implemented curriculum addressed resiliency and burn-out in an Internal Medicine Residency. It was extremely well received and can easily be expanded to other training programs or to providers outside of training.

scholarly journals Process Emulation System for High-Power Piezoelectric Ultrasonic Actuators

2015 ◽  
Vol 2 (3-4) ◽  
pp. 201-205
Author(s):  
Igor Ille ◽  
Sebastian Mojrzisch ◽  
Jens Twiefel
Keyword(s):  
Feedback Control ◽  
Low Cost ◽  
Stable Process ◽  
Present System ◽  
Wide Field ◽  
Hardware In The Loop ◽  
Ultrasonic Assisted ◽  
Long Time ◽  
Number Of Cycles ◽  
High Flexibility

Abstract Ultrasonic actuators are used for a wide field of applications. The vibration energy can be used to realize many processes like ultrasonic welding or bonding. Furthermore there are many processes which run more efficient and faster combined with ultrasonic vibration like ultrasonic-assisted turning or drilling. Piezoelectric transducers are the main part of those applications. Most of the applications have a time-variant load behavior and need an amplitude feedback control to guarantee a stable process. To ensure correct function tests of the feedback control systems have to be done. In this case the processes have to be executed in association with a high number of cycles. To emulate the behavior of the environment the automotive and aerospace industries use hardware in the loop systems since a long time but there is no such a method for ultrasonic systems. This paper presents a method to realize high dynamic load emulation for different ultrasonic applications. Using a piezoelectric transformer it is possible to reproduce load curves by active damping on the secondary side of the transformer using a current proportional digital feedback circuit. A theoretical and experimental study of hardware in the loop system for ultrasonic applications is given by this paper. The present system allows testing a wide field of feedback control algorithms with high flexibility and a high number of cycles by utilization of low-cost components. This proceeding decreases design periods in association with feedback control.

scholarly journals Imaging in Propeller Flap Surgery

2020 ◽  
Vol 34 (03) ◽  
pp. 145-151
Author(s):  
Shimpei Ono ◽  
Hiroyuki Ohi ◽  
Rei Ogawa
Keyword(s):  
Low Cost ◽  
Three Dimensional ◽  
Duplex Sonography ◽  
Computed Tomographic Angiography ◽  
Ease Of Use ◽  
Computed Tomographic ◽  
Imaging Tool ◽  
Preoperative Mapping ◽  
Flap Design ◽  
Tomographic Angiography

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

scholarly journals Processing GOTO data with the Rubin Observatory LSST Science Pipelines I: Production of coadded frames

2021 ◽  
Vol 38 ◽  
Author(s):  
J. R. Mullaney ◽  
L. Makrygianni ◽  
V. Dhillon ◽  
S. Littlefair ◽  
K. Ackley ◽  
...  
Keyword(s):  
Gravitational Wave ◽  
Time Domain ◽  
Wide Area ◽  
Wide Field ◽  
Process Data ◽  
Data Production ◽  
The Time Domain ◽  
Further Development ◽  
High Cadence

Abstract The past few decades have seen the burgeoning of wide-field, high-cadence surveys, the most formidable of which will be the Legacy Survey of Space and Time (LSST) to be conducted by the Vera C. Rubin Observatory. So new is the field of systematic time-domain survey astronomy; however, that major scientific insights will continue to be obtained using smaller, more flexible systems than the LSST. One such example is the Gravitational-wave Optical Transient Observer (GOTO) whose primary science objective is the optical follow-up of gravitational wave events. The amount and rate of data production by GOTO and other wide-area, high-cadence surveys presents a significant challenge to data processing pipelines which need to operate in near-real time to fully exploit the time domain. In this study, we adapt the Rubin Observatory LSST Science Pipelines to process GOTO data, thereby exploring the feasibility of using this ‘off-the-shelf’ pipeline to process data from other wide-area, high-cadence surveys. In this paper, we describe how we use the LSST Science Pipelines to process raw GOTO frames to ultimately produce calibrated coadded images and photometric source catalogues. After comparing the measured astrometry and photometry to those of matched sources from PanSTARRS DR1, we find that measured source positions are typically accurate to subpixel levels, and that measured L-band photometries are accurate to $\sim50$ mmag at $m_L\sim16$ and $\sim200$ mmag at $m_L\sim18$ . These values compare favourably to those obtained using GOTO’s primary, in-house pipeline, gotophoto, in spite of both pipelines having undergone further development and improvement beyond the implementations used in this study. Finally, we release a generic ‘obs package’ that others can build upon, should they wish to use the LSST Science Pipelines to process data from other facilities.

scholarly journals Current role of ultrasound in hemodialysis access evaluation

2021 ◽  
pp. 112972982110346
Author(s):  
Meola Mario ◽  
Jose Ibeas ◽  
Jan Malik
Keyword(s):  
Turning Point ◽  
Point Of Care ◽  
Low Cost ◽  
Wireless Systems ◽  
Future Perspectives ◽  
Maturation Period ◽  
Surveillance Programs ◽  
Dialysis Nurses

Physical examination (PE) is considered the backbone before vascular access (VA) placement, during maturation period and for follow-up. However, it may be inadequate in identifying suitable vasculature, mainly in comorbid patients, or in detecting complications. This review highlights the advantages of ultrasound imaging to manage VA before placement, during maturation and follow-up. Furthermore, it analyses the future perspectives in evaluating early and late VA complications thank to the availability of multiparametric platforms, point of care of ultrasound, and portable/wireless systems. Technical improvements and low-cost systems should favor the widespread ultrasound-based VA surveillance programs. This significant turning point needs an adequate training of nephrologists and dialysis nurses and the standardization of exams, parameters, and procedures.

Processing Panorama Video in Real-time

2014 ◽  
Vol 08 (02) ◽  
pp. 209-227 ◽  
Author(s):  
Håkon Kvale Stensland ◽  
Vamsidhar Reddy Gaddam ◽  
Marius Tennøe ◽  
Espen Helgedagsrud ◽  
Mikkel Næss ◽  
...  
Keyword(s):  
Real Time ◽  
Graphics Processing Units ◽  
Low Cost ◽  
Video Camera ◽  
Wide Field ◽  
High Data ◽  
Data Rates ◽  
Camera Arrays ◽  
Analysis System ◽  
Performance Results

There are many scenarios where high resolution, wide field of view video is useful. Such panorama video may be generated using camera arrays where the feeds from multiple cameras pointing at different parts of the captured area are stitched together. However, processing the different steps of a panorama video pipeline in real-time is challenging due to the high data rates and the stringent timeliness requirements. In our research, we use panorama video in a sport analysis system called Bagadus. This system is deployed at Alfheim stadium in Tromsø, and due to live usage, the video events must be generated in real-time. In this paper, we describe our real-time panorama system built using a low-cost CCD HD video camera array. We describe how we have implemented different components and evaluated alternatives. The performance results from experiments ran on commodity hardware with and without co-processors like graphics processing units (GPUs) show that the entire pipeline is able to run in real-time.

scholarly journals Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Pharmaceutics ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1137
Author(s):  
Irini Chatziralli ◽  
Anat Loewenstein
Keyword(s):  
Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Fundus Photography ◽  
Panretinal Photocoagulation ◽  
Wide Field ◽  
Vascular Endothelial ◽  
Keywords Diabetic Retinopathy ◽  
Anti Vegf ◽  
The Impact

Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

Automated text messaging follow-up for patients who receive peripheral nerve blocks

2021 ◽  
pp. rapm-2021-102472
Author(s):  
Daniel Gessner ◽  
Oluwatobi O Hunter ◽  
Alex Kou ◽  
Edward R Mariano
Keyword(s):  
Regional Anesthesia ◽  
Nerve Block ◽  
Text Messaging ◽  
Low Cost ◽  
Automated System ◽  
Phone Call ◽  
Nerve Blocks ◽  
Patient Response ◽  
Patient Reported

BackgroundRoutine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks.MethodsWe present our experience developing an automated system for completing follow-up via short message service text messaging and our preliminary results using it at three clinical sites. The system is built on REDCap, a secure online research data capture platform developed by Vanderbilt University and currently available worldwide.ResultsOur automated system queried patients who received a variety of nerve block techniques, assessed patient-reported nerve block duration, and surveyed patients for potential complications. Patient response rate to text messaging averaged 91% (higher than our rates of daily phone contact reported previously) for patients aged 18 to 90 years.ConclusionsGiven the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.

Impact of the Karnofsky Performance Status on Survival and its Dynamics during the Terminal Year of Peritoneal Dialysis Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Ana Paula Modesto ◽  
Len Usvyat ◽  
Viviane Calice-Silva ◽  
Dandara Novakowski Spigolon ◽  
Ana Elizabeth Figueiredo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Income ◽  
Independent Predictor ◽  
Karnofsky Performance Status ◽  
Low Cost ◽  
Performance Status ◽  
Multi Center Study ◽  
Complications And Mortality ◽  
First Time

Background Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients’ survival. Methods The data were compiled from the BRAZPD II multi-center study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact of baseline KPS on patients’ survival. Results From the population of 9,905 patients enrolled in the BRAZPD study, 4,133 survived 12 months on PD and were included in the analysis. There was a gradual decline in the KPS scores, which accelerated in the last 2 months before death. These changes were similar irrespective of age, race, family income, gender, diabetes, PD modality, and education level. We observed 989 fatal events in this population during the observation period, and the KPS score was identified as an independent predictor for mortality in this cohort. Conclusions This study demonstrates for the first time the dynamics of KPS before death in PD patients, indicating a progressive and accelerated decline of KPS in the 12 months before patients died. In addition, KPS was an independent predictor of mortality in this population.

scholarly journals Use of Seton in Management of High Variety of Anal Fistula

2017 ◽  
Vol 8 (2) ◽  
pp. 100-104
Author(s):  
Mohammad Noor A Alam ◽  
Sharmin Abbasi
Keyword(s):  
Anal Fistula ◽  
Low Cost ◽  
Dentate Line ◽  
Internal Opening ◽  
Efficacy And Safety ◽  
Medical College ◽  
Small Channel ◽  
A Prospective Study ◽  
Low Rate

Background: Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula.Objectives: Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 57 patients in BIRDEM hospital and some other clinic of Dhaka city in 3 years period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction.Result: Among 57 patients mean age was 38.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 51 patients, incontinence occurred in 2 patients and recurrence occurred in 4 patients.Conclusion: Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 100-104

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