Optimizing electrode positioning in 3-lead ECG chest devices

Although the 12-lead electrocardiogram has become an essential medical and research tool, many current and envisaged applications would benefit from simpler devices, using 3-lead ECG configuration. This is particularly true for Ambient Assisted Living (in a broad perspective). However, the chest anatomy of female patients, namely during pregnancy, can hamper the adequate placement of a 3-lead ECG device and, very often, electrodes are placed below the chest rather than at the precise thoracic landmarks. Thus, the aim of this study was to compare the effect of electrode positioning on the ECG signal of pregnant women and provide guidelines for device development. The effect of breast tissue on the ECG signal was investigated by relating breast size with the signal-to-noise ratio, root mean square and R-wave amplitude. Results show that the 3-lead ECG should be placed on the breast rather than under the breast and indicate positive correlation between breast size and signal-to-noise ratio.

Travel preferences of the residents of Guimarães: a revised model of push and pull motives

The historic center of the Portuguese city of Guimarães is a world heritage site (UNESCO) since 2001, having hosted the European Capital of Culture (ECOC) in 2012. In this sense, Guimarães has made a major effort in promoting tourism, positioning itself as an urban and cultural tourism destination. The present paper has two objectives. The first, to examine if an existing push and pull motivation model finds statistical support with regard to the population of the municipality of Guimarães, a cultural tourism destination. The second, to study the role that important socio-demographic variables, such as gender, age, and education, play in determining travel motivations of residents from this municipality. Insight on tourism motivation may be an important policy tool for tourism planners and managers in the development of products and marketing strategies. The empirical analysis is undertaken based on questionnaires administered in 2012 to residents of Guimarães. The present study shows that gender, age and education make a difference with regard to travel motivations.

Estimating Local Part Thickness in Midplane Meshes for Finite Element Analysis

Within the development of motor vehicles, crash safety (e.g. occupant protection, pedestrian protection, low speed damageability), is one of the most important attributes. In order to be able to fulfill the increased requirements in the framework of shorter cycle times and rising pressure to reduce costs, car manufacturers keep intensifying the use of virtual development tools such as those in the domain of Computer Aided Engineering (CAE). For crash simulations, the explicit finite element method (FEM) is applied. The accuracy of the simulation process is highly dependent on the accuracy of the simulation model, including the midplane mesh. One of the roughest approximations typically made is the actual part thickness which, in reality, can vary locally. However, almost always a constant thickness value is defined throughout the entire part due to complexity reasons. On the other hand, for precise fracture analysis within FEM, the correct thickness consideration is one key enabler. Thus, availability of per element thickness information, which does not exist explicitly in the FEM model, can significantly contribute to an improved crash simulation quality, especially regarding fracture prediction. Even though the thickness is not explicitly available from the FEM model, it can be inferred from the original CAD geometric model through geometric calculations. This paper proposes and compares two thickness estimation algorithms based on ray tracing and nearest neighbour 3D range searches. A systematic quantitative analysis of the accuracy of both algorithms is presented, as well as a thorough identification of particular geometric arrangements under which their accuracy can be compared. These results enable the identification of each technique’s weaknesses and hint towards a new, integrated, approach to the problem that linearly combines the estimates produced by each algorithm.

Slicing for architectural analysis

Current software development often relies on non-trivial coordination logic for combining autonomous services, eventually running on different platforms. As a rule, however, such a coordination layer is strongly woven within the application at source code level. Therefore, its precise identification becomes a major methodological (and technical) problem and a challenge to any program understanding or refactoring process. The approach introduced in this paper resorts to slicing techniques to extract coordination data from source code. Such data are captured in a specific dependency graph structure from which a coordination model can be recovered either in the form of an Orc specification or as a collection of code fragments corresponding to the identification of typical coordination patterns in the system. Tool support is also discussed

Kidney targeting and puncturing during percutaneous nephrolithotomy: recent advances and future perspectives

Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies. Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this review as a summary of the main contributions to kidney targeting and puncturing. Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the applicationofmedical imaging guidance, newsurgical tools,motion tracking systems, robotics, andimage processing and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable solution has yet been reached, and it remains an active and challenging research field. Future developments should focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques

Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience

Purpose: Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Materials and Methods: Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. Results: A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p ¼ 0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p ¼ 0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. Conclusions: The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques

Extracting and verifying coordination models from source code

Current software development relies increasingly on non-trivial coordination logic for com- bining autonomous services often running on di erent platforms. As a rule, however, in typical non-trivial software systems, such a coordination layer is strongly weaved within the application at source code level. Therefore, its precise identi cation becomes a major methodological (and technical) problem which cannot be overestimated along any program understanding or refactoring process. Open access to source code, as granted in OSS certi cation, provides an opportunity for the devel- opment of methods and technologies to extract, from source code, the relevant coordination information. This paper is a step in this direction, combining a number of program analysis techniques to automatically recover coordination information from legacy code. Such information is then expressed as a model in Orc, a general purpose orchestration language

Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach

Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the ‘reversed Nuss’ technique as minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2–3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs’ backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.

Kidney targeting and puncturing during percutaneous nephrolithotomy:recent advances and future perspectives

Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies.

Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience

Purpose: Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Materials and Methods: Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. Results: A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p ¼ 0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p ¼ 0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. Conclusions: The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques.

Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

Performance management framework: the fit between PM framework adopted in Portuguese local government and the Otley’s framework

Purpose/objectives: This paper seeks to investigate whether performance management (PM) framework adopted in Portuguese local government (PLG) fit the Otley’s PM framework (1999). In particularly, the research questions are (1) whether PM framework adopted in PLG (SIADAP) fit the Otley´s framework, and (2) how local politicians (aldermen) see the operation of performance management systems (PMS) in PLG (focusing on the goal-setting process and incentive and reward structures). Theoretical positioning/contributions: With this paper we intend to contribute to literature on how the Otley’s PM framework can guide empirical research about the operation of PMS. In particular, the paper contributes to understand the fit between PMS implemented in PLG and the Otley´s PM framework. The analysis of this fit can be a good contribution to understand if PMS are used in PLG as a management tool or as a strategic response to external pressures (based on interviews conducted to aldermen). We believe that the Otley’s PM framework, as well as the extended PM framework presented by Ferreira and Otley (2009), can provide a useful research tool to understand the operation of PMS in PLG. Research method: The first research question is the central issue in this paper and is analyzed based on the main reforms introduced by Portuguese government on PM of public organizations (like municipalities). On the other hand, interviews conducted on three larger Portuguese municipalities (Oporto, Braga, and Matosinhos) show how aldermen see the operation of PMS in PLG, highlighting the goals setting process with targets associated and the existing of incentive and reward structures linked with performance. Findings: Generally we find that formal and regulated PM frameworks in PLG fit the main issues of the Otley’s PM framework. However, regarding the aldermen perceptions about PMS in practice we find a gap between theory and practice, especially regarding difficulties associated with the lack of a culture of goals and targets setting and the lack of incentive and reward structures linked with performance.

A-scan ultrasound system for real-time puncture safety assessment during percutaneous nephrolithotomy

Background: Kidney stone is a major universal health problem, affecting 10% of the population worldwide. Percutaneous nephrolithotomy is a first-line and established procedure for disintegration and removal of renal stones. Its surgical success depends on the precise needle puncture of renal calyces, which remains the most challenging task for surgeons. This work describes and tests a new ultrasound based system to alert the surgeon when undesirable anatomical structures are in between the puncture path defined through a tracked needle. Methods: Two circular ultrasound transducers were built with a single 3.3-MHz piezoelectric ceramic PZT SN8, 25.4 mm of radius and resin-epoxy matching and backing layers. One matching layer was designed with a concave curvature to work as an acoustic lens with long focusing. The A-scan signals were filtered and processed to automatically detect reflected echoes. Results: The transducers were mapped in water tank and tested in a study involving 45 phantoms. Each phantom mimics different needle insertion trajectories with a percutaneous path length between 80 and 150 mm. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Conclusions: This new solution may alert the surgeon about anatomical tissues changes during needle insertion, which may decrease the need of X-Ray radiation exposure and ultrasound image evaluation during percutaneous puncture.