Pectus Excavatum postsurgical outcome based on preoperative soft body dynamics simulation

Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which an abnormal formation of the rib cage gives the chest a caved-in or sunken appearance. Today, the surgical correction of this deformity is carried out in children and adults through Nuss technic, which consists in the placement of a prosthetic bar under the sternum and over the ribs. Although this technique has been shown to be safe and reliable, not all patients have achieved adequate cosmetic outcome. This often leads to psychological problems and social stress, before and after the surgical correction. This paper targets this particular problem by presenting a method to predict the patient surgical outcome based on pre-surgical imagiologic information and chest skin dynamic modulation. The proposed approach uses the patient pre-surgical thoracic CT scan and anatomical-surgical references to perform a 3D segmentation of the left ribs, right ribs, sternum and skin. The technique encompasses three steps: a) approximation of the cartilages, between the ribs and the sternum, trough b-spline interpolation; b) a volumetric mass spring model that connects two layers - inner skin layer based on the outer pleura contour and the outer surface skin; and c) displacement of the sternum according to the prosthetic bar position. A dynamic model of the skin around the chest wall region was generated, capable of simulating the effect of the movement of the prosthetic bar along the sternum. The results were compared and validated with patient postsurgical skin surface acquired with Polhemus FastSCAN system

Use of performance information by local politicians: a field study in the Portuguese context.

This paper seeks to investigate the use of performance information by politicians and whether the institutional reforms on performance management (PM) have been operationalized by local politicians. Differences on the policy field and the organizational context have been analyzed. Our goal is contribute to knowledge on PM in the political sphere and understand the different responses of politicians to government change initiatives (mainly coercive pressures). Our findings show that local politicians support the notion that greater attention should be devoted to the use of performance information on the evaluation process. Nevertheless they are very skeptic in relation to effective execution of government reforms. There is an internal culture where agencies are embedded, strongly influenced by the high degree of politicisation among senior managers, that lead politicians to be more concerned about personal opinions and informal performance information rather than to use more sophisticated information (output and outcome measures). The institutional approach helps us to identify political responses to institutional pressures and understand the reasons for a reduced use in the Portuguese context.