You Can't Touch This: Touch-free Navigation Through Radiological Images

Keyboards, mice, and touch screens are a potential source of infection or contamination in operating rooms, intensive care units, and autopsy suites. The authors present a low-cost prototype of a system, which allows for touch-free control of a medical image viewer. This touch-free navigation system consists of a computer system (IMac, OS X 10.6 Apple, USA) with a medical image viewer (OsiriX, OsiriX foundation, Switzerland) and a depth camera (Kinect, Microsoft, USA). They implemented software that translates the data delivered by the camera and a voice recognition software into keyboard and mouse commands, which are then passed to OsiriX. In this feasibility study, the authors introduced 10 medical professionals to the system and asked them to re-create 12 images from a CT data set. They evaluated response times and usability of the system compared with standard mouse/keyboard control. Users felt comfortable with the system after approximately 10 minutes. Response time was 120 ms. Users required 1.4 times more time to re-create an image with gesture control. Users with OsiriX experience were significantly faster using the mouse/keyboard and faster than users without prior experience. They rated the system 3.4 out of 5 for ease of use in comparison to the mouse/keyboard. The touch-free, gesture-controlled system performs favorably and removes a potential vector for infection, protecting both patients and staff. Because the camera can be quickly and easily integrated into existing systems, requires no calibration, and is low cost, the barriers to using this technology are low.

Linking local knowledge, conservation practices and ecosystem diversity: comparing two communities in the Tunari National Park (Bolivia)

Combined approaches to conserve both biological and cultural diversity are seen as an alternative to classical nature conservation instruments. The objective of this study was to examine the influence of urbanization coupled with exclusive conservation measures, on land use, local knowledge and biodiversity in two Quechua speaking communities of Bolivia located within the Tunari National Park. We assessed and compared the links between land use, its transformation through conservation practices, local institutions and the worldviews of both communities and the implications they have for biodiversity at the level of ecosystems. Our results show that in both communities, people’s worldviews and environmental knowledge are linked with an integral and diversified use of their territory. However, the community most affected by urbanization and protected area regulations has intensified agriculture in a small area and has abandoned the use of large areas. This was accompanied by a loss of local environmental knowledge and a decrease in the diversity of ecosystems. The second community, where the park was not enforced, continues to manage their territory as a material expression of local environmental knowledge, while adopting community-based conservation measures with external support. Our findings highlight a case in which urbanization coupled with exclusive conservation approaches affects the components of both cultural and biological diversity. Actions that aim to enhance biocultural diversity in this context should therefore address the impact of factors identified as responsible for change in integrated social-ecological systems.

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

A Systems-Level Approach to Human Epileptic Seizures

Epileptic seizures are due to the pathological collective activity of large cellular assemblies. A better understanding of this collective activity is integral to the development of novel diagnostic and therapeutic procedures. In contrast to reductionist analyses, which focus solely on small-scale characteristics of ictogenesis, here we follow a systems-level approach, which combines both small-scale and larger-scale analyses. Peri-ictal dynamics of epileptic networks are assessed by studying correlation within and between different spatial scales of intracranial electroencephalographic recordings (iEEG) of a heterogeneous group of patients suffering from pharmaco-resistant epilepsy. Epileptiform activity as recorded by a single iEEG electrode is determined objectively by the signal derivative and then subjected to a multivariate analysis of correlation between all iEEG channels. We find that during seizure, synchrony increases on the smallest and largest spatial scales probed by iEEG. In addition, a dynamic reorganization of spatial correlation is observed on intermediate scales, which persists after seizure termination. It is proposed that this reorganization may indicate a balancing mechanism that decreases high local correlation. Our findings are consistent with the hypothesis that during epileptic seizures hypercorrelated and therefore functionally segregated brain areas are re-integrated into more collective brain dynamics. In addition, except for a special sub-group, a highly significant association is found between the location of ictal iEEG activity and the location of areas of relative decrease of localised EEG correlation. The latter could serve as a clinically important quantitative marker of the seizure onset zone (SOZ).

Io volcano observer (IVO) integrated approach to optimizing system design for radiation challenges

One of the major challenges for a mission to the Jovian system is the radiation tolerance of the spacecraft (S/C) and the payload. Moreover, being able to achieve science observations with high signal to noise ratios (SNR), while passing through the high flux radiation zones, requires additional ingenuity on the part of the instrument provider. Consequently, the radiation mitigation is closely intertwined with the payload, spacecraft and trajectory design, and requires a systems-level approach. This paper presents a design for the Io Volcano Observer (IVO), a Discovery mission concept that makes multiple close encounters with Io while orbiting Jupiter. The mission aims to answer key outstanding questions about Io, especially the nature of its intense active volcanism and the internal processes that drive it. The payload includes narrow-angle and wide-angle cameras (NAC and WAC), dual fluxgate magnetometers (FGM), a thermal mapper (ThM), dual ion and neutral mass spectrometers (INMS), and dual plasma ion analyzers (PIA). The radiation mitigation is implemented by drawing upon experiences from designs and studies for missions such as the Radiation Belt Storm Probes (RBSP) and Jupiter Europa Orbiter (JEO). At the core of the radiation mitigation is IVO's inclined and highly elliptical orbit, which leads to rapid passes through the most intense radiation near Io, minimizing the total ionizing dose (177 krads behind 100 mils of Aluminum with radiation design margin (RDM) of 2 after 7 encounters). The payload and the spacecraft are designed specifically to accommodate the fast flyby velocities (e.g. the spacecraft is radioisotope powered, remaining small and agile without any flexible appendages). The science instruments, which collect the majority of the high-priority data when close to Io and thus near the peak flux, also have to mitigate transient noise in their detectors. The cameras use a combination of shielding and CMOS detectors with extremely fast readout to mi- imize noise. INMS microchannel plate detectors and PIA channel electron multipliers require additional shielding. The FGM is not sensitive to noise induced by energetic particles and the ThM microbolometer detector is nearly insensitive. Detailed SNR calculations are presented. To facilitate targeting agility, all of the spacecraft components are shielded separately since this approach is more mass efficient than using a radiation vault. IVO uses proven radiation-hardened parts (rated at 100 krad behind equivalent shielding of 280 mils of Aluminum with RDM of 2) and is expected to have ample mass margin to increase shielding if needed.

An analysis of the spatial and temporal patterns of highly pathogenic avian influenza occurrence in Vietnam using national surveillance data

The objectives of this study were to describe the spatio-temporal pattern of an epidemic of highly pathogenic avian influenza (HPAI) in Vietnam and to identify potential risk factors for the introduction and maintenance of infection within the poultry population. The results indicate that during the time period 2004–early 2006 a sequence of three epidemic waves occurred in Vietnam as distinct spatial and temporal clusters. The risk of outbreak occurrence increased with a greater percentage of rice paddy fields, increasing domestic water bird and chicken density. It increased with reducing distance to higher population density aggregations, and in the third epidemic wave with increasing percentage of aquaculture. The findings indicate that agri-livestock farming systems involving domestic water birds and rice production in river delta areas are important for the maintenance and spread of infection. While the government’s control measures appear to have been effective in the South and Central parts of Vietnam, it is likely that in the North of Vietnam the vaccination campaign led to transmission of infection which was subsequently brought under control.

Weeds and endangered herbs have unforeseen dispersal helpers in the agri-environment: gastropods and earthworms

Agri-environmental schemes involving organic farming or set-aside management aim at promoting biodiversity and restoring ecosystem functioning in agrarian landscapes. Application of pesticides in these crop fields is strongly regulated facilitating the spread of weeds but also allowing for the establishment of endangered herbs and a variety of animals.Recent studies found gastropods and earthworms to be legitimate dispersers of seeds of wild plants. We assumed that both groups also playa significant role in the spread and establishment of wild plants within crop fields. Therefore, we are conducting a series of experiments in three different study systems on (1) the role of earthworms and gastropods as dispersers of rare herbs and weeds in an organic rye field in Germany, (2) the seed feeding behavior of gastropods of plants sown in fallow ground in Switzerland, and (3) weed dispersal in irrigated rice fields by golden apple snails in the Philippines.

Integrated Segmentation of Brain Tumor Images for Radiotherapy and Neurosurgery

Image-based modeling of tumor growth combines methods from cancer simulation and medical imaging. In this context, we present a novel approach to adapt a healthy brain atlas to MR images of tumor patients. In order to establish correspondence between a healthy atlas and a pathologic patient image, tumor growth modeling in combination with registration algorithms is employed. In a first step, the tumor is grown in the atlas based on a new multi-scale, multi-physics model including growth simulation from the cellular level up to the biomechanical level, accounting for cell proliferation and tissue deformations. Large-scale deformations are handled with an Eulerian approach for finite element computations, which can operate directly on the image voxel mesh. Subsequently, dense correspondence between the modified atlas and patient image is established using nonrigid registration. The method offers opportunities in atlasbased segmentation of tumor-bearing brain images as well as for improved patient-specific simulation and prognosis of tumor progression.

The surface temperatures of Earth: steps towards integrated understanding of variability and change

Surface temperature is a key aspect of weather and climate, but the term may refer to different quantities that play interconnected roles and are observed by different means. In a community-based activity in June 2012, the EarthTemp Network brought together 55 researchers from five continents to improve the interaction between scientific communities who focus on surface temperature in particular domains, to exploit the strengths of different observing systems and to better meet the needs of different communities. The workshop identified key needs for progress towards meeting scientific and societal requirements for surface temperature understanding and information, which are presented in this community paper. A "whole-Earth" perspective is required with more integrated, collaborative approaches to observing and understanding Earth's various surface temperatures. It is necessary to build understanding of the relationships between different surface temperatures, where presently inadequate, and undertake large-scale systematic intercomparisons. Datasets need to be easier to obtain and exploit for a wide constituency of users, with the differences and complementarities communicated in readily understood terms, and realistic and consistent uncertainty information provided. Steps were also recommended to curate and make available data that are presently inaccessible, develop new observing systems and build capacities to accelerate progress in the accuracy and usability of surface temperature datasets.

State of the art of integrated therapy approaches in the treatment of schizophrenia: empirical evidence and clinical relevance

Objective: Integrated behavior therapy approaches are defined by the combination of behavioral and or cognitive interventions targeting neurocognition combined with other goal-oriented treatment targets such as social cognition, social skills, or educational issues. The Integrated Psychological Therapy Program (IPT) represents one of the very first behavior therapy approaches combining interventions of neurocognition, social cognition, and social competence. This comprehensive group-based bottom-up and top-down approach consists of five subprograms, each with incremental steps. IPT has been successfully implemented in several countries in Europe, America, Australia and in Asia. IPT worked as a model for some other approaches designed in the USA. IPT was undergone two further developments: based on the social competence part of IPT, the three specific therapy programs focusing residential, occupational or recreational topics were developed. Recently, the cognitive part of INT was rigorously expanded into the Integrated Neurocognitive Therapy (INT) designed exclusively for outpatient treatment: INT includes interventions targeting all neurocognitive and social cognitive domains defined by the NIMH-MATRICS initiative. These group and partially PC-based exercises are structured into four therapy modules, each starting with exercises on neurocognitive domains followed by social cognitive targets. Efficacy: The evidence of integrated therapy approaches and its advantage compared to of one-track interventions was becoming a discussion tool in therapy research as well as in mental health systems. Results of meta-analyses support superiority of integrated approaches compared to one-track interventions in more distal outcome areas such as social functioning. These results are in line with the large body of 37 independent IPT studies in 12 countries. Moreover, IPT research indicates the maintenance of therapy effects after the end of therapy and some evidence generalization effects. Additionally, the international randomized multi-center study on INT with 169 outpatients strongly supports the successful therapy of integrated therapy in proximal and distal outcome such as significant effects in cognition, functioning and negative symptoms. Clinical implication: therapy research as well as expert’s clinical experience recommends integrated therapy approaches such as IPT to be successful agents within multimodal psychiatric treatment concepts. Finally, integrated group therapy based on cognitive remediation seems to motivate and stimulate schizophrenia inpatients and outpatients to more successful and independent life also demanded by the recovery movement.

Advances in understanding energy consumption behavior and the governance of its change - Outline of an integrated framework

Transforming today’s energy systems in industrialized countries requires a substantial reduction of the total energy consumption at the individual level. Selected instruments have been found to be effective in changing people’s behavior in single domains. However, the so far weak success story on reducing overall energy consumption indicates that our understanding of the determining factors of individual energy consumption as well as of its change is far from being conclusive. Among others, the scientific state of the art is dominated by analyzing single domains of consumption and by neglecting embodied energy. It also displays strong disciplinary splits and the literature often fails to distinguish between explaining behavior and explaining change of behavior. Moreover, there are knowledge gaps regarding the legitimacy and effectiveness of the governance of individual consumption behavior and its change. Against this backdrop, the aim of this paper is to establish an integrated interdisciplinary framework that offers a systematic basis for linking the different aspects in research on energy related consumption behavior, thus paving the way for establishing a better evidence base to inform societal actions. The framework connects the three relevant analytical aspects of the topic in question: (1) It systematically and conceptually frames the objects, i.e. the energy consumption behavior and its change (explananda); (2) it structures the factors that potentially explain the energy consumption behavior and its change (explanantia); (3) it provides a differentiated understanding of change inducing interventions in terms of governance. Based on the existing states of the art approaches from different disciplines within the social sciences the proposed framework is supposed to guide interdisciplinary empirical research.