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.

How does gender affect visiting a world heritage site?: the case study of Guimarães

To date few studies have been undertaken in Portugal dealing with the attitudes, motivations, and profile of tourists who visit World Heritage Sites. Also, few studies have dealt with destination image (e.g., Agapito, Mendes & Valle, 2010; Lopes, 2011). As far as it is known, none have approached the issue of gender differences in the choice of a Portuguese heritage destination. Since cultural tourism destinations need to differentiate themselves from each other, appropriate market segmentation must be based on a deep understanding of the customers’ motivations and preferences. Keeping in mind results from empirical literature (e.g., Silberberg, 1995; Beerli & Martin, 2004; Richards, 2004; Pérez, 2009; Sheng, Shen, & Chen, 2008), gender seems to be a possible approach to market segmentation, whether for Guimarães or for other cultural tourism destinations around the world. Located in the north-western region of Portugal, Guimarães is a city of strong symbolic and cultural significance, and the nomination of its historical centre as a World Heritage Site in 2001 enhanced its tourism potential. This study analyses the possible relation between gender and attitudes and motivations towards a World Heritage Site, such as Guimarães. Additionally, the empirical approach used in the study tries to capture differences in the perceived attributes of the city. Commonalities and distinctions within and between groups of tourists, by focusing on the specific characteristic of gender, were analysed. The study addressed two main questions: first, whether males and females have similar or different preferences in choosing the city as their destination; and, second, whether there are gender differences in the perception of the attributes of Guimarães. A better understanding of the gendered nature of the destination is a valuable cue for shaping products and services according to visitors’ preferences.

Improving The Robustness Of Interventional 4D Ultrasound Segmentation Through The Use Of Personalized Shape Priors

While fluoroscopy is still the most widely used imaging modality to guide cardiac interventions, the fusion of pre-operative Magnetic Resonance Imaging (MRI) with real-time intra-operative ultrasound (US) is rapidly gaining clinical acceptance as a viable, radiation-free alternative. In order to improve the detection of the left ventricular (LV) surface in 4D ultrasound, we propose to take advantage of the pre-operative MRI scans to extract a realistic geometrical model representing the patients cardiac anatomy. This could serve as prior information in the interventional setting, allowing to increase the accuracy of the anatomy extraction step in US data. We have made use of a real-time 3D segmentation framework used in the recent past to solve the LV segmentation problem in MR and US data independently and we take advantage of this common link to introduce the prior information as a soft penalty term in the ultrasound segmentation algorithm. We tested the proposed algorithm in a clinical dataset of 38 patients undergoing both MR and US scans. The introduction of the personalized shape prior improves the accuracy and robustness of the LV segmentation, as supported by the error reduction when compared to core lab manual segmentation of the same US sequences.

Semi-automatic 3D Segmentation Of Costal Cartilage In CT Data From Pectus Excavatum Patients

One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69±0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.

Validation of percutaneous puncture trajectory during renal access using 4D ultrasound reconstruction

Background: An accurate percutaneous puncture is essential for disintegration and removal of renal stones. Although this procedure has proven to be safe, some organs surrounding the renal target might be accidentally perforated. This work describes a new intraoperative framework where tracked surgical tools are superimposed within 4D ultrasound imaging for security assessment of the percutaneous puncture trajectory (PPT). Methods: A PPT is first generated from the skin puncture site towards an anatomical target, using the information retrieved by electromagnetic motion tracking sensors coupled to surgical tools. Then, 2D ultrasound images acquired with a tracked probe are used to reconstruct a 4D ultrasound around the PPT under GPU processing. Volume hole-filling was performed in different processing time intervals by a tri-linear interpolation method. At spaced time intervals, the volume of the anatomical structures was segmented to ascertain if any vital structure is in between PPT and might compromise the surgical success. To enhance the volume visualization of the reconstructed structures, different render transfer functions were used. Results: Real-time US volume reconstruction and rendering with more than 25 frames/s was only possible when rendering only three orthogonal slice views. When using the whole reconstructed volume one achieved 8-15 frames/s. 3 frames/s were reached when one introduce the segmentation and detection if some structure intersected the PPT. Conclusions: The proposed framework creates a virtual and intuitive platform that can be used to identify and validate a PPT to safely and accurately perform the puncture in percutaneous nephrolithotomy.

Computer-aided recognition of dental implants in X-ray images

Dental implant recognition in patients without available records is a time-consuming and not straightforward task. The traditional method is a complete user-dependent process, where the expert compares a 2D X-ray image of the dental implant with a generic database. Due to the high number of implants available and the similarity between them, automatic/semi-automatic frameworks to aide implant model detection are essential. In this study, a novel computer-aided framework for dental implant recognition is suggested. The proposed method relies on image processing concepts, namely: (i) a segmentation strategy for semi-automatic implant delineation; and (ii) a machine learning approach for implant model recognition. Although the segmentation technique is the main focus of the current study, preliminary details of the machine learning approach are also reported. Two different scenarios are used to validate the framework: (1) comparison of the semi-automatic contours against implant’s manual contours of 125 X-ray images; and (2) classification of 11 known implants using a large reference database of 601 implants. Regarding experiment 1, 0.97±0.01, 2.24±0.85 pixels and 11.12±6 pixels of dice metric, mean absolute distance and Hausdorff distance were obtained, respectively. In experiment 2, 91% of the implants were successfully recognized while reducing the reference database to 5% of its original size. Overall, the segmentation technique achieved accurate implant contours. Although the preliminary classification results prove the concept of the current work, more features and an extended database should be used in a future work.

Multi-centre validation of an automatic algorithm for fast 4D myocardial segmentation in cine CMR datasets

Quantitative analysis of cine cardiac magnetic resonance (CMR) images for the assessment of global left ventricular morphology and function remains a routine task in clinical cardiology practice. To date, this process requires user interaction and therefore prolongs the examination (i.e. cost) and introduces observer variability. In this study, we sought to validate the feasibility, accuracy, and time efficiency of a novel framework for automatic quantification of left ventricular global function in a clinical setting.

O conceito de valor para o consumidor : uma análise sob a óptica da metodologia Laddering

RESUMO: O constructo de customer value é aquele que melhor explica o comportamento do consumidor, uma vez que o seu objectivo é o de entender como os consumidores traduzem os atributos e consequências do uso de um produto em valores pessoais relevantes. A metodologia laddering, que tem como base a teoria das cadeias meios-fim, é um elemento teórico que se considera consistente para estabelecer a relação entre os atributos e os valores do consumidor. Esta dissertação pretende demonstrar a exequibilidade da metodologia laddering em estudos sobre o valor para o consumidor, percebendo quais são as vantagens e limitações do seu uso. É conclusivo que este método, através da construção de cadeias A-C-V, proporciona elementos de estudo que permitem a visualização de hierarquia de valores produzida pelos consumidores, função dos critérios de escolha destes durante e após um processo de compra. A aplicabilidade desta metodologia na perspectiva do valor para o cliente, permite a utilização dos seus resultados num conjunto de áreas específicas do marketing, das quais destacamos a segmentação e análise de mercado, a avaliação do posicionamento de produtos e marcas, a avaliação da publicidade e o desenvolvimento de estratégias de comunicação. ABSTRACT: The customer value construct is the one that best explains the consumer behavior, since its purpose is to understand how consumers translate the attributes and consequences of the use of a product in relevant personal values. The laddering methodology, which is based on the theory of means-end chains, is a theoretical element that is considered consistent for establish the relationship between attributes and consumer values. This thesis attempts to demonstrate the feasibility of the laddering methodology in studies about the value for the consumer, knowing what are the advantages and limitations of its use. It is conclusive that this method, by building chains A-C-V, provides elements of study that allows the visualization of the values hierarchy produced by consumers, according to the criteria of their choice during and after a purchase process. The applicability of this methodology from the perspective of customer value, allows the use of their results in a number of specific areas of marketing, which we emphasize the segmentation and market analysis, evaluation of product and branding positioning, evaluation of advertising and development of communication strategies.

Evaluation of staining techniques on the results of micronucleus in exfoliated oral mucosa cells

Micronuclei (MN) in exfoliated epithelial cells are widely used as biomarkers of cancer risk in humans. MN are classified as biomarkers of the break age and loss of chromosomes. They are small, extra nuclear bodies that arise in dividing cells from centric chromosome/chromatid fragments or whole chromosomes/chromatids that lag behind in anaphase and are not included in the daughter nuclei in telophase. Buccal mucosa cells have been used in biomonitoring exposed populations because these cells are in the direct route of exposure to ingested pollutant, are capable of metabolizing proximate carcinogens to reactive chemicals, and are easily and rapidly collected by brushing the buccal mucosa. The objective of the present study was to further investigate if, and to what extent, different stains have an effect on the results of micronuclei studies in exfoliated cells. These techniques are: Papanicolaou (PAP), Modified Papanicolaou, May-Grünwald Giemsa (MGG), Giemsa, Harris’s Hematoxylin, Feulgen with Fast Green counterstain and Feulgen without counterstain.

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil’s rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO (‘Epidemiologia do Idoso’) Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

Preliminary results of a study of magnetic properties in the Foum-Zguid dyke (Morocco)

This work focuses on the study of flow and propagation of magma using rock magnetic analyses along sections across the thick Jurassic dyke of Foum-Zguid (Southern Morocco). Thermomagnetic data show that Ti-poor titanomagnetite is the main magnetic carrier. Petrographic analysis shows that the main Ti phase (ilmenite) occurs either as lamellae within spinel (center of the dyke) or as isolated grains (dyke margin). Bulk magnetic properties display distinct behavior according to the distance to the dyke margin; grain size of the main magnetic carrier decreases towards the center of the dyke, while the natural remanent magnetization and the bulk magnetic susceptibility increase. Only the magnetic susceptibility ellipsoid close to the dyke margin corresponds to that usually found in thin dykes, with the magnetic foliation sub parallel to dyke margins. Maximum principal axis is in most cases either parallel or perpendicular to the intersection between the planes of magnetic foliation and dyke wall. Moreover, when this axis is perpendicular to the intersection it is associated with a more oblate magnetic susceptibility ellipsoid shape, indicating the presence of complex magnetic fabrics. The studied magnetic properties show that, in this 100 m wide thick dyke, flow structures related with dyke propagation are only preserved close to the quickly cooled dyke margins.

Changes in the influence of board characterisitcs on corporate results due to the recent global financial crisis

The main purpose of this study is to analyse the changes caused by the global financial crisis on the influence of board characteristics on corporate results, in terms of corporate performance, corporate risk-taking, and earnings management. Sample comprises S&P 500 listed firms during 2002-2008. This study reveals that the environmental conditions call for different behaviour from directors to fulfil their responsibilities and suggests changes in normative and voluntary guidelines for improving good practices in the boardroom.

The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil

OBJECTIVE: A cohort study has been designed to identify predictors of adverse health events in the elderly. The methodology of the study and preliminary descriptive results are presented. METHODS: The study population comprises all residents of Bambuí (Minas Gerais, Brazil), aged 60 or more years (n=1.742). From these, 92.2% were interviewed and 85.9% underwent clinical examination, consisting of haematological and biochemical tests, serology for Trypanosoma cruzi, anthropometric and blood pressure measures and electrocardiogram. Aliquots of serum, plasma and DNA were stored for future investigations. The baseline interview included sociodemographic characteristics, self-referred health condition and history of selected diseases, medication use, health service use, source of medical care, physical activities, smoking, drinking and eating habits, reproductive history, physical functioning, life events, social support and mental health. Individuals are being followed up annually. RESULTS: The following characteristics predominated among participants: women (60,0%), married (48.9%) or widowed (35.4%), people living in households with up to 2 residents (73.8%), heads of family (76.7%), people with monthly income between 1.00 and 2.99 Brazilian minimum wages (62.0%) and people with up to 4 years of schooling (89.1%). The median age was 68 years. Among the cohort members, only 1.7% were lost in the first follow-up. CONCLUSIONS: In general, the characteristics of the study population were very similar to those from other epidemiological studies of the elderly based on large Brazilian cities. The small number of losses to follow-up indicates that the choice of Bambuí was adequate, assuring the feasibility of a long term cohort study.

AzoresPhotoID: first results from an open-access photoidentification catalogue

25th Conference of the European Cetacean Society. Long-terms datasets on marine mammals: learning from the past to manage the future, Cadiz, Spain, 21-23 March 2011.

Bryophytes distribution along an altitudinal gradient of native forest in Pico island (Azores): preliminary results of epiphytic genera

MOVECLIM, Mid Course Meeting, 2-6 September 2013, Réunion (Mascarenes).