Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction

Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients’ sides. It highlighted that the prosthesis bar should be modeled according to each patient’s rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

Automatic modeling of pectus excavatum corrective prosthesis using artificial neural networks

Pectus excavatum is the most common deformity of the thorax. Pre-operative diagnosis usually includes Computed Tomography (CT) to successfully employ a thoracic prosthesis for anterior chest wall remodeling. Aiming at the elimination of radiation exposure, this paper presents a novel methodology for the replacement of CT by a 3D laser scanner (radiation-free) for prosthesis modeling. The complete elimination of CT is based on an accurate determination of ribs position and prosthesis placement region through skin surface points. The developed solution resorts to a normalized and combined outcome of an artificial neural network (ANN) set. Each ANN model was trained with data vectors from 165 male patients and using soft tissue thicknesses (STT) comprising information from the skin and rib cage (automatically determined by image processing algorithms). Tests revealed that ribs position for prosthesis placement and modeling can be estimated with an average error of 5.0 ± 3.6 mm. One also showed that the ANN performance can be improved by introducing a manually determined initial STT value in the ANN normalization procedure (average error of 2.82 ± 0.76 mm). Such error range is well below current prosthesis manual modeling (approximately 11 mm), which can provide a valuable and radiation-free procedure for prosthesis personalization.

Exploring the interdisciplinary process in design education

The work presented herein follows an ongoing research that aims to analyze methodological practices to be applied in Design Education. A reflection about methodological strategies in Design Education and the function of drawing in Design represents the beginning of this study. Then, we developed an interdisciplinary pedagogical experience with the Graphic Design 1st grade students from our institution (IPCA). In the current academic year, 2013/2014, we continue to evolve this project, introducing changes in the initial proposal. Major alterations focused on the aspects that could be strengthened in terms of interdisciplinarity. In this article, the authors describe those changes and discuss the outcomes of the novel proposal. As we have already reported, this investigation follows a reflection about working methods to be adopted in Design Education. This is in accordance with other previously published works that purpose the enlargement of Design into new knowledge fields such as Experience or Service Design, changing not only the role of the graphic designer, but also the skills required to be a professional designer (Alain Findelli, 2001), (Brian Lawson, 2006), (Ciampa-Brewer, 2010). Furthermore, concepts such as cooperation or multidisciplinary design, amongst others, have been frequently debated as design teaching strategies (Heller and Talarico, 2011, pp. 82-85). These educational approaches also have an impact on our research. The analysis of all these authors’ contributions together with a reflection on our teaching practice allowed us to propose an improved interdisciplinary intervention.

The strategic management of creation process and of change: a theoretical contribute from the perspective of tourism

The entrepreneurship and innovation have been gradually gaining ground in the academic community as a field of study. However, the interpretations surrounding fragmented, without a univocal definition. In last decades, tourism has received greater attention from researchers in various sciences, varying only by the different emphases considered: economic, social, cultural and environmental. As other emerging sectors in a modern economy, tourism is a dynamic and ever-changing industry. The study has as purpose to provide a better understanding regarding the essence of entrepreneurship: theoretical and practical implications from the perspective of tourism. Regarding the methodology used here, this is a conceptual paper with a literature review that brings together the major components of entrepreneurship and its implications tourist perspective and conceptual model of the dynamic nature of the Triggering Process and innovation (e.g. iTravey, Interactive Stores, Tourist Transportable Tower).

Automatic modeling of pectus excavatum corrective prosthesis using artificial neural networks

Pectus excavatum is the most common deformity of the thorax. Pre-operative diagnosis usually includes Computed Tomography (CT) to successfully employ a thoracic prosthesis for anterior chest wall remodeling. Aiming at the elimination of radiation exposure, this paper presents a novel methodology for the replacement of CT by a 3D laser scanner (radiation-free) for prosthesis modeling. The complete elimination of CT is based on an accurate determination of ribs position and prosthesis placement region through skin surface points. The developed solution resorts to a normalized and combined outcome of an artificial neural network (ANN) set. Each ANN model was trained with data vectors from 165 male patients and using soft tissue thicknesses (STT) comprising information from the skin and rib cage (automatically determined by image processing algorithms). Tests revealed that ribs position for prosthesis placement and modeling can be estimated with an average error of 5.0 ± 3.6 mm. One also showed that the ANN performance can be improved by introducing a manually determined initial STT value in the ANN normalization procedure (average error of 2.82 ± 0.76 mm). Such error range is well below current prosthesis manual modeling (approximately 11 mm), which can provide a valuable and radiation-free procedure for prosthesis personalization.

Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction

Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients’ sides. It highlighted that the prosthesis bar should be modeled according to each patient’s rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

Assessment of 3D scanners for modeling pectus carinatum corrective bar

Pectus Carinatum (PC) is a chest deformity consisting on the anterior protrusion of the sternum and adjacent costal cartilages. Non-operative corrections, such as the orthotic compression brace, require previous information of the patient chest surface, to improve the overall brace fit. This paper focuses on the validation of the Kinect scanner for the modelling of an orthotic compression brace for the correction of Pectus Carinatum. To this extent, a phantom chest wall surface was acquired using two scanner systems – Kinect and Polhemus FastSCAN – and compared through CT. The results show a RMS error of 3.25mm between the CT data and the surface mesh from the Kinect sensor and 1.5mm from the FastSCAN sensor.

Automatic modeling of an orthotic bracing for nonoperative correction of pectus carinatum

Pectus Carinatum is a deformity of the chest wall, characterized by an anterior protrusion of the sternum, often corrected surgically due to cosmetic motivation. This work presents an alternative approach to the current open surgery option, proposing a novel technique based on a personalized orthosis. Two different processes for the orthosis’ personalization are presented. One based on a 3D laser scan of the patient chest, followed by the reconstruction of the thoracic wall mesh using a radial basis function, and a second one, based on a computer tomography scan followed by a neighbouring cells algorithm. The axial position where the orthosis is to be located is automatically calculated using a Ray-Triangle intersection method, whose outcome is input to a pseudo Kochenek interpolating spline method to define the orthosis curvature. Results show that no significant differences exist between the patient chest physiognomy and the curvature angle and size of the orthosis, allowing a better cosmetic outcome and less initial discomfort.

An Electromagnetic Tracker System for the design of a dental superstructure

Nowadays, different techniques are available for manufacturing full-arch implant-supported prosthesis, many of them based on an impression procedure. Nevertheless, the long-term success of the prosthesis is highly influenced by the accuracy during such process, being affected by factors such as the impression material, implant position, angulation and depth. This paper investigates the feasibility of a 3D electromagnetic motion tracking system as an acquisition method for modeling such prosthesis. To this extent, we propose an implant acquisition method at the patient mouth, using a specific prototyped tool coupled with a tracker sensor, and a set of calibration procedures (for distortion correction and tool calibration), that ultimately obtains combined measurements of the implant’s position and angulation, and eliminating the use of any impression material. However, in the particular case of the evaluated tracking system, the order of magnitude of the obtained errors invalidates its use for this specific application.

The international harmonization process of public accounting in Portugal: the perspective of different stakeholders

This paper investigates the reform of public accounting in Portugal through the IPSAS adoption highlighting the perception of different stakeholders. Two competing theories (NPM and the institutional theory) are used to understand public accounting changes within the Portuguese context. In general, different stakeholders agree with the favorable moment and the context of the reform. The context of financial crises and the great external pressures to cut public deficits and to improve the quality of financial information seem to be the most important factors to stimulate changes in public accounting. In addition, stakeholders recommend the use of different strategies to ensure success.

The internationally standardized process of public accounting: the perspective of different stakeholders in Portugal

New Public Management (NPM) led to great pressures for to introduce and adapt businesslike accounting in the public sector (Hood, 1995; Lapsley, 2008; Lapsley et al., 2009), specially the transition from cash basis to accrual-based accounting. In consequence, since the last 20 years we assist to a movement towards internationally standardized of public sector accounting that led to the publication of 32 International Public Sector Accounting Standards (IPSAS) for all public sector entities from national central governments to local governments (IFAC, 2008). These standards are accrual-basis and they emphasize the balance sheet approach, the fair value measurement and the revenue-expense approach (Hints, 2007). The main innovations are associated with the use of the balance sheet approach and the fair value measurement because, traditionally, public accounting systems are mainly focused on the revenue-expense approach and on historical cost valuation (Oulasvirta, 2014).

How middle managers contribute to strategy formation process: connection of strategy processes and strategy practices

The role of middle management is essential when managing integrative and emergent strategy formation processes. We stand out the importance of its role connecting micro and macro organizational level offering a very important contribution when examining the strategy-as-practice perspective and integrative strategy formation process. The main goal of this research is to analyse the relationship between the integrative strategy formation process and the roles of middle management under the strategy-as-practice perspective. To check it out we adopted a qualitative methodology droving a case analysis in a Spanish University. Data was collected by means of personal interviews with members of different levels of the Institution, documents analysis and direct observation. In advance of some results we find out that the University develops an integrative strategy formation process and confers to middle management an important role extended all over the organization.

Modeling the Diffusion of Energy Performance Contracting

The Portuguese Energy Policy considers the development of a commercially viable and competitive market for energy performance contracting (EPC) as a main mechanism to achieve the objectives of energy efficiency improvement. This paper proposes a study to investigate how to achieve widespread adoption of energy performance contracting by means of system dynamics modelling and simulation. To explore and gather insights on this question, a system dynamics model representing the system of the Portuguese EPC market at industry level will be created. The simulation of that model will provide a helpful basis for analysing and explaining the development of key variables, and accelerating learning on the managerial, organizational and political adaptation processes that foster the diffusion of EPC adoption. The first phase of this research project aims at identifying and analysing the key factors and critical cause-effect relations that drive the adoption of EPC. With this purpose, a qualitative content analysis on relevant documents was performed and a set of interviews was conducted. That data was analysed to capture the critical variables and its interrelation to formulate a preliminary representation of the system structure as stock and flow diagrams.

The process of implementing answerability in contemporary Brazil

Abstract: The aim of this study was to characterize the trajectory of answerability in Brazil. In the light of studies based on the historical neo-institutionalism approach, formal institutional changes adopted at federal level between 1985 and 2014, and which favor the typical requirements of answerability - information and justification - were identified and analyzed through the content analysis technique. The conclusion is that the trajectory of answerability in contemporary Brazil can be characterized as continuous, primarily occurring through the layering strategy, and whose leitmotif, since its origin, has consisted of matters of financial and budgetary nature. Nevertheless, a recent influence of deeper democratic subjects on it has been observed.