Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine

STUDY DESIGN: Utility of using computed tomography to predict pedicle screw misplacement. OBJECTIVE: This study defines the sensitivity and specificity of predicting pedicle screw placement by experienced clinicians using a CT scan image. SUMMARY OF BACKGROUND DATA: In clinical and research settings, the method most commonly used to evaluate pedicle screws placement has been computed tomography. However, no current literature describes the accuracy of this method of evaluating screw placement. METHOD: Cobalt-chrome and titanium alloy pedicle screws of identical size were placed in six cadaveric human lumbar spine. Wide laminectomy was performed to allow complete visualization of the pedicles. Three consecutive lumbar levels were instrumented in each spine, giving 36 pedicle screw placements to identify. The instrumented spines were imaged, and four orthopaedic spine surgeons and a musculoskeletal radiologist were asked to read the images to identify the accuracy of screw placement within the pedicles. RESULTS: The sensitivity rate of identifying a misplaced screw was 67 +/- 6% for cobalt-chrome screws compared with 86 +/- 5% for titanium screws (P < 0.005). The specificity rates of radiographic diagnosis of misplaced pedicle screws were 66 +/- 10% for cobalt-chrome screws and 88 +/- 8% for titanium screws (P < 0.005). Similarly, a statistically significant difference was found in the sensitivity rates of identifying screws placed correctly in the pedicle: 70 +/- 10% for cobalt-chrome screws versus 89 +/- 8% for titanium screws (P < 0.005). Overall accuracy rates were 68 +/- 7% for cobalt chrome screws versus 87 +/- 3% for titanium screws (P < 0.002). CONCLUSION: Reliance on the computed tomography scan data alone in determining accuracy of pedicle screws can lead to inaccuracies in both clinical and research conditions.     

What is driving health system change?

Socially amoral economic forces now drive health system change. The authors, assisted by a panel of experts on employers, health plans, providers, and consumers, discuss current drivers such as (1) employers' price-focused purchasing, without good quality/value measures; (2) health plans' growing successes and market clout; (3) providers declining prospects and fears about their future; and (4) consumers' worries about less choice. Future influences will include Medicare reforms, better information, and pro-consumer regulation of managed care, as well as rising social distress. The health system's future is now open for resolution in an evolving, imperfect market.     

Successful Aging

This issue's Works in Progress department presents six abstracts for projects that are developing interesting solutions to the elderly's quality of life challenges. The first two abstracts discuss projects that will help provide the elderly with freedom and independence by instrumenting their environments with supportive technology. The next two abstracts discuss projects building specialized user interfaces for addressing some of the challenges associated with aging, such as vision impairment. The final two abstracts present projects that will aid independence for the elderly by providing remote monitoring and assistance.     

Silicon bipolar chipset for SONET/SDH 10 Gb/s fiber-opticcommunication links

High-speed multiplexers, demultiplexers, frequency dividers, mixers, and amplifiers are key electronic components in high-speed fiber-optic communications systems such as SONET/SDH. In this paper, we present several important digital and analog integrated circuits (IC) which have been developed for use in SONET/SDH 10 Gb/s optical communication links. The circuits have been fabricated in MOSAIC 5E, an advanced silicon bipolar technology (f_T=26 GHz). The resulting chipset which amounts to a total of 10 IC's consists of multiplexers, demultiplexers, a regenerative frequency divider (2:1), a dual output limiting amplifier, and two different types of mixers for clock extraction. Specifically, the design and performance of these IC's and a hybrid clock recovery module are discussed. The high performance and potential low cost of this research chipset show that advanced silicon bipolar circuit technology can play an important role in future multigigabit fiber-optic communication systems     

Characterization of optoacoustic surgical devices

Describes a measurement technique specially developed to characterize optoacoustic sources. The technique provides a convenient baseline for a comparison of different surgical ultrasonic systems utilizing optoacoustic and ultrasonic transducers. In addition, it provides a well-defined tool to optimize the performance of a variety of designs. Attention is focused on the laser-assisted devices in which appropriately delivered light energy is converted into acoustic shock wave. A meaningful comparison of such devices with other therapeutic equipment designed for a direct interaction with tissue requires knowledge of energy needed for a successful surgical treatment. It is demonstrated that knowledge of the key shock wave parameters allows the total acoustic energy associated with the shock wave to be determined. The procedure developed to calculate this energy is discussed and it is shown that the value of this energy can be conveniently used as an indicator of efficacy of an optoacoustic converter in a clinical environment. The influence of the performance of the polyvinylidene fluoride (PVDF) hydrophone probes on the measurement results was also analyzed. It was determined that when appropriately selected, the wide-band PVDF probes are well suited for characterization of the optoacoustic devices in the frequency range 1-100 MHz. The characterization procedure developed is applicable to surgical ultrasonic systems including conventional and laser-assisted phacoemulsifiers     

Straining phenomena of POY revealed by thermal retraction and other techniques

Partially oriented polyesters yarns (POY) were strained at different strain rates (0.03–12.00 min^?1) and temperatures above and below T_g (3–92°C). Thermal retraction, density, DSC, and WAXS techniques show that strain-induced crystallization takes place by straining at temperatures above as well as below T_g. Above T_g, depending upon the strain rate, two regimes are observed: Below the strain rate of 1.5 min^?1, the flow regime; the degree of crystallinity is reduced as the strain rate increases. Above the strain rate of 1.5 min^?1, the strain-induced crystallization regime; the degree of crystallinity increases as the strain rate increases. Thermal retraction, stress–relaxation, and sonic modulus techniques indicate that, upon cold straining, instead of the original T_g at 65–69°C, two glass transitions occur: an upper T_g (u) and a lower T_g (l). For POY strained at 3°C and at a strain rate of 10 min^?1, the values are 78°C and 37°C, respectively. The higher the strain rate and the lower the straining temperature, the large the difference between T_g (u) and T_g (l).     

Impoverishment of YOY‐fish assemblages by intense commercial navigation in a large Lowland river

Navigation‐induced physical forces have been suggested to modify the structure of riverine fish assemblages by impeding especially the recruitment of littoral bound species. To investigate the effect of vessel frequency on fish, we compared the composition and seasonal succession of young‐of‐the‐year (YOY) fish assemblages in three similarly degraded river reaches differing in average vessel passages (2, 6 and 41 per day). Fish were caught by electrofishing biweekly between May and September. Multivariate tests were used to analyse differences between YOY‐fish assemblages and hurdle regression models applied to determine abiotic factors predicting fish occurrence and abundance. Roach (Rutilus rutilus) and perch (Perca fluviatilis) densities were compared. Roach larvae remain in the littoral zone while perch larvae shift to the pelagic zone immediately after hatch. YOY‐fish assemblage structure substantially changed along the traffic intensity gradient. In the high traffic intensity reach, species number and total fish density were markedly reduced compared to the other reaches. Roach densities were lowest in the high traffic intensity reach whereas perch densities did not decline along the gradient. Hurdle regressions confirmed a stronger effect of commercial navigation traffic intensity on roach than on perch. The total zooplankton biomass was highest in the high traffic intensity reach. Our results provide empirical evidence that intensive commercial navigation impoverishes fish assemblages in width‐restricted waterways. They underlined that in particular those species that have their first nursery habitats in shoreline areas were more affected by intensive commercial navigation than species whose larvae live predominantly pelagic. The results indicate that the negative effect of intensive navigation on riverine fish results primarily from the navigation‐induced hydraulic disturbances along the banks. Therefore, mitigation of navigation‐induced hydraulic forces is required to prevent degradation of fish communities in waterways. Copyright © 2010 John Wiley & Sons, Ltd.     

CAD oriented frequency,temperature, and DC bias dependent small‐signal,scalable circuit model of parallel‐plate paraelectric varactors

Simple, CAD compatible small‐signal scalable circuit model for the thin film parallel‐plate ferroelectric varactors is reported. It is based on the measured permittivity and loss tangent of the ferroelectric films along with the fundamental theoretical relationships of ferroelectrics in paraelectric phase. The model makes use of the measured DC field (voltage) at the inflection point of the C‐V curve where the nonlinearity (dC/dV) and the tunability are maximum. Both the capacitance and the equivalent loss resistance (dielectric losses) in the ferroelectric film take into account the low permittivity layers at the boundaries of the nano‐columns of the film. The frequency dependent losses in the top and bottom plates of the varactors and the parasitic inductance of the plates are also taken into account. The model is valid for ferroelectric films having columnar structure. It is useful in wide temperature, DC field, and frequency ranges. © 2008 Wiley Periodicals, Inc. Int J RF and Microwave CAE, 2009.     

Identification and control of open-loop unstable processes by relay methods

This paper describes a reliable automatic PID tuning method for open-loop unstable processes. Identification with low order models is performed by means of two relay tests, one with an additional delay, which does not require a priori knowledge about the process, with the only necessary condition being that the process be gain stabilisable. This paper provides an overview of the method, states conditions that need to be satisfied for its successful implementation, and demonstrates its application on a number of examples.     

An algebraic criterion for robust stability of linear controlsystems

A new robust stability test for linear control systems is described. The condition at which robust stability is violated is transformed into an equivalent problem in which the existence of a real root of a multivariable polynomial is investigated. This multivariable problem is reduced to that of the solvability of a set of univariable polynomial equations in real numbers, for which a number of efficient numerical methods are available. The use of the method is illustrated in the design of feedback control for an open-loop unstable batch chemical reactor