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.     

A New Algorithm for the Elimination of Common Subexpressions in Hardware Implementation of Digital Filters by Using Genetic Programming

A new algorithm based on Genetic Programming (GP) for the problem of optimization of Multiple constant Multiplication (MCM) by Common Subexpression Elimination(CSE) is developed. This method is used for hardware optimization for DSP systems. A solution based on Genetic Programming is shown in this paper. The performance of the technique is demonstrated in one- and multi-dimensional digital filters with constant coefficients.     

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     

On development of a finite dynamic element and solution of associated eigenproblem by a block Lanczos procedure

The paper first presents the details of the development of a new six-noded plane triangular finite dynamic element. A block Lanczos algorithm is developed next for the accurate and efficient solution of the quadratic matrix eigenvalue problem associated with the finite dynamic element formulation. The resulting computer program fully exploits matrix sparsity inherent in such a discretization and proves to be most efficient for the extraction of the usually required first few roots and vectors, including repeated ones. Most importantly, the present eigenproblem solution effort is shown to be comparable to that of the corresponding finite element analysis, thereby rendering the associated dynamic element method rather attractive owing to superior convergence characteristics of such elements, presented herein.     

A generalized continuum theory for multiphase suspension flows

A continuum theory for multiphase particulate suspensions in a fluid media is formulated. The generalized fundamental balance laws for the particulate phases as well as for the continuous suspending fluid phase are presented. The thermodynamics of a multiphase system is studied and the method of Lagrangian multipliers is employed to include the constraints of incompressibility of materials of the constituents and the criterion for fully saturated media. Constitutive equations are developed which include microrotational and microdilatational effects. The basic equations of motion of different phases are derived and discussed. Special considerations are given to the case of incompressible constituents. Examples of applications of the present theory to dilute suspension flows and multiphase sedimentations are also discussed.     

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     

An integrated methodology to control the risk of cardiovascular disease in patients with hypertension and type 1 diabetes

Today, air pollution, smoking, use of fatty acids and ready‐made foods, and so on, have exacerbated heart disease. Therefore, controlling the risk of such diseases can prevent or reduce their incidence. The present study aimed at developing an integrated methodology including Markov decision processes (MDP) and genetic algorithm (GA) to control the risk of cardiovascular disease in patients with hypertension and type 1 diabetes. First, the efficiency of GA is evaluated against Grey Wolf optimization (GWO) algorithm, and then, the superiority of GA is revealed. Next, the MDP is employed to estimate the risk of cardiovascular disease. For this purpose, model inputs are first determined using a validated micro‐simulation model for screening cardiovascular disease developed at Tehran University of Medical Sciences, Iran by GA. The model input factors are then defined accordingly and using these inputs, three risk estimation models are identified. The results of these models support WHO guidelines that provide medicine with a high discount to patients with high expected LYs. To develop the MDP methodology, policies should be adopted that work well despite the difference between the risk model and the actual risk. Finally, a sensitivity analysis is conducted to study the behavior of the total medication cost against the changes of parameters.     

Pd/Cu-Free Cobalt-Catalyzed Suzuki and Heck Using Green Bio-Magnetic Hybrid and DFT-Based Theoretical Study

Catalysis Letters - Several highly efficient and magnetically recyclable cobalt catalytic systems were prepared using magnetic chitosan and some safe and available organic compounds...