Search results for: spinal alignment

Authors: Shailendra Kumar, Lokesh Kashyap, Puneet Khanna, Nishant Patel, Rakesh Kumar, Arshad Ayub, Kelika Prakash, Yudhyavir Singh, Krithikabrindha V.

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Introduction: Spinal anesthesia is considered a standard anesthesia technique for caesarean delivery. The incidence of spinal hypotension during caesarean delivery is 70 -80%. Spinal hypotension may cause cerebral hypoperfusion in the mother, but physiologically cerebral autoregulatory mechanisms accordingly prevent cerebral hypoxia. Cerebral blood flow remains constant in the 50-150 mmHg of Cerebral Perfusion Pressure (CPP) range. Near-infrared spectroscopy (NIRS) is a non-invasive technology that is used to detect Cerebral Desaturation Events (CDEs) immediately compared to other conventional intraoperative monitoring techniques. Objective: The primary aim of the study is to correlate the change in cerebral oxygen saturation using NIRS with respect to a fall in mean blood pressure after spinal anaesthesia and to find out the effects of spinal hypotension on neonatal APGAR score, neonatal acid-base variations, and presence of Postoperative Delirium (POD). Methodology: NIRS sensors were attached to the forehead of all the patients, and their baseline readings of cerebral oxygenation on the right and left frontal regions and mean blood pressure were noted. Subarachnoid block was given with hyperbaric 0.5% bupivacaine plus fentanyl, the dose being determined by the individual anaesthesiologist. Co-loading of IV crystalloid solutions was given to the patient. Blood pressure reading and cerebral saturation were recorded every 1 minute till 30min. Hypotension was a fall in MAP less than 20% of the baseline values. Patients going for hypotension were treated with an IV Bolus of phenylephrine/ephedrine. Umbilical cord blood samples were taken for blood gas analysis, and neonatal APGAR was noted by a neonatologist. Study design: A prospective observational study conducted in a population of Thirty ASA 2 and 3 parturients scheduled for lower segment caesarean section (LSCS). Results: Mean fall in regional cerebral saturation is 28.48 ± 14.7% with respect to the mean fall in blood pressure 38.92 ± 8.44 mm Hg. The correlation coefficient between fall in saturation and fall in mean blood pressure is 0.057, and p-value {0.7} after subarachnoid block. A fall in regional cerebral saturation occurred 2±1 min before a fall in mean blood pressure. Twenty-nine out of thirty patients required vasopressors during hypotension. The first dose of vasopressor requirement is needed at 6.02±2 min after the block. The mean APGAR score was 7.86 and 9.74 at 1 and 5 min of birth, respectively, and the mean umbilical arterial pH of 7.3±0.1. According to DRS-98 (Delirium Rating Scale), the mean delirium rating score on postoperative day 1 and day 2 were 0.1 and 0.7, respectively. Discussion: There was a fall in regional cerebral oxygen saturation, which started before with respect to a significant fall in mean blood pressure readings but was statistically not significant. Maximal fall in blood pressure requiring vasopressors occurs within 10 min of SAB. Neonatal APGAR scores and acid-base variations were in the normal range with maternal hypotension, and there was no incidence of postoperative delirium in patients with post-spinal hypotension.

Keywords: cerebral oxygenation, LSCS, NIRS, spinal hypotension

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Authors: Vahid Mehrabi, Iman Sharifi, H. A. Talebi

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The automation of rehabilitation procedure by the implementation of robotic devices can overcome the limitation in conventional physiotherapy methods by increasing training sessions and duration of process. In this paper, the design of a simple rehabilitation robot for forearm-wrist therapy in stroke and spinal cord injuries is presented. Wrist’s biological joint motion is modeled by a gimbal-like mechanism which resembles the human arm anatomy. Presented device is an exoskeleton robot with rotation axes corresponding to human skeleton anatomy. The mechanical structure, actuator and sensor selection, system kinematics and comparison between our device range of motion and required active daily life values is illustrated.

Keywords: rehabilitation, robotic devices, physiotherapy, forearm-wrist

Procedia PDF Downloads 239

Authors: Aqeel Zeid, Hasna Anees, Mohamed Adheeb, Mohamed Rifan, Kalpani Manathunga

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To achieve constructive alignment in a higher education program, a clear set of learning outcomes must be defined. Traditional learning outcome definition techniques such as Bloom’s taxonomy are not written to be utilized by the student. This might be disadvantageous for students in student-centric learning settings where the students are expected to formulate their own learning strategies. To solve the problem, we propose the learning outcome relation and aggregation (LORA) model. To achieve alignment, we developed learning outcome, assessment, and resource authoring tools which help teachers to tag learning outcomes during creation. A pilot study was conducted with an expert panel consisting of experienced professionals in the education domain to evaluate whether the LORA model and tools present an improvement over the traditional methods. The panel unanimously agreed that the model and tools are beneficial and effective. Moreover, it helped them model learning outcomes in a more student centric and descriptive way.

Keywords: learning design, constructive alignment, Bloom’s taxonomy, learning outcome modelling

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Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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Authors: Robert C. Pritchett, Elizabeth Broad, Kelly L. Pritchett

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Individuals a with spinal cord injuries have been suggested to be at risk for a 25(OH)D insufficiency. However, little is known regarding the relationship between seasonal Vitamin D status and performance in a spinally injured athletic population. Purpose: The purpose of this study was: 1) to examine the seasonal change in 25(OH)D concentrations and 2) to determine whether 25(OH)D status impacts athletic performance in US Paralympic athletes. Methods: 25 (OH)D concentrations were measured in 11 outdoor track athletes ( 5 men/6 females), between fall (October/November) and winter(February). Dietary intake and lifestyle habits were assessed via questionnaire, and performance measurements were assessed using a 20meter sprint test. 25(OH)D concentrations were assessed using a blood spot method (ZRT Laboratory). Results: There was no significant change in 25 (OH) D concentrations across seasons (P=0.505; 31 + 6.35 ng/mL, 29 + 8.72 ng/mL (mean + SD) for Fall and Winter, respectively. In the Fall,42% of the athletes had sufficient levels (>32ng/mL), and 58% were insufficient. (20ng/mL -31ng/mL) where as the winter levels dropped with 33% being sufficient and 58% being insufficient and 1% being deficient (<20ng/mL). There was a weak but significant correlation between a change in 25(OH)D concentrations, and change in 20m sprint time (p<0.05; r=0.408). Conclusion: A substantial proportion of elite athletes with an SCI have low vitamin D status. However, results suggest there was little seasonal variation in 25(OH)D status in elite track athletes with an SCI. Furthermore, any change that was observed demonstrated a very weak relationship with a change in performance.

Keywords: 25(oh)d, performance, spinal cord injuries, elite, sprint, concentration

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Authors: Won Man Park, Dae Kyung Choi, Kyungsoo Kim, Yoon Hyuk Kim

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Traction therapy has been used in the treatment of spinal pain for decades. However, a case study reported the occurrence of large disc protrusion during motorized traction therapy. In this study, we hypothesized that additional local decompression with a global axial traction could be helpful for risk reduction of intervertebral disc damage. A validated three dimensional finite element model of the lumbar spine was used. Two-step traction therapy using the axial global traction (the first step) with 1/3 body weight and the additional local decompression (the second step) with 7 mm translation of L4 spinal bone was determined for the traction therapy. During two-step traction therapy, the sacrum was constrained in all translational directions. Reduced lordosis angle by the global axial traction recovered with the additional local decompression. Stress on fibers of the annulus fibrosus by the axial global traction decreased with the local decompression by 17%~96% in the posterior region of intervertebral disc. Stresses on ligaments except anterior longitudinal ligaments in all motion segments decreased till 4.9 mm~5.6 mm translation of L4 spinal bone. The results of this study showed that the additional local decompression is very useful for reducing risk of damage in the intervertebral disc and ligaments caused by the global axial traction force. Moreover, the local decompression could be used to enhance reduction of intradiscal pressure.

Keywords: lumbar spine, traction-therapy, biomechanics, finite element analysis

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Authors: A. Bouabid, B. Bielenberg, S. Ainane, N. Pasha

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In this paper, a team of faculty members of the Petroleum Institute in Abu Dhabi, UAE representing six different courses across General Engineering (ENGR), Communication (COMM), and Design (STPS) worked together to establish a clear developmental progression of learning outcomes and performance indicators for targeted knowledge, areas of competency, and skills for the first three semesters of the Bachelor of Sciences in Engineering curriculum. The sequences of courses studied in this project were ENGR/COMM, COMM/STPS, and ENGR/STPS. For each course’s nine areas of knowledge, competency, and skills, the research team reviewed the existing learning outcomes and related performance indicators with a focus on identifying linkages across disciplines as well as within the courses of a discipline. The team reviewed existing performance indicators for developmental progression from semester to semester for same discipline related courses (vertical alignment) and for different discipline courses within the same semester (horizontal alignment). The results of this work have led to recommendations for modifications of the initial indicators when incoherence was identified, and/or for new indicators based on best practices (identified through literature searches) when gaps were identified. It also led to recommendations for modifications of the level of emphasis within each course to ensure developmental progression. The exercise has led to a revised Sequence Performance Indicator Mapping for the knowledge, skills, and competencies across the six core courses.

Keywords: curriculum alignment, horizontal and vertical progression, performance indicators, skill level

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Authors: Jarmila Štěpánová, Martin Kudláček, Lukáš Jakubec

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The people with spinal cord injury are one of the least sport active members of our society. Their hypoactivity is determined by primary injury, i.e., the loss of motor function, the injured part of the body is connected with health complications and social handicap. Study performs one part of the standardization process of semi-structured interview PARA-SCI.CZ (Czech version of the Physical Activity Recall Assessment for People with Spinal Cord Injury), which measures the type, frequency, duration, and intensity of physical activity of people with spinal cord injury. The study focused on persons with paraplegia who use a wheelchair as their primary mode of mobility. The aim of this study was to perform a process to determine the criterion validity of PARA-SCI.CZ. The actual physical activity of wheelchair users was monitored during three days by using accelerometers Actigraph GT3X fixed on the non-dominant wrist, and semi-structured interview PARA-SCI.CZ. During the PARA-SCI.CZ interview, participants were asked to recall activities they had done over the past 3 days, starting with the previous day. PARA-SCI.CZ captured frequency, duration, and intensity (low, moderate, and heavy) of two categories of physical activity (leisure time physical activity and activities of a usual day). Accelerometer Actigraph GT3X captured duration and intensity (low and moderate + heavy) of physical activity during three days and nights. The study presented three potential recalculations of measured data. Standardization process of PARA-SCI.CZ is essential to critically approach issues of health and active lifestyle of persons with spinal cord injury in the Czech Republic. Standardized PARA-SCI.CZ can be used in practice by physiotherapists and sports pedagogues from the field of adapted physical activities.

Keywords: physical activity, lifestyle, paraplegia, semi-structure interview, accelerometer

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Authors: Maryam Kiani, Abdul Basit Kiani

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Simple hydrothermal method to synthesize new nanocomposites consisting of nitrogen-doped graphene and NiFe₂O₄. By analyzing the X-Ray Powder Diffraction (XRD) images, we confirmed that the NiFe₂O₄ phase is pure and has a Face Centered Cubic (FCC) structure. The average size of the NiFe₂O₄ nanoparticles is approximately 40±2 nm. Additionally, we used X-ray photoelectron spectroscopy (XPS) to study the surface chemical composition and cation oxidation states of both the NiFe₂O₄ nanoparticles and the nitrogen-doped graphene/NiFe₂O₄ nanocomposites. A magnetic interaction between nitrogen doped graphene/NiFe₂O₄ was studied. Increases in hydrothermal synthesis temperature lead to the improved crystalline structure of NiFe₂O₄ nanoparticles, which improves the magnetic properties.

Keywords: nickel ferrite spinal, nitrogen doped graphene, magnetic nanocomposite, hydrothermal synthesis

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Authors: David Tresner-Kirsch

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Reconciling patient medication lists from multiple sources is a critical task supporting the safe delivery of patient care. Manual reconciliation is a time-consuming and error-prone process, and recently attempts have been made to develop efficiency- and safety-oriented automated support for professionals performing the task. An important capability of any such support system is automated alignment – finding which medications from a list correspond to which medications from a different source, regardless of misspellings, naming differences (e.g. brand name vs. generic), or changes in treatment (e.g. switching a patient from one antidepressant class to another). This work describes a new algorithmic solution to this alignment task, using a greedy matching approach based on string similarity, edit distances, concept extraction and normalization, and synonym search derived from the RxNorm nomenclature. The accuracy of this algorithm was evaluated against a gold-standard corpus of 681 medication records; this evaluation found that the algorithm predicted alignments with 99% precision and 91% recall. This performance is sufficient to support decision support applications for medication reconciliation.

Keywords: clinical decision support, medication reconciliation, natural language processing, RxNorm

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Authors: Sanchita B. Sarma, M. P. Nath

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Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 µg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.

Keywords: analgesia, magnesium, pre eclampsia, spinal anaesthesia

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Authors: Thi Phuong Lan Nguyen

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Vietnamese English Language Teacher Education (ELTE) has been changing a lot in response to the rapidly evolving socio-economic context requirements. The Vietnamese government assigns the Ministry of Education and Training (MOET) primary tasks to have policy changes to prepare for ELTE development in the globalization and socialization process. Many educational policies have been made to develop ELTE, however, they seem not to address the new global or social demands. The issue is that there are still significant disparities between the national policy and the institutional implementation. This study is to investigate the alignment between ELTE institutional curriculum, pedagogies, and MOET standards. This study used a mixed-method with the data sources from policy documents, a survey, and 33 interviews conducted with the lecturers and administrators from eleven Vietnamese ELTE institutions. The data have been analysed to understand the gap between policy and practice. The initial findings are (i) a low alignment of curriculum and language proficiency standards and (ii) a moderate alignment between curriculum and future-career skills standards. Many pedagogical challenges have been found. In order to address these gaps, it is necessary for the curriculum to be standards-based designed. It is also vital for professional development in order to improve the quality teaching. The study offers multiple perspectives on a complex issue. The study is meaningful not only to educational governance, but also to teaching practitioners, English language researchers, and English language learners. The significance lies in its relevance to English teaching careers across all parts of Vietnam, it yet remains relevant to ELTE in other countries teaching English as a foreign language.

Keywords: alignment, curriculum, educational policy, English language teaching, pedagogy, standards

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Authors: Qingqing Gai, Junxing Shen, Yu Luo

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Due to the hardware architecture characteristics, some operators tend to acquire better performance if the input/output tensor dimensions are aligned to a certain minimum granularity, such as convolution and deconvolution commonly used in deep learning. Furthermore, if the requirements are not met, the general strategy is to pad with 0 to satisfy the requirements, potentially leading to the under-utilization of the hardware resources. Therefore, for the convolution and deconvolution whose input and output channels do not meet the minimum granularity alignment, we propose to transfer the W-dimensional data to the C-dimension for computation (W2C) to enable the C-dimension to meet the hardware requirements. This scheme also reduces the number of computations in the W-dimension. Although this scheme substantially increases computation, the operator’s speed can improve significantly. It achieves remarkable speedups on multiple hardware accelerators, including Nvidia Tensor cores, Qualcomm digital signal processors (DSPs), and Huawei neural processing units (NPUs). All you need to do is modify the network structure and rearrange the operator weights offline without retraining. At the same time, for some operators, such as the Reducemax, we observe that transferring the Cdimensional data to the W-dimension(C2W) and replacing the Reducemax with the Maxpool can accomplish acceleration under certain circumstances.

Keywords: convolution, deconvolution, W2C, C2W, alignment, hardware accelerator

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Authors: Yassir Abdelrazig, Ren Moses

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Roadway planning and design is a very complex process involving five key phases before a project is completed; planning, project development, final design, right-of-way, and construction. The planning phase for a new roadway transportation project is a very critical phase as it greatly affects all latter phases of the project. A location study is usually performed during the preliminary planning phase in a new roadway project. The objective of the location study is to develop alignment alternatives that are cost efficient considering land acquisition and construction costs. This paper describes a methodology to develop optimal preliminary roadway alignments utilizing spatial-data. Four optimization criteria are taken into consideration; roadway length, land cost, land slope, and environmental impacts. The basic concept of the methodology is to convert the proposed project area into a grid, which represents the search space for an optimal alignment. The aforementioned optimization criteria are represented in each of the grid’s cells. A spatial-data optimization technique is utilized to find the optimal alignment in the search space based on the four optimization criteria. Two case studies for new roadway projects in Duval County in the State of Florida are presented to illustrate the methodology. The optimization output alignments are compared to the proposed Florida Department of Transportation (FDOT) alignments. The comparison is based on right-of-way costs for the alignments. For both case studies, the right-of-way costs for the developed optimal alignments were found to be significantly lower than the FDOT alignments.

Keywords: gemoetric design, optimization, planning, roadway planning, roadway design

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Authors: Xiuzhan Guo, Arthur Berrill, Ajinkya Kulkarni, Kostya Belezko, Min Luo

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Ontology operations, e.g., aligning and merging, were studied and implemented extensively in different settings, such as categorical operations, relation algebras, and typed graph grammars, with different concerns. However, aligning and merging operations in the settings share some generic properties, e.g., idempotence, commutativity, associativity, and representativity, labeled by (I), (C), (A), and (R), respectively, which are defined on an ontology merging system (D~M), where D is a non-empty set of the ontologies concerned, ~ is a binary relation on D modeling ontology aligning and M is a partial binary operation on D modeling ontology merging. Given an ontology repository, a finite set O ⊆ D, its merging closure Ô is the smallest set of ontologies, which contains the repository and is closed with respect to merging. If (I), (C), (A), and (R) are satisfied, then both D and Ô are partially ordered naturally by merging, Ô is finite and can be computed, compared, and sorted efficiently, including sorting, selecting, and querying some specific elements, e.g., maximal ontologies and minimal ontologies. We also show that the ontology merging system, given by ontology V -alignment pairs and pushouts, satisfies the properties: (I), (C), (A), and (R) so that the merging system is partially ordered and the merging closure of a given repository with respect to pushouts can be computed efficiently.

Keywords: ontology aligning, ontology merging, merging system, poset, merging closure, ontology V-alignment pair, ontology homomorphism, ontology V-alignment pair homomorphism, pushout

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Authors: Minhyuk Heo, Jihwan Yun, Seonghun Park

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It has been reported that intervertebral fusion surgery, which removes most of the ligaments and muscles of the spine, increases the degenerative disease in adjacent spinal segments. Therefore, it is required to develop a lumbar interspinous process fixation device that minimizes the risks and side effects from the surgery. The objective of the current study is to design an interspinous process fixation device with simple structures in order to minimize soft tissue removal and operation time during intervertebral fusion surgery. For the design concepts of a lumbar fixation device, the principle of the ratchet was first applied on the joining parts of the device in order to shorten the operation time. The coil spring structure was selected for connecting parts between the spinous processes so that a normal range of motion in spinal segments is preserved and degenerative spinal diseases are not developed in the adjacent spinal segments. The stiffness of the spring was determined not to interrupt the motion of a lumbar spine. The designed value of the spring stiffness allows the upper part of the spring to move ~10° which is higher than the range of flexion and extension for normal lumbar spine (6°-8°), when a moment of 10Nm is applied on the upper face of L1. A finite element (FE) model composed of L1 to L5 lumbar spines was generated to verify the mechanical integrity and the dynamic stability of the designed lumbar fixation device and to further optimize the lumbar fixation device. The FE model generated above produced the same pressure value on intervertebral disc and dynamic behavior as the normal intact model reported in the literature. The consistent results from this comparison validates the accuracy in the modeling of the current FE model. Currently, we are trying to generate an abnormal model with defects in one or more components of the normal FE model above. Then, the mechanical integrity and the dynamic stability of the designed lumbar fixation device will be analyzed after being installed in the abnormal model and then the lumbar fixation device will be further optimized.

Keywords: lumbar interspinous process fixation device, finite element method, lumbar spine, kinematics

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Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

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Authors: Mengmeng Zhang, Honghui Chen, Kalle Lyytinen

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The major challenges for sustainable business-IT alignment (BITA) in a company root in its volatile external competitive environment, increasingly complex internal relationships, and subversive IT roles. Failure to adequately address BITA results in wasting organizational resources, losing competitive advantages, and failing to produce adequate returns on investments. The coevolution is more suitable to describe the dynamic relationships of business and IT and has received certain attention in recent years. Multiple mechanisms for achieving BITC (e.g., sharing domain knowledge, modular design) were obtained. However, instead of a complete managing process, BITC achievement is still hard to operate in practice. This study emphasizes what the BITC management process looks like and how to execute this coevolution step-by-step. A practical coevolutionary framework that combines the enterprise architecture (EA) method with misalignment analysis is proposed in this paper. It contains steps of EA design, misalignment detection, misalignment correction, and EA management /misalignment prevention. The step of misalignment correction is especially discussed at length. This study also evaluates the proposed framework by comparing the characteristics, principles, and approaches of coevolution in the literature.

Keywords: business-IT alignment, business-IT coevolution, enterprise architecture, misalignment analysis, misalignment correction

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Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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Authors: Deepthinath Reghunathan, Satheesha Nayak, Sudarshan S., Prasad Alathady Maloor, Prakash Shetty

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Lumbar plexus is formed by the union of ventral rami of T12, L1, L2, L3 spinal nerves and the larger upper division of L4 lumbar spinal nerves. Variations in the normal anatomy of the lumbar and sacral plexus might be seen in some cases and are reported in the literature, but finding such an unusual case comprising of multiple variations which is normally not expected in a clinical setup, proves to be a vital piece of information for clinicians and medical practitioners. During the dissection of the abdomen and pelvis of an approximately 70 year old cadaver, we observed the following variations in the formation of the lumbar and sacral nerves. 1. The genitofemoral nerve bifurcated at a higher level; genital branch of genitofemoral nerve gave branches to the anterior abdominal wall muscles, 2. A communicating branch was given from the lateral cutaneous nerve of thigh to the medial cutaneous nerve of thigh, 3. A muscular branch was given from femoral nerve to psoas major, 4. There was absence of contribution of L4 spinal nerve in the formation of the lumbosacral trunk and 5. Lumbosacral trunk gave communicating branches to the femoral and obturator nerves. Most of the variations found were rare and finding all the above said variations in a single cadaver is even rare. Documentation of such rare cases with multiple variations in the formation of nerves from the lumbar plexus provides vital information on such occurrences. This information would in turn improve the knowledge of clinicians and surgeons dealing with this region. Emphasizing such knowledge of this region would prevent accidental damage to the structures with a variant anatomy.

Keywords: femoral nerve, genitofemoral nerve, lumbar plexus, lumbosacral trunk

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Authors: Michelle Jennett, Jana Dengler, Maytal Perlman

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Background: Cervical spinal cord injury (SCI) is a devastating event that results in upper limb paralysis, loss of independence, and disability. People living with cervical SCI have identified improvement of upper limb function as a top priority. Nerve and tendon transfer surgery has successfully restored upper limb function in cervical SCI but is not universally used or available to all eligible individuals. This exploratory mixed-methods study used an implementation science approach to better understand these factors that influence access to upper limb reconstruction in the Canadian context and design an intervention to increase access to care. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the annual rate of nerve transfer and tendon transfer surgeries performed in cervical SCI in Canada over the last 15 years. Semi-structured interviews informed by the consolidated framework for implementation research (CFIR) were used to explore Ontario healthcare provider knowledge and practices around upper limb reconstruction. An inductive, iterative constant comparative process involving descriptive and interpretive analyses was used to identify themes that emerged from the data. Results: Healthcare providers (n = 10 upper extremity surgeons, n = 10 SCI physiatrists, n = 12 physical and occupational therapists working with individuals with SCI) were interviewed about their knowledge and perceptions of upper limb reconstruction and their current practices and discussions around upper limb reconstruction. Data analysis is currently underway and will be presented. Regional variation in rates of upper limb reconstruction and trends over time are also currently being analyzed. Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb reconstruction in Canada remains low. There are a complex array of interrelated individual-, provider- and system-level barriers that prevent individuals with cervical SCI from accessing upper limb reconstruction. In order to offer equitable access to care, a multi-modal approach addressing current barriers is required.

Keywords: cervical spinal cord injury, nerve and tendon transfer surgery, spinal cord injury, upper extremity reconstruction

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Authors: Nidhal K. Azawi, John M. Gauch

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Colorectal cancer is one of the leading causes of cancer death in the US and the world, which is why millions of colonoscopy examinations are performed annually. Unfortunately, noise, specular highlights, and motion artifacts corrupt many images in a typical colonoscopy exam. The goal of our research is to produce automated techniques to detect and correct or remove these noninformative images from colonoscopy videos, so physicians can focus their attention on informative images. In this research, we first automatically extract features from images. Then we use machine learning and deep neural network to classify colonoscopy images as either informative or noninformative. Our results show that we achieve image classification accuracy between 92-98%. We also show how the removal of noninformative images together with image alignment can aid in the creation of image panoramas and other visualizations of colonoscopy images.

Keywords: colonoscopy classification, feature extraction, image alignment, machine learning

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Authors: Radoslaw Nagay

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The Paulina Project aims to address the challenges faced by immobilized individuals, such as those with multiple sclerosis, muscle dystrophy, or spinal cord injuries, by developing a flexible hardware and software solution. This paper presents the research and development efforts of our team, which commenced in 2019 and is now in its final stage. Recognizing the diverse needs and limitations of individuals with limited mobility, we conducted in-depth testing with a group of 30 participants. The insights gained from these tests led to the complete redesign of the system. Our presentation covers the initial project ideas, observations from in-situ tests, and the newly developed system that is currently under construction. Moreover, in response to the financial constraints faced by many disabled individuals, we propose an affordable business model for the future commercialization of our invention. Through the Paulina Project, we strive to empower immobilized individuals, providing them with greater independence and improved quality of life.

Keywords: UI, human-machine interface, social inclusion, multiple sclerosis, muscular dystrophy, spinal cord injury, quadriplegic

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Authors: Rajeswar Pal

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Toni Morrison’s novels belong to present day relations of Africans with the White peoples and tangible man-woman relations. Her literary criticism can be seen as a contribution to the debate over the revision of the canon that dominated much of the scholarship of the 1980s and 1990s. New Criticism began to give way to theories of cultural studies, feminist scholarship, postcolonial revisions and investigations of race and ethnicity. Morrison is concerned with the definition of the American literature whether it reflects an eternal, universal or transcending paradigm – a paradigm that separates it clearly and unequivocally Chicano or African-American or Asian-American or Native American literature. She sees evidence on an incursion of third world or so-called minority literature into a Eurocentric stronghold, which threatens power structures and leads to an upheaval of existing norms. We see women more aligned, cross-culturally, with nature; however, the very critical distinction is that within a white world, the alignment seems to lead towards individuation for women yet separation from white male culture, and within a black world the alignment leads towards individuation and connection to a ownership of a racial consciousness. Whether externally or internally, the characters of Morrison are marked with a sense of incompleteness and mutual conflict, which drives them towards some force of wholeness. Present study fucusses to elucidate and enunciate the man-woman relations and an individual cataclysmic conflict in their minds.

Keywords: tangible, postcolonial, ethnicity, paradigm, upheaval, alignment, elucidate, cataclysmic

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Authors: M. V. Manoj Kumar, Likewin Thomas, Annappa

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Process mining research discipline bridges the gap between data mining and business process modeling and analysis, it offers the process-centric and end-to-end methods/techniques for analyzing information of real-world process detailed in operational event-logs. In this paper, we have proposed a notation called trace logo for graphically representing control-flow perspective (order of execution of activities) of process. A trace logo consists of a stack of activity names at each position, sizes of the activity name indicates their frequency in the traces and the total height of the activity depicts the information content of the position. A trace logo created from a set of aligned traces generated using Multiple Trace Alignment technique.

Keywords: consensus trace, process mining, multiple trace alignment, trace logo

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Authors: Kazumasa Kawasaki, Isamu Tsuji, Hiroshi Gunbara

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A face gear drive is actually composed of a spur or helical pinion that is in mesh with a face gear and transfers power and motion between intersecting or skew axes. Due to the peculiarity of the face gear drive in shunt and confluence drive, it shows potential advantages in the application in the helicopter transmission. The advantages of such applications are the possibility of the split of the torque that appears to be significant where a pinion drives two face gears to provide an accurate division of power and motion. This mechanism greatly reduces the weight and cost compared to conventional design. Therefore, this has been led to revived interest and the face gear drive has been utilized in substitution for bevel and hypoid gears in limited cases. The face gear drive with a spur or a helical pinion is newly designed in order to determine an effective meshing area under the design parameters and specific design dimensions. The face gear has two unique dimensions which control the face width of the tooth, and the outside and inside diameters of the face gear. On the other hand, it is necessary to modify the tooth surfaces of face gear drive in order to avoid the influences of alignment errors on the tooth contact patterns in practical use. In this case, the pinion tooth surfaces are usually modified in the conventional method. However, it is hard to control the tooth contact pattern intentionally and adjust the position of the pinion axis in meshing of the gear pair. Therefore, a method of the modification of the tooth surfaces of the face gear is proposed. Moreover, based on tooth contact analysis, the tooth contact pattern and transmission errors of the designed face gear drive are analyzed, and the influences of alignment errors on the tooth contact patterns and transmission errors are investigated. These results showed that the tooth contact patterns and transmission errors were controllable and the face gear drive which is insensitive to alignment errors can be obtained.

Keywords: alignment error, face gear, gear design, helicopter transmission, tooth contact analysis

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Authors: Sang Hoon Lee, Tae Il Lee, Su Jeong Lee, Jae Min Myoung

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In order to manufacture short gap single Si nanowire (NW) field effect transistor (FET) by imprinting and transferring method, we introduce the method using Al2O3 sacrificial layer. The diameters of cylindrical Si NW addressed between Au electrodes by dielectrophoretic (DEP) alignment method are controlled to 106, 128, and 148 nm. After imprinting and transfer process, cylindrical Si NW is embedded in PVP adhesive and dielectric layer. By curing transferred cylindrical Si NW and Au electrodes on PVP-coated p++ Si substrate with 200nm-thick SiO2, 3μm gap Si NW FET fabrication was completed. As the diameter of embedded Si NW increases, the mobility of FET increases from 80.51 to 121.24 cm2/V•s and the threshold voltage moves from –7.17 to –2.44 V because the ratio of surface to volume gets reduced.

Keywords: Al2O3 sacrificial transfer layer, cylindrical silicon nanowires, dielectrophorestic alignment, field effect transistor

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Authors: Sylwia Orzechowska, Andrzej Wróbel, Eugeniusz Rokita

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The mineralization is a curious problem of connective tissues. Factors which may play a decisive role in the regulation of the yellow ligaments (YL) mineralization are still open questions. The aim of the studies was a detailed description of the chemical composition and morphology of mineral deposits in the human yellow ligaments. Investigations of the structural features of deposits were used to explain the impact of various factors on mineralization process. The studies were carried out on 24 YL samples, surgically removed from patients suffer from spinal canal stenosis and the patients who sustained a trauma. The micro-computed tomography was used to describe the morphology of mineral deposits. The X-ray fluorescence method and Fourier transform infrared spectroscopy were applied to determine the chemical composition of the samples. In order to eliminate the effect of blur in microtomographic images, the correction method of partial volume effect was used. The mineral deposits appear in 60% of YL samples, both in patients with a stenosis and following injury. The mineral deposits have a heterogeneous structure and they are a mixture of the tissue and mineral grains. The volume of mineral grains amounts to (1.9 ± 3.4)*10-3 mm3 while the density distribution of grains occurs in two distinct ranges (1.75 - 2.15 and 2.15-2.5) g/cm3. Application of the partial volume effect correction allows accurate calculations by eliminating the averaging effect of gray levels in tomographic images. The B-type carbonate-containing hydroxyapatite constitutes the mineral phase of majority YLs. The main phase of two samples was calcium pyrophosphate dihydrate (CPPD). The elemental composition of minerals in all samples is almost identical. This pathology may be independent on the spine diseases and it does not evoke canal stenosis. The two ranges of grains density indicate two stages of grains growth and the degree of maturity. The presence of CPPD crystals may coexist with other pathologies.

Keywords: FTIR, micro-tomography, mineralization, spinal ligaments

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Authors: Deborah O. Ajumobi, Michael Kyobe

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Studies show that women entrepreneurs are constrained and faced with challenges that inhibit the growth and performance of their businesses. However, with their human competencies, mobile technology and the appropriate business strategy, women-led SMEs can steer their businesses to better performance. While the need for SMEs to align these three elements has been suggested, there is limited knowledge on how SMEs can achieve this and no studies to the authors’ knowledge have examined this in women-led SMEs. This study therefore seeks to fill this gap by investigating how Women-led SMEs can best align these three elements to enhance business performance. In light of this, extensive literature review and theoretical work on the phenomenon has been conducted. Given the existence of the interplay between these three elements, we argue that the perspective of alignment as gestalts is most appropriate in determining the best way women-Led SMEs may align these aspects.

Keywords: women-led SMEs, human Competencies, mobile technology, business strategy, alignment

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Authors: Simona Capossela, Ramona Schaniel, Singer Franziska, Aquino Fournier Catharine, Daniel Stekhoven, Jivko Stoyanov

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A spinal cord injury (SCI) is a traumatic life event that often results in ageing associated health conditions such as muscle mass decline, adipose tissue increase, decline in immune function, frailty, systemic chronic inflammation, and psychological distress and depression. Psychological, oxidative, and metabolic stressors may facilitate accelerated ageing in the SCI population with reduced life expectancy. Research designs using biomarkers of aging and stress are needed to elucidate the role of psychological distress in accelerated aging. The aim of this project is a feasibility pilot study to observe changes in stress biomarkers and correlate them with aging markers in SCI patients during their first rehabilitation (longitudinal cohort study). Biological samples were collected in the SwiSCI (Swiss Spinal Cord Injury Cohort Study) Biobank in Nottwil at 4 weeks±12 days after the injury (T1) and at the end of the first rehabilitation (discharge, T4). The "distress thermometer" is used as a selfassessment tool for psychological distress. Stress biomarkers, as cortisol and protein carbonyl content (PCC), and markers of cellular aging, such as telomere lengths, will be measured. 2 Preliminary results showed that SCI patients (N= 129) are still generally distressed at end of rehabilitation, however we found a statistically significant (p< 0.001) median decrease in distress from 6 (T1) to 5 (T4) during the rehabilitation. In addition, an explorative transcriptomics will be conducted on N=50 SCI patients to compare groups of persons with SCI who have different trajectories of selfreported distress at the beginning and end of the first rehabilitation after the trauma. We identified 4 groups: very high chronic stress (stress thermometer values above 7 at T1 and T4; n=14); transient stress (high to low; n=14), low stress (values below 5 at T1 and T4; n=14), increasing stress (low to high; n=8). The study will attempt to identify and address issues that may occur in relation to the design and conceptualization of future study on stress and aging in the SCI population.

Keywords: stress, aging, spinal cord injury, biomarkers

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