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Search Results: 1 - 10 of 5343 matches for " Luca Regli "
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Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study
Marc Kelliny, Philippe Maeder, Stefano Binaghi, Marc Levivier, Luca Regli, Reto Meuli
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-8
Abstract: An observational retrospective review was carried out of all consecutive patients with non-traumatic subarachnoid hemorrhage who underwent both CT angiography and catheter angiography to exclude an aneurysm. CT angiography negative cases (no aneurysm) were classified according to their CT hemorrhage pattern as "aneurismal", "perimesencephalic" or as "no-hemorrhage."Two hundred and forty-one patients were included. A CT angiography aneurysm detection sensitivity and specificity of 96.4% and 96.0% were observed. All 35 cases of perimesencephalic or no-hemorrhage out of 78 CT angiography negatives also had negative angiography findings.CT angiography is self-reliant to exclude ruptured aneurysms when either a perimesencephalic hemorrhage or no-hemorrhage pattern is identified on the CT within a week of symptom onset.Spontaneous subarachnoid hemorrhage (SAH) is a sub-type of hemorrhagic stroke with an extremely poor prognosis. Eighty-five percent of non-traumatic SAHs are caused by ruptured intracranial aneurysms. Ten percent fit into the non-aneurismal perimesencephalic hemorrhage (PMH) pattern, whose etiology remains debated. The final five percent are usually due to various rare causes, such as arteriovenous malformations [1].When the CT is positive for subarachnoid blood, the combination of digital subtraction angiography (DSA) with 3D rotational angiography (3DRA) has been and is still considered the gold standard [2-6]. Meanwhile, CT angiography (CTA) has improved to a sensitivity of about 95% for detecting ruptured aneurysms, when compared to DSA [7-9]. Thus, in many centers, patients with SAH undergo CTA first which is often the basis for an endovascular or neurosurgical approach [10-12]. In any case, DSA remains a relatively riskier procedure than CTA. In patients with coiled intracranial aneurysms, the complication rate of routine angiographic surveillance is 0.43% [13] and that of general diagnostic angiography in an academic center has a complication rate of
Validation of Exposure Visualization and Audible Distance Emission for Navigated Temporal Bone Drilling in Phantoms
Eduard H. J. Voormolen, Peter A. Woerdeman, Marijn van Stralen, Herke Jan Noordmans, Max A. Viergever, Luca Regli, Jan Willem Berkelbach van der Sprenkel
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041262
Abstract: Background A neuronavigation interface with extended function as compared with current systems was developed to aid during temporal bone surgery. The interface, named EVADE, updates the prior anatomical image and visualizes the bone drilling process virtually in real-time without need for intra-operative imaging. Furthermore, EVADE continuously calculates the distance from the drill tip to segmented temporal bone critical structures (e.g. the sigmoid sinus and facial nerve) and produces audiovisual warnings if the surgeon drills in too close vicinity. The aim of this study was to evaluate the accuracy and surgical utility of EVADE in physical phantoms. Methodology/Principal Findings We performed 228 measurements assessing the position accuracy of tracking a navigated drill in the operating theatre. A mean target registration error of 1.33±0.61 mm with a maximum error of 3.04 mm was found. Five neurosurgeons each drilled two temporal bone phantoms, once using EVADE, and once using a standard neuronavigation interface. While using standard neuronavigation the surgeons damaged three modeled temporal bone critical structures. No structure was hit by surgeons utilizing EVADE. Surgeons felt better orientated and thought they had improved tumor exposure with EVADE. Furthermore, we compared the distances between surface meshes of the virtual drill cavities created by EVADE to actual drill cavities: average maximum errors of 2.54±0.49 mm and ?2.70±0.48 mm were found. Conclusions/Significance These results demonstrate that EVADE gives accurate feedback which reduces risks of harming modeled critical structures compared to a standard neuronavigation interface during temporal bone phantom drilling.
Meteorological Influences on the Incidence of Aneurysmal Subarachnoid Hemorrhage – A Single Center Study of 511 Patients
Marian Christoph Neidert, Michael Sprenger, Heini Wernli, Jan-Karl Burkhardt, Niklaus Krayenbühl, Oliver Bozinov, Luca Regli, Christoph Michael Woernle
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081621
Abstract: Objective To assess the potential meteorological influence on the incidence of aneurysmal subarachnoid hemorrhage (SAH). Previous studies used inhomogeneous patient groups, insufficient study periods or inappropriate statistics. Patients and Methods We analyzed 511 SAH admissions between 2004 and 2012 for which aneurysmal rupture occurred within the Zurich region. The hourly meteorological parameters considered are: surface pressure, 2-m temperature, relative humidity and wind gusts, sunshine, and precipitation. For all parameters we investigate three complementary statistical measures: i) the time evolution from 5 days before to 5 days after the SAH occurrence; ii) the deviation from the 10-year monthly mean; and iii) the change relative to the parameter's value two days before SAH occurrence. The statistical significance of the results is determined using a Monte Carlo simulation combined with a re-sampling technique (1000×). Results Regarding the meteorological parameters considered, no statistically significant signal could be found. The distributions of deviations relative to the climatology and of the changes during the two days prior to SAH events agree with the distributions for the randomly chosen days. The analysis was repeated separately for winter and summer to exclude compensating effects between the seasons. Conclusion By using high-quality meteorological data analyzed with a sophisticated and robust statistical method no clearly identifiable meteorological influence for the SAH events considered can be found. Further studies on the influence of the investigated parameters on SAH incidence seem redundant.
Automated Detection of Healthcare Associated Infections: External Validation and Updating of a Model for Surveillance of Drain-Related Meningitis
Maaike S. M. van Mourik, Karel G. M. Moons, Wouter W. van Solinge, Jan-Willem Berkelbach-van der Sprenkel, Luca Regli, Annet Troelstra, Marc J. M. Bonten
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0051509
Abstract: Objective Automated surveillance of healthcare-associated infections can improve efficiency and reliability of surveillance. The aim was to validate and update a previously developed multivariable prediction model for the detection of drain-related meningitis (DRM). Design Retrospective cohort study using traditional surveillance by infection control professionals as reference standard. Patients Patients receiving an external cerebrospinal fluid drain, either ventricular (EVD) or lumbar (ELD) in a tertiary medical care center. Children, patients with simultaneous drains, <1 day of follow-up or pre-existing meningitis were excluded leaving 105 patients in validation set (2010–2011) and 653 in updating set (2004–2011). Methods For validation, the original model was applied. Discrimination, classification and calibration were assessed. For updating, data from all available years was used to optimally re-estimate coefficients and determine whether extension with new predictors is necessary. The updated model was validated and adjusted for optimism (overfitting) using bootstrapping techniques. Results In model validation, the rate of DRM was 17.4/1000 days at risk. All cases were detected by the model. The area under the ROC curve was 0.951. The positive predictive value was 58.8% (95% CI 40.7–75.4) and calibration was good. The revised model also includes Gram stain results. Area under the ROC curve after correction for optimism was 0.963 (95% CI 0.953– 0.974). Group-level prediction was adequate. Conclusions The previously developed multivariable prediction model maintains discriminatory power and calibration in an independent patient population. The updated model incorporates all available data and performs well, also after elaborate adjustment for optimism.
An ASP-Based Architecture for Autonomous UAVs in Dynamic Environments: Progress Report
Marcello Balduccini,William C. Regli,Duc N. Nguyen
Computer Science , 2014,
Abstract: Traditional AI reasoning techniques have been used successfully in many domains, including logistics, scheduling and game playing. This paper is part of a project aimed at investigating how such techniques can be extended to coordinate teams of unmanned aerial vehicles (UAVs) in dynamic environments. Specifically challenging are real-world environments where UAVs and other network-enabled devices must communicate to coordinate---and communication actions are neither reliable nor free. Such network-centric environments are common in military, public safety and commercial applications, yet most research (even multi-agent planning) usually takes communications among distributed agents as a given. We address this challenge by developing an agent architecture and reasoning algorithms based on Answer Set Programming (ASP). ASP has been chosen for this task because it enables high flexibility of representation, both of knowledge and of reasoning tasks. Although ASP has been used successfully in a number of applications, and ASP-based architectures have been studied for about a decade, to the best of our knowledge this is the first practical application of a complete ASP-based agent architecture. It is also the first practical application of ASP involving a combination of centralized reasoning, decentralized reasoning, execution monitoring, and reasoning about network communications. This work has been empirically validated using a distributed network-centric software evaluation testbed and the results provide guidance to designers in how to understand and control intelligent systems that operate in these environments.
Towards an ASP-Based Architecture for Autonomous UAVs in Dynamic Environments (Extended Abstract)
Marcello Balduccini,William C. Regli,Duc N. Nguyen
Computer Science , 2014,
Abstract: Traditional AI reasoning techniques have been used successfully in many domains, including logistics, scheduling and game playing. This paper is part of a project aimed at investigating how such techniques can be extended to coordinate teams of unmanned aerial vehicles (UAVs) in dynamic environments. Specifically challenging are real-world environments where UAVs and other network-enabled devices must communicate to coordinate -- and communication actions are neither reliable nor free. Such network-centric environments are common in military, public safety and commercial applications, yet most research (even multi-agent planning) usually takes communications among distributed agents as a given. We address this challenge by developing an agent architecture and reasoning algorithms based on Answer Set Programming (ASP). Although ASP has been used successfully in a number of applications, to the best of our knowledge this is the first practical application of a complete ASP-based agent architecture. It is also the first practical application of ASP involving a combination of centralized reasoning, decentralized reasoning, execution monitoring, and reasoning about network communications.
Deregulated Electricity Market and Auctions: The Italian Case  [PDF]
Luca Grilli
iBusiness (IB) , 2010, DOI: 10.4236/ib.2010.23030
Abstract: The Electricity Market (in Europe) undergoes a period of transformations never seen before. The competitive model suggested by the European Commission is based on a gradual increase in the classes of consumers able to choice, freely, their providers. In general, liberalization, deregulation, competition result in a spur to development and low prices for consumers. The Electricity Market isn’t likely to follow such a rule. Electricity Markets are best described and analyzed as first-price multi-unit procurement iterated auctions. In this paper we present an analysis of the Italian case in order to show the effects of deregulation on final prices for users.
Positional release techniques as a diagnostic-therapeutic approach in physiotherapy  [PDF]
Luca Collebrusco
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.21004
Abstract: Manual Therapy is a rehabilitative approach based on the use of therapeutic procedures that includes several techniques, but this paper focuses on what is known as Positional Release (PR), a therapeutic model that includes a series of manoeuvres that are mainly used for the treatment of soft tissue. A deeper understanding of this type of therapeutic approach, especially its well known and widespread variant, Strain-Counterstrain, could, through controlled trials and systematic reviews, confirm its effectiveness, definitively explain the neurophysiological mechanism, and therefore make Positional Release another indispensable option in the professional expertise of the physiotherapist.
An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs  [PDF]
Luca Collebrusco
Open Journal of Therapy and Rehabilitation (OJTR) , 2015, DOI: 10.4236/ojtr.2015.31002
Abstract: The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.
New Risks and the Reframing of Local Welfare as Social Investment: The Case of the FORJAD Program in Switzerland  [PDF]
Luca Martignani
Open Journal of Political Science (OJPS) , 2016, DOI: 10.4236/ojps.2016.61002
Abstract: FORJAD (Formation Professionelle pour le Jeunes Adults en Difficulté) was a program of social policy implemented in Switzerland since 2006. Its specific aim is to sustain the professional training of young unemployed adults (18 - 25) in order to allow them to become autonomous from the social assistance and to (re)entry into the labour market. This paper deals with specific dimensions of this program, with particular reference to its complex and plural governance and to the cultural framework of the Social Investment Welfare State (SIWS). This paradigm tries to connect the logics of activation and training with the necessity to realize a better quality of welfare services and to invest in personal capabilities of welfare recipients. In this framework, FORJAD seems to represent a social innovation realized to contrast at a local level the young unemployment as an example of emergent new social risks.
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