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Irreversible Electroporation (IRE) is a non-thermal tumor ablation treatment applicable for prostate cancer. IRE uses ultra-short but strong electrical pulses to destroy cancer cells nonthermally [1]. Clinically available IRE therapy requires two or more needle electrodes placed around the target tissue to apply the electric fields. A pre-requirement to achieve successful and effective ablation is an accurate and parallel needle placement to cover the tumor zone. Differences in tissue density, organ surface curvature as well as organ and patient motion in combination with long and highly flexible needle electrodes causes’ difficulties to achieve the desired target accuracy during needle placement process. We propose a concept of a shooting mechanism in combination with a grid template support to improve the parallel needle placement process for prostate cancer treatment. Instead of conventionally inserting the needle in the body by hand, it can be placed with high speed using a shooting device setup, that works similar like a biopsy gun.

Today's healthcare challenges with unmet clinical needs, high regulation and certification standards, and increasing costs demand faster innovation and technical translation. To address this challenge, Stanford released a fellowship called Biodesign, where need-based healthcare innovation is taught with the approach identify, invent and implement. Since then, different European institutions have adopted the Biodesign innovation approach and organized within the Biomedical Engineering- Innovation, Design, and Entrepreneurship Alliance (BMEidea EU). The generation of successful healthcare innovation isn't only based on participating in an Innovation teaching program. It is much more a matter of having the right innovation ecosystem with an open creative mindset, experts, the respective stakeholders, and access to essential resources within reach (close to clinic). Through a qualitative survey, seven Biodesign based teaching programs in the EU were examined. The study from an academic perspective contains information covering Resources, Activities, Academic Performance, and Transfer Performance. The demand for new healthcare innovations, and especially innovation training programs that address challenges, developed collaboratively with the respective stakeholders, is increasing. Additionally, there is a growing expectation that innovation needs to reach the market quickly and be implemented accordingly. A Healthcare Innovation Ecosystem, where different entities function as a productive unit with a shared vision and committed to application-driven research and technology transfer, will increase innovation's success and adaptation.

Auscultation methods allow a non-invasive diagnosis of cardiovascular diseases like atherosclerosis based on blood flow sounds of the carotid arteries. Since this process is highly dependent on the clinician’s experience, it is of great interest to develop automated data processing techniques for objective assessment. We have recently proposed a computerassisted auscultation system that we use to acquire carotid blood flow sounds. In this work, we present an approach for detecting artifacts within the blood flow sound caused by swallowing or coughing events. For this purpose, we first decompose the signal using a discrete wavelet transform (DTW). Then, we compute an energy ratio between the DWT scales associated with the signal information with and without artifacts using a sliding window of 1 s length. Evaluation based on Kruskal-Wallis and Wilcoxon rank-sum tests shows a statistically significant difference (p-value

About 50 % of complications during laparoscopy occur when surgical access is created. The Veress needle and proposed technical alternatives do not provide reliable information to support the surgeons in guiding the needle, or the feedback is not clearly perceivable. Based on acoustic emissions, Surgical Audio Guidance (SURAG) proposes a non-invasive and efficient way to enhance the perception of guidance information through acoustic and visual feedback displayed in real-time. This article demonstrates that the developed feedback matches the information about tissue layer crossings provided by force measurements. This indicates that SURAG can provide an effective means to make laparoscopic access more precise and safe, especially in pediatric surgery, where space for placing the needle is minimal.

Introduction : The grade of reperfusion after endovascular treatment of ischemic stroke e.g. mechanical thrombectomy is determined based on the mTICI score. The mTICI score shows significant interrater variability; it is usually biased towards better reperfusion results if selfassessed by the operator. We therefore developed a semiautomated image processing technique for assessing and evaluating the degree of reperfusion independently, resulting in a more objective mTICI score. Methods: Fifty angiography datasets of patients who were treated with mechanical thrombectomy for middle cerebral artery (MCA) occlusion were selected from our database. Image datasets were standardized by adjustment of field of view and orientation. Based on pixel intensity features, the internal carotid artery (ICA) curve was detected automatically and used as a starting point for identifying the target downstream territory (TDT) of the MCA on the DSA series. Furthermore, a grid with predefined dimensions was used to divide the TDT into checkzones and be classified as perfused or unperfused. Results: The algorithm detected the TDT and classified each zone of the grid as perfused or unperfused. Lastly, the percentage of the perfused area in the TDT was calculated for each patient and compared to the grading of experienced clinical users. Conclusion: A semi-automatic image-processing workflow was developed to evaluate perfusion rate based on angiographic images. The approach can be used for the objective calculation of the mTICI score. The semi-automatic grading is currently feasible for MCA occlusion but can be extended for other brain territories. The work shows a starting point for a machine learning approach to achieve a fully automated system that can evaluate and give an accurate mTICI score to become a common AI-based grading standard in the coming near future.

Auscultation methods allow the non-invasive diagnosis of pathological conditions (e.g., of the lung, heart or blood vessels) based on sounds that the body produces (e.g., breathing, heartbeat, swallowing or the blood flow). Through regular homebased examinations and Big Data combined with Machine learning techniques like Deep Learning, these could help detect diseases in an early stage, thus preventing serious health conditions and subsequently ensuring optimal therapy through continuous monitoring. This paper presents BODYTUNE, a novel inexpensive multi-auscultation system that aims at providing a tool for establishing a baseline of audio signal derived classification parameters that could be used for the self-monitoring of personal health for everybody through the analysis of deviations from that baseline. In the future, Big Data analysis could additionally lead to prediction and early detection of disease events.

Ultrasound (US) imaging is used as a preliminary diagnostic tool for the detection, risk-stratification and classification of thyroid nodules. In order to perform the risk stratification of nodules in US images physicians first need to effectively detect the nodules. This process is affected due to the presence of inter-observer and intra-observer variability and subjectivity. Computer Aided Diagnostic tools prove to be a step in the right direction towards reducing the issue of subjectivity and observer variability. Several segmentation techniques have been proposed, from these Deep Learning techniques have yielded promising results. This work presents a comparison between four state of the art (SOTA) Deep Learning segmentation algorithms (UNet, SUMNet, ResUNet and Attention UNet). Each network was trained on the same dataset and the results are compared using performance metrics such as accuracy, dice coefficient and Intersection over Union (IoU) to determine the most effective in terms of thyroid nodule segmentation in US images. It was found that ResUNet performed the best with an accuracy, dice coefficient and IoU of 89.2%, 0.857, 0.767. The aim is to use the trained algorithm in the development of a Computer Aided Diagnostic system for the detection, riskstratification and classification of thyroid nodules using US images to reduce subjectivity and observer variability

Health longevity, cost reduction, prevention-based healthcare, personalized medicine, predictive diagnostic, transformed care delivery, de-aging, healthy lifestyle trends, and implementation of intelligent technologies should lead to a more democratized (availability for everyone on this planet) healthcare provision. Forecasting the future of healthcare and health policy certainly is imperfect but nevertheless a precious scientific approach that can lead to novel innovative approaches. In the last decade, the healthcare system faced several challenges, including the significant increase of care costs, demographic changes towards the older population, inability to prevent and overcome pandemics, increased chronic and non-communicable diseases, or resistance to adopting emerging technologies. The need to shift the focus from sickness to health becomes a critical mission. We developed a lecture titled "Healthtech Innovation Design" for graduate students from medicine, biomedical engineering, neuroscience and software engineering. The lecture's goal is to teach innovation methodologies, exponential technologies and methods to achieve healthcare democratization. A critical component is to promote initiatives with global teams focused on the future of health. The educational and initiative programs were impactful in growing interest toward innovation, focusing on disruption and healthcare democratization. Participants awareness towards the main issues and challenges was raised. Interdisciplinary participation was qualitatively processed to generate a holistic vision toward innovation. Through embracing digitalization to a patient-centric approach, affordable care services, and the expansion of precision medicine, the entire healthcare organization and management will likely undergo a worldwide change. Notably, digital technologies, the leverage of artificial intelligence and empathy would satisfy unmet clinical needs. With a future-oriented statement, the forecast of healthcare becomes more imaginable, in which democratization will allow the affordability of services in different countries and economic status.

Industry 4.0 and digital transformation will likely come with an era of changes for most manufacturers and tech industries, and even healthcare delivery will likely be affected. A few trends are already foreseeable such as an increased number of patients, advanced technologies, different health-related business models, increased costs, revised ethics, and regulatory procedures. Moreover, cybersecurity, digital invoices, price transparency, improving patient experience, management of big data, and the need for a revised education are challenges in response to digital transformation. Indeed, forward-looking innovation about exponential technologies and their effect on healthcare is now gaining momentum. Thus, we developed a framework, followed by an online survey, to investigate key areas, analyze and visualize future-oriented developments concerning technologies and innovative business models while attempting to translate visions into a strategy toward healthcare democratization. When forecasting the future of health in a short and long-term perspective, results showed that digital healthcare, data management, electronics, and sensors were the most common predictions, followed by artificial intelligence in clinical diagnostic and in which hospitals and homes would be the places of primary care. Shifting from a reactive to a proactive digital ecosystem, the focus on prevention, quality, and faster care accessibility are the novel value propositions toward democratization and digitalization of patient-centered services. Longevity will translate into increased neurodegenerative, chronic diseases, and mental illnesses, becoming severe issues for a future healthcare setup. Besides, data privacy, big data management, and novel regulatory procedures were considered as potential problems resulting from digital transformation. However, a revised education is needed to address these issues while preparing future health professionals. The “P4 of health”, a novel business model that is outcome-based oriented, awareness and acceptance of technologies to support public health, a different mindset that is proactive and future-oriented, and an interdisciplinary setting to merge clinical and technological advances would be key to a novel healthcare ecosystem. Lastly, based on the developed framework, we aim to conduct regular surveys to capture up-to-date technological trends, sustainable health-related business models, and interdependencies. The engagement of stakeholders through awareness and participation is the key to recognizing and improving healthcare needs and services.

During thermal ablation in a target tissue the information about temperature is crucial for decision making of successful therapy. An observable temporal and spatial temperature propagation would give a visual feedback of irreversible cell damage of the target tissue. Potential temperature features in ultrasound (US) B-Mode image sequences during radiofrequency (RF) ablation in ex-vivo porcine liver were found and analysed. These features could help to detect the transition between reversible and irreversible damage of the ablated target tissue. Experimental RF ablations of ex-vivo porcine liver were imaged with US B-Mode imaging and image sequences were recorded. Temperature was simultaneously measured within the liver tissue around a bipolar RF needle electrode. In the B-Mode images, regions of interest (ROIs) around the centre of the measurement spots were analysed in post-processing using average gray-level (AVGL) compared against temperature. The pole of maximum energy level in the time-frequency domain of the AVGL changes was investigated in relation to the measured temperatures. Frequency shifts of the pole were observed which could be related to transitions between the states of tissue damage.

The effectiveness, efficiency, availability, agility, and equality of global healthcare systems are in question. The COVID-19 pandemic have further highlighted some of these issues and also shown that healthcare provision is in many parts of the world paternalistic, nimble, and often governed too extensively by revenue and profit motivations. The 4th industrial revolution - the machine learning age - with data gathering, analysis, optimisation, and delivery changes has not yet reached Healthcare / Health provision. We are still treating patients when they are sick rather then to use advanced sensors, data analytics, machine learning, genetic information, and other exponential technologies to prevent people from becoming patients or to help and support a clinicians decision. We are trying to optimise and improve traditional medicine (incremental innovation) rather than to use technologies to find new medical and clinical approaches (disruptive innovation). Education of future stakeholders from the clinical and from the technology side has not been updated to Health 4.0 demands and the needed 21st century skills. This paper presents a novel proposal for a university and innovation lab based interdisciplinary Master education of HealthTEC innovation designers.

This work aims to demonstrate the feasibility that haptic information can be acquired from a da Vinci robotic tool using audio sensing according to sensor placement requirements in a real clinical scenario. For that, two potential audio sensor locations were studied using an experimental setup for performing, in a repeatable way, interactions of a da Vinci forceps with three different tissues. The obtained audio signals were assessed in terms of their resulting signal-to-noise-ratio (SNR) and their capability to distinguish between different tissues. A spectral energy distribution analysis using Discrete Wavelet Transformation was performed to extract signal signatures from the tested tissues. Results show that a high SNR was obtained in most of the audio recordings acquired from both studied positions. Additionally, evident spectral energy-related patterns could be extracted from the audio signals allowing us to distinguish between different palpated tissues.

Endoscopy is an important modality in medical imaging. Thin flexible endoscopes are for example used to examine the upper airways, for gastroscopy procedures or lung inspection. With standard flexible endoscopes one can change the direction of view by bending the tip with the disadvantage of large space required due to the bending radius. With first experiences of a concept of a moveable camera head on the tip of rigid endoscopes, we now propose a novel design employing a swiveling camera for flexible endoscopes. This concept is based on the use of a shape memory wire used to control the movement of the camera, a flexible plastic flap joint for tight rotation and flexible printed circuits for the electronic connection. The prototype was realized in a first low cost setup using a 5,5 mm HD chip on the tip camera with LED light. The motion and imaging performance of the prototype allowed swiveling of the camera on the endoscope tip from straight view to 100° side view. The space needed in fully rotation was limited to 9mm with an overall diameter of the endoscope in straight view of only 5,6mm, but could even be further reduced in a more professional setup. The image quality is good, but close-up views appear blurry due to the fixed focus point of the low-cost camera. The presented steering concept of the camera is promising, as it could potentially improve imaging of narrow cavities using flexible endoscopes. Especially for “in office” examinations this principle could add value to diagnosis and patient comfort.

Vascular endoscopic imaging is known for a long time but has never made its way into clinical routine. Reasons for that are the complexity, lack of low-cost portable systems, and the lack of suitable endoscopes providing high image quality with small dimensions. In addition, an interruption of the blood flow caused by the device and the opacity of blood are difficult to manage. In the past we have already developed ideas to overcome these difficulties and now we present a feasibility test of a thin diameter ureteroscope for observation of vascular procedures. The imaging system was tested in a phantom where side branches were explored, a stent was placed and a simulated aneurysm coiled.

Photodynamic therapy (PDT) is a potential option for treatment of cancer since it can be performed non- invasive for superficial cancers or minimal-invasive with low traumatization. But PDT is intrinsically inefficient due to the complex accumulation of the photosensitizing drug inside the tumor and the processes of heme syntheses to create the needed cell killing components. To optimize the outcome of PDT and increase acceptance as viable option it is necessary to predict the optimal time for the start of the treatment based on measurable precursors. A former cell study proposed a new filter fluorometer in a complex and sensitive setup. In this work we now designed and tested a simplified system that can be used in combination with standard endoscopic imaging systems. This system will be used as base to prove viability of this approach for a future clinical study.

Arthroscopic surgery is a technically challenging but common minimally invasive procedure with a long learning curve and a high incidence of iatrogenic damage. These damages can occur due to the lack of feedback and supplementary information regarding tissue-instrumentcontact during surgery. Deliberately performed interactions can be used however to obtain clinically relevant information, e.g. when a surgeon uses the tactile feedback to assess the condition of articular cartilage. Yet, the perception of such events is highly subjective. We propose a novel proximally attached sensing concept applied to arthroscopic surgery to allow an objective characterization and utilization of interactions. It is based on acoustic emissions which originate from tissue-instrument-contact, that propagate naturally via the instrument shaft and that can be obtained by a transducer setup outside of the body. The setup was tested on its ability to differentiate various conditions of articular cartilage. A femoral head with varying grades of osteoarthritic cartilage was tapped multiple times ex-vivo with a conventional Veress needle with a sound transducer attached at the outpatient end. A wavelet-based processing of the obtained signals and subsequent analysis of distribution of spectral energy showed the potential of tool-tissue-interactions to characterize different cartilage conditions. The proposed concept needs further evaluation with a dedicated design of the palpation tool and should be tested in realistic arthroscopic scenarios.

The short-range and sharp dose fall-off of beta particles in tissue make them an interesting option for use in the radiation therapy of superficial skin tumors. This can be used to protect bony or other sensitive structures located right beneath the tumor. In a previous study, we studied the feasibility of using 3D printing technology to create 2D radioactive models for the treatment of skin tumors. In the current study, the Monte Carlo method was used to simulate the transverse dose profile form 3D printed extruded line containing yttrium-90 (Y-90) particles. The time and activity required for treating a superficial skin tumor using these extruded lines were also calculated.

Longitudinal and perpendicular changes in the blood vessels of the vocal fold have been related to the advancement from benign to malignant laryngeal cancer stages. The combination of Contact Endoscopy (CE) and Narrow Band Imaging (NBI) provides intraoperative realtime visualization of vascular pattern in Larynx. The evaluation of these vascular patterns in CE+NBI images is a subjective process leading to differentiation difficulty and subjectivity between benign and malignant lesions. The main objective of this work is to compare multi-observer classification versus automatic classification of laryngeal lesions. Six clinicians visually classified CE+NBI images into benign and malignant lesions. For the automatic classification of CE+NBI images, we used an algorithm based on characterizing the level of the vessel’s disorder. The results of the manual classification showed that there is no objective interpretation, leading to difficulties to visually distinguish between benign and malignant lesions. The results of the automatic classification of CE+NBI images on the other hand showed the capability of the algorithm to solve these issues. Based on the observed results we believe that, the automatic approach could be a valuable tool to assist clinicians to classifying laryngeal lesions.

For assessing clinically relevant structures in the neck area, especially the thyroid, it has been shown that 3D or tomographic ultrasound (3D US or tUS) is able to outperform standard 2D ultrasound [1] and computed tomography [2] for certain diagnostic procedures. However, when using a freehand and unassisted scanning method to acquire a 3D US volume data set in this area overlapping image slices, a variation of the probe angulation or differences in training might lead to unusable scanning results. Based on previous works [3] [4] we propose the design - with subsequent testing - of an assistive device that is able to aid physicians during the tUS scanning process on the neck. To validate the feasibility and efficacy we compared the image quality of both freehand and assisted scanning.

In robot-assisted procedures, the surgeon controls the surgical instruments from a remote console, while visually monitoring the procedure through the endoscope. There is no haptic feedback available to the surgeon, which impedes the assessment of diseased tissue and the detection of hidden structures beneath the tissue, such as vessels. Only visual clues are available to the surgeon to control the force applied to the tissue by the instruments, which poses a risk for iatrogenic injuries. Additional information on haptic interactions of the employed instruments and the treated tissue that is provided to the surgeon during robotic surgery could compensate for this deficit. Acoustic emissions (AE) from the instrument/tissue interactions, transmitted by the instrument are a potential source of this information. AE can be recorded by audio sensors that do not have to be integrated into the instruments, but that can be modularly attached to the outside of the instruments shaft or enclosure. The location of the sensor on a robotic system is essential for the applicability of the concept in real situations. While the signal strength of the acoustic emissions decreases with distance from the point of interaction, an installation close to the patient would require sterilization measures. The aim of this work is to investigate whether it is feasible to install the audio sensor in non-sterile areas far away from the patient and still be able to receive useful AE signals. To determine whether signals can be recorded at different potential mounting locations, instrument/tissue interactions with different textures were simulated in an experimental setup. The results showed that meaningful and valuable AE can be recorded in the non-sterile area of a robotic surgical system despite the expected signal losses.

Novel challenges and developments require adaptations on skill set, content, and associated education. A biomedical engineer will require a broad range of skills - which to a large extent are currently not taught - in the coming years to meet the development needs of future healthcare: intensive interdisciplinary team work, advanced communication skills, team management and coaching capabilities, advanced project management, learn how to learn, visionary and forward looking thinking, understanding of health economics, entrepreneurship and leadership. But above all empathy towards the clinical user and patients is needed as well as a basic understanding of the current and future clinical workflows that can globally vary. An innovation process for a healthcare related product or service will likely only create value through the consideration and implementation of several of these points. Even though techniques for the development of innovation and enhancing creativity in individuals are widely discussed, there are relatively few reports on the practice of mainstreaming creativity in an organizational setting. We report on the setup of our Graduate School “Technology Innovation in Therapy and Imaging (T²I²)” that has implemented a structured post graduate program and focuses on interdisciplinary and application-oriented innovation generation education. The educational process starts with the observation and identification of clinical needs and an in-depth understanding of the problem and subsequently covers all steps necessary to transfer prototypes into viable solutions and further into implementing valuable products.

Cerebrovascular diseases like atherosclerosis pose a great threat to health and wellbeing of people worldwide. To enable early diagnosis and treatment of a gradually progressing occlusion of the carotid arteries, we propose the BODYTUNE system. Consisting of a custom-built auscultation device and a mobile application, it aims at enabling the monitoring of the blood flow within the carotid arteries on a regular basis at home. In this work, we present the results of a survey with 65 participants from the system target group to investigate aspects like technical affinity and experience with comparable systems. These results provide the basis on how the BODYTUNE system should be designed to be user-centered, match the users needs and address their concerns.

Marco Kalmar, Axel Boese, Ivan Maldonado, Rainer Landes, Michael FriebeIntelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, GermanyCorrespondence: Marco KalmarOtto-von-Guericke-University, Universitaetsplatz 2, Magdeburg 39106, GermanyTel +49 391 675 7025Email marco.kalmar@ovgu.deBackground: The magnetic resonance imaging (MRI) environment with its high-strength magnetic fields requires specialized and sometimes sophisticated solutions for otherwise simple problems. One of these problems is MR-compatible actuator mechanisms that transfer a signal into an action.Purpose: Normal actuators are based on a magnetic effect (eg, relays) and will typically not work in magnetic fields exceeding 1000 G, eg, inside the bore of an MR scanner. To enable the use of clinical devices inside the MRI, eg, for interventional procedures, there is a need for fully compatible actuators.Patients and methods: Various actuators were compared for the purpose as a simple on-off switch within an MRI. NITNOL wire as an actuator showed the highest potential because of its simplicity and reliability. We tested the possible force achieved by the NITINOL wire related to the respective energy consumption, to provide a travel range of 2 mm.Results: Compared to other actuators, the NITNOL wire is cheaper and requires less space. In the switching process however, there is a delay due to the time required for the heating of the wire up to the transformation temperature. The NITINOL switch shows a reliable behavior with regard to the generated force and the switching path over the entire measurement. Significant artifacts, caused by the NITNOL wire could not be detected in the MRI.Conclusion: NITINOL wires can be repeatedly used, are relatively easy to implement and could be an economic alternative to other more complicated actuator technologies.Keywords: interventional MRI, MRI compatible, high-field magnet, actuator, injector

The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.

Thomas Sühn,1 Moritz Spiller,1 Rutuja Salvi,2 Stefan Hellwig,2 Axel Boese,1 Alfredo Illanes,1 Michael Friebe1 1INKA - Innovation Laboratory for Image Guided Therapy, Medizinische Fakultät, Otto-Von-Guericke-Universität, Magdeburg, Sachsen-Anhalt, Germany; 2IDTM GmbH, Castrop-Rauxel, Nordrhein-Westfalen, GermanyCorrespondence: Thomas Sühn Email thomas.suehn@med.ovgu.deIntroduction: Atherosclerotic diseases of the carotid are a primary cause of cerebrovascular events such as stroke. For the diagnosis and monitoring angiography, ultrasound- or magnetic resonance-based imaging is used which requires costly hardware. In contrast, the auscultation of carotid sounds and screening for bruits – audible patterns related to turbulent blood flow – is a simple examination with comparably little technical demands. It can indicate atherosclerotic diseases and justify further diagnostics but is currently subjective and examiner dependent.Methods: We propose an easy-to-use computer-assisted auscultation system for a stable and reproducible acquisition of vascular sounds of the carotid. A dedicated skin-transducer-interface was incorporated into a handheld device. The interface comprises two bell-shaped structures, one with additional acoustic membrane, to ensure defined skin contact and a stable propagation path of the sound. The device is connected wirelessly to a desktop application allowing real-time visualization, assessment of signal quality and input of supplementary information along with storage of recordings in a database. An experimental study with 5 healthy subjects was conducted to evaluate usability and stability of the device. Five recordings per carotid served as data basis for a wavelet-based analysis of the stability of spectral characteristics of the recordings.Results: The energy distribution of the wavelet-based stationary spectra proved stable for measurements of a particular carotid with the majority of the energy located between 3 and 40 Hz. Different spectral properties of the carotids of one individual indicate the presence of sound characteristics linked to the particular vessel. User-dependent parameters such as variations of the applied contact pressure appeared to have minor influence on the general stability.Conclusion: The system provides a platform for reproducible carotid auscultation and the creation of a database of pathological vascular sounds, which is a prerequisite to investigate sound-based vascular monitoring.Keywords: stenosis, screening, computer-assisted auscultation, vascular disease, bruit, long-term monitoring, heart sound

The endoscopic detection of perpendicular vascular changes (PVC) of the vocal folds has been associated with vocal fold cancer, dysplastic lesions, and papillomatosis, according to a classification proposed by the European Laryngological Society (ELS). The combination of contact endoscopy with narrow-band imaging (NBI-CE) allows intraoperatively a highly contrasted, real-time visualization of vascular changes of the vocal folds. Aim of the present study was to determine the association of PVC to specific histological diagnoses, the level of interobserver agreement in the detection of PVC, and their diagnostic effectiveness in diagnosing laryngeal malignancy. The evaluation of our data confirmed the association of PVC to vocal fold cancer, dysplastic lesions, and papillomatosis. The level of agreement between the observers in the identification of PVC was moderate for the less-experienced observers and almost perfect for the experienced observers. The identification of PVC during NBI-CE proved to be a valuable indicator for diagnosing malignant and premalignant lesions.

Carbon nanotube (CNT) is a new technology used to generate gamma photons in X-ray tubes. CNTs, in comparison to other small X-ray sources, produce high X-ray intensities and as they are not based on a thermionic principle they considered cold electron sources with a very high conversion of electrical to photon energy. Their small size and other interesting properties could make them feasible for use in intraoperative radiation therapy applications. In this study, physical characteristics of the photon beam generated by the CNT-based X-ray source were assessed. A soft X-ray ionization chamber and a flat panel detector was used to measure dose and photon counts, respectively. The repetitively produced pulses had almost the same photon intensities with differences of less than 1% between them. For a typical selected pulse, the variation in the pulse amplitude was also insignificant, which shows a stable radiation exposure of the tube during the ON-mode. When moving from the center of the beam profile to the lateral distance of 25 mm, both intensity profile and dose profile showed a falling trend by a factor of almost 3 in the measured values.

Photodynamic diagnostic (PDD) is an optical enhancement option for the endoscope to support the detection of cancer, for example in the bladder. In real application PDD efficiency suffers due to the complex accumulation of the photosensitizing drug inside the tumor and the associated processes of heme syntheses to create the fluorescent components needed. To optimize the diagnostic outcome of PDD it would be helpful to predict the optimal time for diagnosis based on measurable precursors. In a previous cell study, we proposed a new filter fluorometer to image the accumulation of the precursors Coproporphyrin III (CP-III) and Uroporphyrin III (UP-III) that metabolize to Protoporphyrin IX (PP-IX) later. This accumulation process can be used to predict the optimal time slot for diagnostic imaging. Therefore, a new filter system was designed to distinguish between CP-III and PP-IX. In this work we tested this filter system in combination with a standard PDD endoscopic imaging system. Goal of this study was to prove the technical feasibility in a non-patient setup to prepare a later clinical study.

Radiation therapy of skin cancer using beta particles can be an interesting treatment when the lesion is very superficial. Due to their low penetration depth in tissue, beta particles can well protect underlying sensitive structures such as bone. 3D printing technology can be used to create applicators, for beta-emitters, that are made based on the individual shape and size of the tumor. The tumor-volume optimized applicator limits and shapes the beta radiation dose to the tumor surface anatomy while protecting healthy tissue nearby. This study illustrates the workflow to fabricate these tumor-specific applicators., Transactions on Additive Manufacturing Meets Medicine, Vol 1 (2019): Trans. AMMM

Skin brachytherapy is an effective treatment for patients with skin cancers. It is based upon the use of an applicator containing a gamma-emitting source located near the tumor. For superficial and shallow skin tumors close to sensitive structures, we propose a new brachytherapy method using 3D printing technology employing beta-emitting isotopes. The beta-emitting patches would allow for directed, effective and controlled dose delivery to the skin tumors, thus mitigating exposure to sensitive structures., Transactions on Additive Manufacturing Meets Medicine, Vol 1 (2019): Trans. AMMM

The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.

Made available in DSpace on 2020-12-11T01:57:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-10-29 Griffith University Gowonda HPC Cluster Queensland Cyber Infrastructure Foundation Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research. 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Toulouse, France ASCR, Inst Mol Genet, CZ Openscreen, Prague, Czech Republic Univ Turku, Inst Biomed, Turku, Finland York Univ, Sch Kinesiol & Hlth Sci, Toronto, ON, Canada Univ Calif Los Angeles, Stein Eye Inst, Ophthalmol, Los Angeles, CA USA Agr & Agri Food Canada, Ottawa Res & Dev Ctr, Ottawa, ON, Canada Helmholtz Zentrum Geesthacht, Mat Design & Characterizat, Geesthacht, Germany Unvers Genova, Internal Med, Genoa, Italy Otto von Guericke Univ, Intelligent Catheter INKS, Magdeburg, Germany Univ Toledo, Canc Biol, 2801 W Bancroft St,Hlth Sci Campus, Toledo, OH 43606 USA CRUK Beatson Inst, Struct Biol, Glasgow, Lanark, Scotland Leibniz Inst Primate Res, Med RNA Biol, Gottingen, Germany Univ Limoges, PEIRENE, EA 7500, Limoges, France Hainan Univ, Vet Med, Haikou, Hainan, Peoples R China UCL, Sch Pharam, Pharmacognosy & Phytotherapy, London, England Univ Oulu, Ecol & Genet Res Unit, Oulu, Finland Rhein Westfal TH Aachen, Inst Biochem & Mol Immunol, Aachen, Germany Univ Stuttgart, Inst Biochem & Tech Biochem, Stuttgart, Germany Peking Univ, Shenzhen Grad Sch, Sch Chem Biol & Biotechnol, Shenzhen, Peoples R China GIGA Res Inst, Med Oncol, Liege, Belgium CHULiege, Liege, Belgium Fdn Bruno Kessler, MPBA, Trento, Italy Hokkaido Univ, Grad Sch Med, Dept Neurobiol, Sapporo, Hokkaido, Japan Univ Leuven, Oncol, Leuven, Belgium Chalmers Univ Technol, Dept Math Sci, Gothenburg, Sweden Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Nijmegen, Netherlands Univ South Australia, Sch Informat Technol & Math Sci, Adelaide, SA, Australia Bio Thera Solut Ltd, Dept Computat Biol, Guangzhou, Guangdong, Peoples R China Inst Invest Biosanitario Granada IBS, Otolaryngol, Granada, Spain Curtin Univ, Sch Mol & Life Sci, Perth, WA, Australia Newcastle Univ, Inst Cellular Med, Newcastle Upon Tyne, Tyne & Wear, England Goethe Univ, Biol DCAL, Inst Pharm, Frankfurt, Germany Univ Lyon, ICBMS, UMR 5246, Lyon, France Inst Pasteur, Dept Genomes & Genet, Paris, France Univ Valencia, Pharmacol, Valencia, Spain Council Agr Res & Econ, Res Ctr Olive Citrus & Tree Fruit, Caserta, Italy Fraunhofer Inst Toxicol & Expt Med ITEM, Preclin Pharmacol & Vitro Toxicol, Hannover, Germany Univ Tasmania, Sch Med, Hobart, Tas, Australia Chugai Pharmaceut Co Ltd, Oncol Lifecycle Management Dept, Tokyo, Japan Univ Lubeck, Inst Neurobiol, Lubeck, Germany NYU, Sch Med, Neurol, New York, NY USA Univ Putra Malaysia, Dept Plant Pathol, Seri Kembangan, Malaysia Univ N Carolina, Biol, Chapel Hill, NC 27515 USA Univ Southampton, Fac Hlth Sci, Southampton, Hants, England Univ Highlands & Islands, Genet & Immunol Res Grp, Inverness, Scotland Heidelberg Univ, Inst Pathol, Heidelberg, Germany Indraprastha Inst Informat Technol, Dept Computat Biol, New Delhi, India Glasgow Caledonian Univ, Sch Hlth & Life Sci, Glasgow, Lanark, Scotland Liverpool John Moores Univ, Pharm & Biomol Sci, Liverpool, Merseyside, England Parkinsons Inst & Clin Ctr, Basic Res, Sunnyvale, CA USA Luxembourg Inst Sci & Technol, Environm Res & 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Biodiversite ISYEB, MNHN,CNRS,UMR 7205,EPHE, Paris, France CNRS, Inst Adv Biosci, Paris, France Univ Western Australia, Sch Mol Sci, Perth, WA, Australia Univ Ft Hare, Biochem & Microbiol, Alice, South Africa Univ Tubingen, Phys, Tubingen, Germany Griffith Univ, Sch Environm & Sci, Brisbane, Qld, Australia Philosoph Theol Hsch Vallendar, Stat & Standardised Methods, Vallendar, Germany Imperial Coll London, Life Sci, London, England Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia Univ Nebraska Med Ctr, Dept Pharmacol & Expt Neurosci, Omaha, NE USA Technol Univ Dublin, FOCAS Res Inst, Dublin, Ireland INSERM, Natl Inst Hlth & Med Res, Canc Res Ctr Toulouse, Paris, France Univ Santiago de Compostela, Dept Bioloxia Func, Grp BRAINSHARK, Galiza, Spain Univ Nebraska, Biol, Kearney, NE USA Univ Autonoma Barcelona, Dept Genet & Microbiol, Barcelona, Spain Univ Pisa, Chem & Ind Chem, Pisa, Italy Univ Manchester, Wellcome Trust Ctr Cell Matrix Res, Manchester, Lancs, England Univ Montpellier, CNRS, Inst Human Genet, Montpellier, France Czech Acad Sci, Inst Organ Chem & Biochem, Prague, Czech Republic CSIC, Natl Ctr Biotechnol CNB, Computat Syst Biol Grp, Madrid, Spain Natl Cheng Kung Univ, Dept Biochem & Mol Biol, Tainan, Taiwan Harvard Med Sch, Schepens Eye Res Inst, Ophthalmol, Boston, MA 02115 USA Lanzhou Univ, Hosp 2, Dept Gen Surg, Lanzhou, Gansu, Peoples R China Univ Technol Sydney, Sch Life Sci, Sydney, NSW, Australia JT Chen Clin, Gynecol, Tokyo, Japan Univ Western Australia, Sch Agr & Environm, Perth, WA, Australia Beijing Normal Univ, Fac Geog Sci, Beijing, Peoples R China Univ Missouri, Elect Engn & Comp Sci, Columbia, MO USA Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Res Inst, Dept Publ & Occupat Hlth, Amsterdam, Netherlands Semmelweis Univ, Med Biochem, Budapest, Hungary Queen Elizabeth Hosp, Dept Clin Oncol, Hong Kong, Peoples R China Univ Pittsburgh, Chem, Pittsburgh, PA USA GB Pant Inst Post Grad Med Educ & Res, Neurol, New Delhi, India Univ Copenhagen, Vet & Anim Sci, Copenhagen, Denmark Univ Palermo, Biomed Dept Internal & Specialist Med DIBIMIS, Sect Endocrinol, Palermo, Italy UCL, NPP, London, England Univ Florida, Microbiol & Cell Sci, Gainesville, FL USA Univ Salford, Sch Hlth Sci, Manchester, Lancs, England Cardiff Univ, Inst Med Genet, Cardiff, S Glam, Wales INSERM, ICO Canc Ctr, Angers, France Univ Colombo, Fac Med, Microbiol, Colombo, Sri Lanka Beijing Univ Chinese Med, Sch Chinese Mat Med, Beijing, Peoples R China Univ Porto, Fac Pharm, Porto, Portugal Univ Nottingham, Div Primary Care, Nottingham, England Univ Illinois, Pharm Syst Outcomes & Policy, Chicago, IL USA Pontificia Univ Catolica Goias, Escola Ciencias Agr & Biol, Goiania, Go, Brazil China Japan Friendship Hosp, Dept Oncol, Beijing, Peoples R China Boston Univ, Chem, Boston, MA 02215 USA Amer Univ, Environm Sci, Washington, DC 20016 USA Carleton Univ, Neurosci, Ottawa, ON, Canada Univ Regina, Chem & Biochem, Regina, SK, Canada Univ Montreal, Microbiolgy, Montreal, PQ, Canada Univ Leicester, Dept Genet & Genome Biol, Leicester, Leics, England Univ Queensland, Sch Agr & Food Sci, Gatton, Qld, Australia CNRS, BIOM, Paris, France UCL, Hatter Cardiovasc Inst, London, England Flinders Univ S Australia, Sci & Engn, Adelaide, SA, Australia Univ Warwick, Engn, Coventry, W Midlands, England Katholieke Univ Leuven, Ctr Human Genet, Leuven, Belgium Fudan Univ, Dept Macromol Sci, Shanghai, Peoples R China Dokuz Eylul Univ, Biol Educ, Izmir, Turkey Indiana Univ Sch Med, Dept Biochem & Mol Biol, Indianapolis, IN 46202 USA Mondo Med, Pulm Dis, Borgomanero, Italy US Naval, Res Lab, Ctr Bio Mol Sci & Engn, Washington, DC USA Univ Oslo, Inst Basic Med Sci, Dept Nutr, Oslo, Norway Peking Univ, Dept Mech & Engn Sci, Beijing, Peoples R China Saarland Univ, Dept Pharm Pharmaceut & Med Chem, Saarbrucken, Germany INSERM, Natl Inst Hlth & Med Res, Skin Res Inst, Paris, France Shanghai Proton & Heavy Ion Ctr, Res & Dev, Shanghai, Peoples R China Univ Georgia, Epidemiol, Athens, GA 30602 USA Univ Freiburg, Med Ctr, Dept Plast & Hand Surg, Freiburg, Germany Sidra Med, Res, Doha, Qatar Rostock Univ, Med Ctr, Dept Oral Maxillofacial & Plast Surg, Rostock, Germany Harvard Med Sch, Brigham & Womens Hosp, Emergency Med, Boston, MA 02115 USA AgResearch, Forage Sci, Palmerston North, New Zealand Univ Calif Los Angeles, Med, Los Angeles, CA USA Arizona State Univ, Biodesign Inst, Virginia G Piper Ctr Personalized Diagnost, Tempe, AZ USA Sheffield Hallam Univ, Res Inst, Mat & Engn, Sheffield, S Yorkshire, England Aneurin Bevan Univ Healthboard, Resp Med, Newport, Shrops, England Univ Calif San Francisco, Neurol Surg, San Francisco, CA 94143 USA Univ Western Australia, UWA Dent Sch, Perth, WA, Australia Fordham Univ, Biol Sci, Bronx, NY 10458 USA Univ Helsinki, Inst Biotechnol, Helsinki, Finland Fujian Normal Univ, Coll Life Sci, Fuzhou, Fujian, Peoples R China Univ Fukui, Dept Frontier Fiber Technol & Sci, Fukui, Japan Univ Southampton, Fac Med, Clin & Expt Sci, Southampton, Hants, England Univ Urbino, Dept Biomol Sci, Urbino, Italy Osped San Luigi, Allergol Unit, Turin, Italy Muljibhai Patel Urol Hosp, Dept Urol, Nadiad, Gujarat, India Univ Granada, Stratig & Paleontol, Granada, Spain Massey Univ, Sch Vet Sci, Auckland, New Zealand CNR, High Performance Comp & Networking Inst, Naples, Italy Univ Childrens Hosp Zurich, Div Metab, Zurich, Switzerland Univ Childrens Hosp Zurich, Childrens Res Ctr, Zurich, Switzerland Univ Melbourne, Biochem & Mol Biol, Parkville, Vic, Australia Inst Pasteur, Leptospirosis Res & Expertise Unit, Noumea, New Caledonia Tsinghua Univ, Sch Life Sci, Beijing, Peoples R China Cheikh Anta Diop Univ UCAD, Sci Fac, Biol Anim Dept, Dakar, Senegal Providence Portland Med Ctr, Earle A Chiles Res Inst, Portland, OR USA Agr & Agri Food Canada, Lacombe Res & Dev Ctr, Lacombe, AB, Canada Alberta Innovates, Performance Management & Evaluat, Edmonton, AB, Canada Univ Malaga, CSIC, Inst Hortofruticultura Subtrop Mediterranea La Ma, IHSM,UMA, Malaga, Spain James Cook Univ, Coll Publ Hlth Med & Vet Sci, Cairns, Qld, Australia European Commiss, Joint Res Ctr, Ispra, Italy Univ Montpellier, Montpellier, France CSIRO, Floreat, WA, Australia Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Guangzhou, Guangdong, Peoples R China Vanderbilt Univ, Pharmacol, 221 Kirkland Hall, Nashville, TN 37235 USA RIKEN, KFU RIKEN Translat Genom Unit, Yokohama, Kanagawa, Japan Univ Tubingen, Neurobiol Vocal Commun, Tubingen, Germany Univ Colorado, UCCS Ctr Biofrontiers Inst, Colorado Springs, CO 80907 USA Fred Hutchinson Canc Ctr, Div Basic Sci, Seattle, WA USA Univ Geneva, Fac Med, Primary Care Unit, Geneva, Switzerland Ernst Moritz Arndt Univ Greifswald, Dept Mol Genet & Infect Biol, Greifswald, Germany East China Univ Sci & Technol, Dept Fine Chem, Shanghai, Peoples R China Ohio State Univ, Surg, Columbus, OH 43210 USA Oragenics, R&D, Tampa, FL USA Natl Environm Agcy, Environm Hlth Inst, Singapore, Singapore Friedrich Loeffler Inst, Inst Diagnost Virol, Greifswald, Germany Queen Elizabeth Hosp, Oncol, Woodville, SA, Australia USDA, Emerging Pests & Pathogens Res Unit, Ithaca, NY USA Univ Freiburg, Med Ctr, Dept Neurosurg, Epilepsy Ctr, Freiburg, Germany Univ Hong Kong, Fac Educ, Informat & Technol Studies, Hong Kong, Peoples R China Univ Tokyo, Grad Sch Agr & life Sci, Agr & Environm Biol, Tokyo, Japan Univ Pittsburgh, Dept Med, Pittsburgh Heart Lung & Blood Vasc Med Inst, Pittsburgh, PA USA Guys & St Thomas NHS Fdn Trust, Directorate Transplant Renal & Urol, London, England Univ Sarajevo, Clin Ctr, Clin Heart Blood Vessel & Rheumat Dis, Sarajevo, Bosnia & Herceg Univ Kent, Sch Math Stat & Actuarial Sci, Canterbury, Kent, England Tokyo Inst Technol, Dept Life Sci & Technol, Tokyo, Japan Univ Appl Sci Munich, Laser Ctr Dept Appl Sci & Mechatron, Munich, Germany CIC NanoGUNE, Nanodevices, San Sebastian, Spain Vrije Univ Amsterdam Med Ctr, Gynaecol, Amsterdam, Netherlands Cardiff Univ, Med Sch, Div Populat Med, Cardiff, S Glam, Wales Karolinska Inst, Dept Med, Solna, Sweden Natl Inst Genet, Ctr Informat Biol, Mishima, Shizuoka, Japan Murdoch Univ, Harry Perkins Inst Med Res, Perth, WA, Australia Univ Limerick, Phys Educ & Sport Sci, Limerick, Ireland Ruhr Univ Bochum, Campus Clin Gynecol, Univ Str, Bochum, Germany Southwest Med Univ, Sch Publ Hlth, Epidemiol & Biostat, Luzhou, Sichuan, Peoples R China Beijing Canc Hosp, Minist Educ Beijing, Key Lab Carcinogenesis & Translat Res, Ctr Mol Diagnost, Beijing, Peoples R China Chinese Acad Sci, Chengdu Inst Biol, Herpetol Dept, Chengdu, Sichuan, Peoples R China Key Lab Nano Biol Effects & Safety, Beijing, Peoples R China NIBR, PK Sci, Basel, Switzerland Daejeon St Marys Hosp, Pain Ctr, Daejeon, South Korea Univ Western Ontario, Sch Hlth Studies, London, ON, Canada Univ Aberdeen, Hlth Psychol Grp, Aberdeen, Scotland Univ Colorado, Anesthesiol, Anschutz Med Campus, Boulder, CO 80309 USA Univ Antwerp, UZA Antwerp Univ Hosp, Crit Care Med, Edegem, Belgium Aarhus Univ Hosp, Endocrinol, Aarhus, Denmark Univ Pretoria, Ctr Transport Dev, Ind & Syst Engn, Pretoria, South Africa Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA Pontificia Univ Catolica Goias, Med Pharmaceut & Biomed Sci Sch, Goiania, Go, Brazil Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Cardiovasc Med, Stockholm, Sweden UCL, Clin Educ & Hlth Psychol, London, England KRIBB, Dev & Differentiat Res Ctr, Daejeon, South Korea Univ dArtois, Lab Barriere Hematoencephal, Arras, France AstraZeneca, IMED Biotech Unit, Discovery Sci, Quantitat Biol, Cambridge, England Pacific Northwest Natl Lab, Environm Mol Sci Lab, Richland, WA 99352 USA Coventry Univ, Appl Maths Res Ctr, Stat Phys Grp, Coventry, W Midlands, England Wilton Ctr, Invista Performance Technol, Cleveland, England Thunen Inst Forest Genet, Genome Res, Grosshansdorf, Germany Lebanese Amer Univ, Nat Sci, Byblos, Lebanon Takeda, Evidence & Value Generat, Osaka, Japan King Abdullah Int Med Res Ctr, Stem Cell & Regenerat Med, Riyadh, Saudi Arabia Univ Bahri, Ind Pulp & Paper, Khartoum, Sudan Univ Queensland, Mater Med Res Inst, Mater Res Inst, Brisbane, Qld, Australia Colorado State Univ, NREL, Ft Collins, CO 80523 USA Rzeszow Univ Hosp, Ob Gyn Dept, Rzeszow, Poland Univ Leeds, Fac Biol Sci, Leeds, W Yorkshire, England Massachusetts Gen Hosp, Endocrine Unit, Boston, MA 02114 USA Carl von Ossietzky Univ Oldenburg, Neurosci, Oldenburg, Germany UNSW, St George & Sutherland Clin Sch, Microbiome Res Ctr, Sydney, NSW, Australia NYU, Sch Med, Dept Biochem, New York, NY 10016 USA NYU, Sch Med, Dept Mol Pharmacol, New York, NY USA Univ Mississippi, Med Ctr, Med Infect Dis, Jackson, MS 39216 USA Tampere Univ, Fac Social Sci Psychol, Tampere, Finland Univ Cyprus, Dept Biol Sci, Nicosia, Cyprus Goethe Univ, Inst Med Microbiol & Infect Control, Frankfurt, Germany Charite Med Univ Berlin, Inst Radiol, Berlin, Germany Univ Cologne, Univ Hosp Cologne, Internal Med 1, Cologne, Germany Univ Calif Los Angeles, Sch Dent, Sect Periodont, Los Angeles, CA 90024 USA Aalborg Univ Hosp, Dept Clin Biochem, Aalborg, Denmark Manipal Acad Higher Educ, Pharm Practice, Manipal, Karnataka, India Univ Tokyo, Inst Med Sci, Dept Radiol, Tokyo, Japan Cukurova Univ, Family Med, Fac Med, Adana, Turkey Catholic Univ Korea, Coll Med, Dept Humanities & Social Med, Seoul, South Korea Univ Ghent, Food Technol Safety & Hlth, Ghent, Belgium UNSW Sydney, Sch Biol Earth & Environm Sci BEES, Sydney, NSW, Australia St Vincent Shoulder & Sports Clin, Res Unit, Vienna, Austria Cornell Univ, Biomed Engn, Ithaca, NY USA Leibniz Inst Plant Genet & Crop Plant Res IPK, Res Grp Bioinformat & Informat Technol, Gatersleben, Germany Univ Europea Madrid, Sch Doctoral Studies, Madrid, Spain CSIRO Mfg, Biomed Mfg, Melbourne, Vic, Australia Depaul Univ, Biol Sci, Chicago, IL 60604 USA Konkuk Univ, Dept Anim Sci & Technol, Seoul, South Korea Chang Gung Univ, Grad Inst Med Mechatron, Taoyuan, Taiwan Korea Univ, Coll Med, Psychiat, Seoul, South Korea Princeton Univ, Chem, Princeton, NJ 08544 USA Henan Univ Chinese Med, Henan Key Lab Chinese Med Resp Dis, Zhengzhou, Henan, Peoples R China Univ Med Ctr Mainz, Dept Psychiat & Psychotherapy, Mainz, Germany Monash Univ Malaysia, Sch Sci, Selangor, Malaysia Univ Mississippi, Med Ctr, Physiol & Biophys, Jackson, MS 39216 USA Univ Oslo, Dept Transplantat Med, Oslo, Norway Sichuan Agr Univ, Triticeae Res Inst, Yaan, Sichuan, Peoples R China Guangzhou Univ Chinese Med, Gastroenterol, Guangzhou, Guangdong, Peoples R China Southeast Univ, Sch Biol Sci & Med Engn, Suzhou, Jiangsu, Peoples R China Mt Allison Univ, Biol, Sackville, NB, Canada Ithaca Coll, Biol, Ithaca, NY 14850 USA Univ Cagliari, Dept Med Sci & Publ Hlth, Monserrato, Italy Univ Vienna, Chromosome Biol, Vienna, Austria Univ Zurich, Nephrol, Zurich, Switzerland Friedrich Schiller Univ, Inst Nutr Sci, Jena, Germany UNSW Sydney, Grad Sch Biomed Engn, Sydney, NSW, Australia Tulane Univ, Sch Med, Biochem & Mol Biol, 1430 Tulane Ave, New Orleans, LA 70112 USA NINDS, NIH, Bldg 36,Rm 4D04, Bethesda, MD 20892 USA NIH, NCBI, Natl Lib Med, Bldg 10, Bethesda, MD 20892 USA LOreal Res & Innovat, Aulnay Sous Bois, France Lund Univ, Dept Psychol, Malmo, Sweden Catholic Univ Louvain, Inst Rech Expt & Clin, Brussels, Belgium Georgia State Univ, Neurosci Inst, Atlanta, GA 30303 USA Univ Melbourne, Ophthalmol, Surg, Parkville, Vic, Australia Univ Western Australia, Ctr Ophthalmol & Visual Sci, Perth, WA, Australia Iran Univ Med Sci, Med Phys, Fac Med, Tehran, Iran Salk Inst Biol Studies, Cellular Neurobiol, La Jolla, CA USA Imperial Coll London, Fibrosis Res Grp, London, England Univ Texas MD Anderson Canc Ctr, Genitourinary Med Oncol, Houston, TX 77030 USA Univ Liege, GIGA Neurosci, Liege, Belgium Univ Crete, Sch Med, Urol, Iraklion, Greece Flinders Univ S Australia, Flinders Med Ctr, Dept Clin Pharmacol, Adelaide, SA, Australia Max Planck Inst Immunobiol & Epigenet, Bioinformat, Breisgau, Germany Cardiff Univ, Sch Psychol, Cardiff, S Glam, Wales Imperial Coll London, Chem Engn, London, England Lund Univ, Skane Univ Hosp, Clin Sci, Malmo, Sweden Sahlgrens Acad, Inst Clin Sci, Dept Mol & Clin Med, Gothenburg, Sweden Univ Cent Lancashire, Sch Pharm & Biomed Sci, Preston, Lancs, England Hosp Univ Doctor Peset, Psychiat & Clin Psychol, Valencia, Spain Ctr Biol Mol Severo Ochoa, Genome Dynam & Funct, Madrid, Spain Unvivers Hosp Lille, Dept Intens Care, Lille, France Kansai Med Univ, Surg, Osaka, Japan Univ Toulouse, Inst Natl Polytech Toulouse, Ecole Natl Super Agron Toulouse, Lab Genom & Biotechnol Fruit, Toulouse, France UiT Arctic Univ Norway, Inst Psychol, Tromsto, Norway Queens Univ, Ctr Publ Hlth, Belfast, Antrim, North Ireland Univ Manchester, Ctr Primary Care & Hlth Serv Res, Manchester, Lancs, England Griffith Univ, Menzies Hlth Inst, Gold Coast, Qld, Australia Anglia Ruskin Univ, FHSCE, Cambridge, England Univ Lleida, Dept Expt Med, Lleida, Spain NIEHS, Biomol Screening Branch, Div Natl Toxicol Program, POB 12233, Res Triangle Pk, NC 27709 USA Albany Med Coll, Immunol & Microbial Dis, Albany, NY 12208 USA Univ Queensland, Queensland Brain Inst, Brisbane, Qld, Australia Univ Kent, Sch Biosci, Canterbury, Kent, England Univ Bourgogne Franche Comte, INSERM, LNC, UMR 1231, Besancon, France Ritsumeikan Univ, Coll Life Sci, Dept Biotechnol, Shiga, Japan Kent State Univ, Biol Sci, Kent, OH 44242 USA Natl Inst Infect Dis, Dept Safety Res Blood & Biol Prod, Tokyo, Japan European Inst Marine Studies, Lab Microbiol Extreme Environm, Plouzane, France Univ Iowa, Dept Pharmacol, Roy J & Lucille A Carver Coll Med, Iowa City, IA 52242 USA Natl Univ Singapore, Biol Sci, Singapore, Singapore Conservatoire Natl Arts & Metiers, Lab GBA, EA4627, Paris, France Univ Michigan, Dept Human Genet, Ann Arbor, MI 48109 USA Lomonosov Moscow State Univ, Belozersky Inst Physicochem Biol, Moscow, Russia Jikei Univ, Sch Med, Dept Mol Biol, Tokyo, Japan Univ South Wales, Genom & Computat Biol, Treforest, Wales Duke Univ, Med Ctr, Obstet & Gynecol, Durham, NC USA Univ Technol Sydney, Climate Change Cluster, Sydney, NSW, Australia Nagoya Univ, Grad Sch Med, Dept Radiol, Nagoya, Aichi, Japan Western Sydney Univ, Sch Sci & Hlth, Sydney, NSW, Australia TEI Epirus, Dept Speech & Language Therapy, Ioannina, Greece Indiana Univ Purdue Univ, Orthopaed Surg, Indianapolis, IN 46202 USA Oniris, Vet Pathol, Nantes, France Royal Vet Coll, Pathobiol & Populat Sci, Hatfield, Herts, England Univ Ghent, Lab Pharmaceut Biotechnol, Ghent, Belgium Norwegian Inst Nat Res, Terr Ecol, Trondheim, Norway Univ Calif Merced, Mol & Cell Biol, Merced, CA USA Univ Dublin, Trinity Coll Dublin, Sch Engn, Ctr Transport Res, Dublin, Ireland Lund Univ, Inst Clin Sci, Nephrol, Malmo, Sweden Univ Birmingham, Mech Engn, Birmingham, W Midlands, England Lund Univ, Inst Clin Sci, OB GYN, Lund, Sweden Fdn Jimenez Diaz Hosp, Nephrol & Hypertens, Madrid, Spain Queensland Univ Technol, Sch Chem Phys & Mech Engn, Brisbane, Qld, Australia Otto von Guericke Univ, Psychol, Magdeburg, Germany Univ Med Ctr Gottingen, Dept Expt Neurodegenerat, Gottingen, Germany Harvard Med Sch, Spaulding Rehabil Hosp, Phys Med & Rehabil, Boston, MA 02115 USA Quadram Inst Biosci, Sci Operat, Norwich, Norfolk, England Ostbayer Tech Hsch Regensburg OTH Regensburg, Regensburg Med Image Comp ReMIC, Regensburg, Germany Deakin Univ, Fac Arts & Educ, Melbourne, Vic, Australia Univ Warwick, Warwick Med Sch, Coventry, W Midlands, England INSERM, Natl Inst Hlth & Med Res, Biochem & Mol Biol, Paris, France Univ Liege, Tax Inst, Liege, Belgium Univ Leeds, Sch Mol & Cellular Biol, Leeds, W Yorkshire, England IRCCS Ist Giannina Gaslini, UOC Genet Med, Genoa, Italy Res Diets Inc, Sci, New Brunswick, NJ USA Univ Perugia, Dept Phys & Geol, Perugia, Italy Walter Reed Natl Mil Med Ctr, Cellular Immunol, Bethesda, MD USA Univ Fed Santa Catarina, Biol Sci Ctr, Microbiol Immunol & Parasitol Dept, Florianopolis, SC, Brazil Univ Edinburgh, Royal Infirm, Ctr Liver & Digest Disorders, Edinburgh, Midlothian, Scotland Orion Pharma, Crit Care Proprietary Prod Div, Espoo, Finland MIT, Dept Civil & Environm Engn, 77 Massachusetts Ave, Cambridge, MA 02139 USA Univ Turin, Dept Vet Sci, Turin, Italy Univ G dAnnunzio, Dept Psychol Hlth & Territorial Sci, Chieti, Italy NYU, Sch Med, OB GYN, New York, NY USA Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland Univ Turku, Dept Biol, Turku, Finland Tech Univ Berlin, Bioanalyt, Berlin, Germany Univ Goettingen, Inst Phys Biophys 3, Gottingen, Germany Univ Texas MD Anderson Canc Ctr, Inst Appl Canc Sci, Translat Res Adv Therapeut & Innovat Oncol TRACTI, Houston, TX 77030 USA Univ Liege, Life Sci, Liege, Belgium Tarbiat Modares Univ, Fac Med Sci, Dept Toxicol, Tehran, Iran ARS, USDA, Stoneville, MS USA Univ Regensburg, RCI Regensburg Ctr Intervent Immunol, Regensburg, Germany Univ Nottingham, Sch Psychol, Nottingham, England NIH, Pathol Lab, Bethesda, MD 20892 USA Univ Carlos III Madrid, Elect Engn, Madrid, Spain Inst Med Mol, Chem Biol, Lisbon, Portugal Univ Costa Rica, CIET, San Jose, Costa Rica Univ Stavanger, Fac Hlth Sci, Stavanger, Norway Erasmus MC, Urol, Rotterdam, Netherlands Univ Edinburgh, Sch Biol Sci, Edinburgh, Midlothian, Scotland German Res Ctr Environm Hlth GmbH, Helmholtz Zentrum Munchen, Inst Bioinformat & Syst Biol IBIS, Ingolstadter Landstr 1, D-85764 Neuherberg, Germany Leiden Univ, Huygens Kamerlingh Onnes Lab, Leiden, Netherlands Univ Vienna, Nutr Sci, Vienna, Austria Kolling Inst Med Res, Med, St Leonards, NSW, Australia Johns Hopkins Sch Med, Biol Chem, Baltimore, MD USA Univ Montreal, Med Nutr & Microbiome Lab, Montreal, PQ, Canada GlaxoSmithKline, Cell & Gene Therapy, Stevenage, Herts, England Univ Trieste, Life Sci, Trieste, Italy Rhein Westfal TH Aachen, Dept Radiol, Aachen, Germany Univ Duisburg Essen, Univ Hosp Essen, West German Canc Ctr, Dept Med Oncol, Essen, Germany Med Univ Vienna, Obstet & Gynecol, Vienna, Austria FHI 360, Social & Behav Hlth Sci Div, Washington, DC USA KU Leuven VIB, Switch Lab, Leuven, Belgium Bielefeld Univ, Fac Technol, Bielefeld, Germany Capital Med Univ, Beijing Shijitan Hosp, Dept Clin Nutr, Dept Gastrointestinal Surg, Beijing, Peoples R China Meiji Univ, Dept Agr Chem, Kawasaki, Japan Yonsei Univ, Coll Med, Microbiol, Seoul, South Korea Johnson & Johnson EAME, Maidenhead, Berks, England Penn State Coll Med, Pediat, Hershey, PA USA Univ N Carolina, Dept Social Med, Chapel Hill, NC 27515 USA Univ Western Australia, ARC CoE Plant Energy Biol, Perth, WA, Australia Wageningen Univ, Div Human Nutr & Hlth, Wageningen, Netherlands Kings Coll London, Dept Neuroimaging, London, England Univ Murcia, Biochem & Mol Biol, Murcia, Spain Old Dominion Univ, Dept Biol Sci, Norfolk, VA 23529 USA Monash Univ, Biochem & Mol Biol, Melbourne, Vic, Australia Chinese Acad Sci, Inst Genet & Dev Biol, Beijing, Peoples R China Univ Pittsburgh, Pharmacol & Chem Biol, Pittsburgh, PA USA Univ Lausanne, Ctr Integrat Genom, Lausanne, Switzerland Univ Queensland, Sch Pharm, Brisbane, Qld, Australia Leibniz Inst Plant Genet & Crop Plant Res IPK Gat, Genebank, Gatersleben, Germany Piramal Imaging, Res & Dev, Berlin, Germany Univ Leeds, Civil Engn, Leeds, W Yorkshire, England Univ Missouri, Chem & Biochem, St Louis, MO 63121 USA US Geol Survey, Coastal & Marine Geol Program, Pacific Coastal & Marine Sci Ctr, Santa Cruz, CA USA Ajinomoto Genet Res Inst, Moscow, Russia Jagiellonian Univ, Fac Biochem Biophys & Biotechnol, Dept Plant Biotechnol, Krakow, Poland Univ Puerto Rico, Engn Sci & Mat, Mayaguez, PR USA Univ Regina, Dept Chem & Biochem, Regina, SK, Canada Argonne Natl Lab, Ctr Nanoscale Mat, 9700 S Cass Ave, Argonne, IL 60439 USA Univ Sunshine Coast, Sunshine Coast Mind & Neurosci Thompson Inst, Sippy Downs, Qld, Australia Chinese Peoples Liberat Army Gen Hosp, Dept Gastroenterol & Hepatol, Beijing, Peoples R China Griffith Univ, Griffith Ctr Social & Cultural Res, Gold Coast, Qld, Australia Tohoku Univ, Inst Dev Aging Canc, Dept Mol Oncol, Sendai, Miyagi, Japan Indiana Univ, Comp Sci, Bloomington, IN USA Fukushima Med Univ, Sch Med, Dept Pulm Med, Fukushima, Japan MEDIVIR AB, Biol, Huddinge, Sweden Western Sydney Univ, Neuroimmunol, Sydney, NSW, Australia Univ Jordan, Nutr & Food Technol, Amman, Jordan Thunen Inst Forest Genet, Fed Res Ctr Rura Areas Forestry & Fisheries, Inst Biodivers, Grosshansdorf, Germany Univ Edinburgh, Inst Cell Biol, Edinburgh, Midlothian, Scotland Univ Edinburgh, Ctr Integrat Physiol, Edinburgh, Midlothian, Scotland Univ Toronto, Struct Genom Consortium, Toronto, ON, Canada Canadian Mem Chiropract Coll, Grad Educ & Res, Toronto, ON, Canada Agilent Technol, R&D, Leuven, Belgium Univ British Columbia, Sch Nursing, Vancouver, BC, Canada Monash Univ, Monash Hlth, Sch Clin Sci, Stroke & Ageing Res,Dept Med, Melbourne, Vic, Australia French Natl Canc Inst, Innovat, Transfer, Biol, Boulogne, France Ludwig Maximilians Univ Munchen, Phys Chem, NanoBioSci, Munich, Germany Bandung Inst Technol, Sch Pharm, Med Chem, Bandung, Indonesia Univ Luxembourg, Life Sci Res Unit, Luxembourg, Luxembourg Lund Univ, Skane Univ Hosp, Dept Gastroenterol, Malmo, Sweden Millennium Hlth, Translat Genet, San Diego, CA USA Aristotle Univ Thessaloniki, Med Dept 2, Clin Res & Evidence Based Med Unit, Thessaloniki, Greece Jan Kochanowski Univ Humanities & Sci, Piotrkow Trybunalski Branch, Dept Psychol, Kielce, Poland McMaster Univ, Engn Phys, Hamilton, ON, Canada Marche Polytech Univ, Dept Agr Food & Environm Sci, Ancona, Italy Kuwait Univ, Fac Med, Microbiol, Kuwait, Kuwait Fujita Hlth Univ, Dept Breast Surg, Toyoake, Aich, Japan North West Reg Spinal Injuries Ctr, Spinal Injuries Ctr, Southport, Merseyside, England Luxembourg Inst Hlth, Competence Ctr Methodol & Stat, Luxembourg, Luxembourg Nestle Inst Hlth Sci SA, Metab Hlth, Ecublens, Vaud, Switzerland Ctr Inflammat Res VIB, Ghent, Belgium Univ Ghent, Dept Biomed Mol Biol, Ghent, Belgium Univ Lisbon, Inst Educ, Curriculo Formacao Prof & Tecnol, Lisbon, Portugal Univ Edinburgh, Ctr Inflammat Res, Edinburgh, Midlothian, Scotland Univ Melbourne, Sch BioSci, Parkville, Vic, Australia Northumbria Univ, Comp & Informat Sci, Newcastle Upon Tyne, Tyne & Wear, England Univ Valencia, Endocrinol, Valencia, Spain INRS, Inst Armand Frappier, Laval, PQ, Canada Univ Laval, INAF, Sch Nutr, Quebec City, PQ, Canada Univ Konstanz, Dept Biol, Constance, Germany Univ Cote dAzur, LAMHESS, Nice, France Scion, Syst Ecol, Christchurch, New Zealand CUNY, Grad Sch Publ Hlth & Hlth Policy, Epidemiol & Biostat, New York, NY 10021 USA Univ Queensland, Sch Dent, Brisbane, Qld, Australia George Inst Global Hlth, Renal & Metab Div, Sydney, NSW, Australia Wuhan Univ, Coll Chem & Mol Sci, Wuhan, Hubei, Peoples R China Griffith Univ, Sch Environm & Sci, Gold Coast, Qld, Australia Univ Minnesota, Radiat Oncol, Minneapolis, MN USA Goethe Univ, Fac Med, Frankfurt, Germany Natl Yunlin Univ Sci & Technol, Dept & Grad Sch Safety & Environm Engn, Touliu, Yunlin, Taiwan Massey Univ, Sch Sport Exercise & Nutr, Auckland, New Zealand Univ Florida, Wildlife Ecol & Conservat, Gainesville, FL USA Bournemouth Univ, Dept Psychol, Poole, Dorset, England Robert Koch Inst, Project Grp P2, Berlin, Germany Univ Edinburgh, MRC Inst Genet & Mol Med, Edinburgh, Midlothian, Scotland Univ Basel, Biozentrum, Basel, Switzerland Univ Wollongong, Sch Med, Wollongong, NSW, Australia Univ Cologne, Inst Human Genet, Cologne, Germany Rural Econ Branch, Econ Res Serv, Washington, DC USA Uivers Bordeaux, CNRS, Inst Neurosci Cognit & Integrat Aquitaine, Bordeaux, France Univ Calif Riverside, Dept Chem & Environm Engn, Riverside, CA 92521 USA Univ Calif Riverside, Mat Sci & Engn Program, Riverside, CA 92521 USA Mackay Med Coll, Dept Med, New Taipei, Taiwan Univ Bern, Div Anim Welf, Bern, Switzerland Oregon Hlth & Sci Univ, Dept Physiol & Pharmacol, Portland, OR 97201 USA Shanghai Univ 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Brazzaville, Rep Congo Univ Hosp BesanCon, Infect Control Dept, Besancon, France Galapagos NV, Clin Dev, Mechelen, Belgium Univ Tasmania, Integrated Marine Observing Syst, Hobart, Tas, Australia Georg August Univ Gottingen, Albrecht von Haller Inst Plant Sci, Dept Systemat Biodivers & Evolut Plants, Gottingen, Germany Univ Occupat & Environm Hlth, Dept Psychiat, Fukuoka, Fukuoka, Japan IMDEA Food, Program Precis Nutr & Aging, Madrid, Spain Radboud Univ Nijmegen, Med Sch, IQHealthcare, Nijmegen, Netherlands Maastricht Univ, Dept Cardiovasc Surg, Maastricht, Netherlands German Diabet Ctr, Inst Clin Biochem & Pathobiochem, Dusseldorf, Germany Juntendo Univ, Grad Sch Med, Dept Radiol, Tokyo, Japan Deakin Univ, Sch Informat Technol, Melbourne, Vic, Australia Max Planck Inst Eusenforschung, Dept Interface Chem & Surface Sci, Dusseldorf, Germany Edge Hill Univ, Dept Psychol, Ormskirk, England Aga Khan Univ, Psychiat, Karachi, Pakistan KRIBB, Korean Bioinformat Ctr, Seoul, South Korea Cardinal 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London, ON, Canada Univ Melbourne, Infrastruct Engn, Parkville, Vic, Australia Univ Canberra, Fac Hlth, Canberra, ACT, Australia Univ Cambridge, MRC Cognit & Brain Sci Unit, Cambridge, England Emory Univ, Biostat & Bioinformat, Atlanta, GA 30322 USA Johns Hopkins Sch Med, Anesthesiol & Crit Care Med, Baltimore, MD USA Nottingham Trent Univ, Sch Anim Rural & Environm Sci, Nottingham, England Univ Exeter, Biosci, Exeter, Devon, England Hillingdon Hosp NHS Fdn Trust, London, England Univ Glasgow, MRC CSO Social & Publ Hlth Sci Unit, Glasgow, Lanark, Scotland Natl & Kapodistrian Univ Athens, Evaggelismos Athens Hosp, ICU, Athens, Greece Univ Newcastle, Biol Sci, Callaghan, NSW, Australia Coventry Univ, Fac Hlth & Life Sci, Ctr Innovat Res Life Course, Coventry, W Midlands, England Lausanne Univ Hosp, Serv Endocrinol Diabet & Metab, Lausanne, Switzerland Charles Sturt Univ, Sch Community Hlth, Bathurst, NSW, Australia Queens Univ Belfast, Inst Global Food Secur, Belfast, Antrim, North 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Informat Engn, Xiangtan, Hunan, Peoples R China Univ Hlth Network, Mood Disorders & Psychopharmacol, Toronto, ON, Canada Sao Paulo State Univ UNESP, Dept Anim Sci, Sao Paulo, Brazil Sao Paulo State Univ, Vet Clin, Sao Paulo, Brazil

In almost any medical procedure respiratory motion is an issue and may result in image degradation. Most currently available devices and systems, which are intended to reduce respiratory influences do not come into operation however in clinics due to their high cost and complex operation. In our paper we evaluated an interactive breath hold control system that helps flat breathing to subsequently reduce respiratory motion during signal acquisitions or procedure treatments. With that the human subjects are enabled to regulate their own breath by following visual feedback via a specially designed display. That display shows biofeedback information about the respiratory excursion through air pressure deviations measured inside an air bellows belt. The system was assessed quantitatively in a laboratory setup and qualitatively by applications in real clinical procedures. The obtained results are very promising and can be further improved with additional developments to provide an easy to use and relatively inexpensive solution for respiratory motion related imaging problems.

Incremental innovation, something better or cheaper or more effective, is the standard innovation process for medical product development. Disruptive innovation is often not recognized as disruptive, because it very often starts as a simple and easy alternative to existing products with much reduced features and bad performance. Innovation is the invention multiplied with a commercial use, or in other words something that eventually provides a value to a clinical user or patient. To create such innovation not a technology push (technology delivered from a technical need perspective) but rather a pull (by learning and working with the clinical users) is required. Medical technology students need to understand that only through proper observation, procedure know-how and subsequent analysis and evaluation, clinically relevant and affordable innovation can be generated and possibly subsequently used for entrepreneurial ventures. The dedicated laboratory for innovation, research and entrepreneurship- INNOLAB ego.-INKUBATOR IGT (Image Guided Therapies) is financed by the state of Sachsen-Anhalt as part of the European ego.-INKUBATOR program with (EFRE funds) at the university clinic operated by the technical chair for catheter technologies and image guided surgeries. It forms a network node between medicine, research and economics. It teaches students to lead innovation processes, technology transfer to the user and is designed to stimulate the start-up intentions.

In Image Guided Surgeries (IGS), incremental innovation is normally not a technology push (technology delivered) but rather a pull (by learning and working with the clinical users) from understanding how these surgeries are performed. Engineers need to understand that only through proper observation, procedure know-how and subsequent analysis and evaluation, clinically relevant innovation can be generated. And, it is also essential to understand the associated health economics that could potentially come with new technological approaches. We created a new lecture format (6 ECTS) for graduate students that combined the basics of image guided procedures with innovation tools (Design Thinking, Lean Engineering, Value Proposition Canvas, Innovation Games) and actual visits of a surgical procedure. The students had to attend these procedures in small groups and had to identify and work on one or more innovation projects based on their observations and based on a prioritisation of medical need, pains and gains of the stakeholders, and ease of implementation. Almost 200 graduate students completed this training in the past 5 years with excellent results for the participating clinicians, and for the future engineers. This paper presents the lecture content, the setup, some statistics and results with the hope that other institutions will follow to offer similar programs that not only help the engineering students identify what clinically relevant innovation is (invention x clinical implementation), but that also pave the path for future interdisciplinary teams that will lead to incremental and disruptive innovation.

Michael Friebe Institute of Medical Engineering, Otto-von-Guericke-University, Magdeburg, Germany Abstract: There has been little technical innovation over the last few years for contrast media (CM) injectors that are used for diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], and hybrid imaging systems, such as positron emission tomography–CT or magnetic resonance–positron emission tomography) examinations. The medical need of CM for the enhancement of diagnostic images has been around for a long time, but the application of theCM into the blood stream comes with potential medical complications for the patient and requires a lot of operator experience and training. Most power injector systems that are currently used can do significantly more than what is typically required; this complexity however, adds error potential and cost. This paper focuses on the main features that CM injector systems should have and highlights the technical developments that are useful to have but which add complexity and cost, increase setup time, and require intensive training for safe use. CM injection protocols are very different between CT and MRI, with CT requiring many more variances, has a need for multiphase protocols, and requires a higher timing accuracy. A CM injector used in the MRI suite, on the other-hand, could only need a relatively time insensitive injection with a standard injection flow rate and a volume that is dependent on the patients’ weight. This would make easy and lightweight systems possible, which areable to safely and accurately perform the injection task, while allowing full MRI compatibility with relatively low cost investment and consumable costs. Keywords: power injector, contrast media injection, injection protocols, MRI compatibility

Aus der Einführung: "Eine systematische Vorgehensweise entsprechend der Konstruktionsmethodik gilt als zielführender Ansatz bei der Findung von technischen Lösungen und der Entwicklung von Produkten. In der Literatur finden sich dazu zahlreiche Veröffentlichungen z. B. Feldhusen & Grote 2013; Ehrlenspiel 2014; Ehrlenspiel 2009; Roth 1994 und Livotov 2013. Die VDI Richtlinie 2221 „Methodik zum Entwickeln und Konstruieren technischer Systeme und Produkte“ (VDI 1993) beschreibt ebenfalls allgemeingültige Regeln bei der systematischen Lösungsfindung. Iterativ wird in mehreren Teilschritten eine zuvor definierte Aufgabe in eine Lösung überführt. Dabei werden die Phasen der Planung, der Konzeption, des Entwurfes und der Ausarbeitung durchschritten. In der Literatur und den Richtlinien ist jedoch keine explizite Rückkopplung mit dem Nutzer gefordert oder angedacht. Gerade vor dem Hintergrund der voranschreitenden Individualisierung der Produkte und kann hierin ein entscheidender Vorteil liegen. Entwicklungszyklen und die Zeit bis zur Markteinführung von Produkten können reduziert werden. Zudem ist von einer höheren Akzeptanz durch den Kunden auszugehen. ..."

Background For autonomous robot-delivered surgeries to ever become a feasible option, we recommend the combination of human-centered artificial intelligence (AI) and transparent machine learning (ML), with integrated Gross anatomy models. This can be supplemented with medical imaging data of cadavers for performance evaluation. Methods We reviewed technological advances and state-of-the-art documented developments. We undertook a literature search on surgical robotics and skills, tracing agent studies, relevant frameworks, and standards for AI. This embraced transparency aspects of AI. Conclusion We recommend "a procedure/skill template" for teaching AI that can be used by a surgeon. Similar existing methodologies show that when such a metric-based approach is used for training surgeons, cardiologists, and anesthetists, it results in a >40% error reduction in objectively assessed intraoperative procedures. The integration of Explainable AI and ML, and novel tissue characterization sensorics to tele-operated robotic-assisted procedures with medical imaged cadavers, provides robotic guidance and refines tissue classifications at a molecular level.