This document describes the development of an electronic version of the Carolinas Comfort Scale (CCS) survey. The CCS is used to assess quality of life for hernia repair patients. It was originally a paper survey, but clinicians wanted a digital version for easier distribution, standardized scoring, and data analysis. An Adobe Flash application was prototyped that replicated the paper survey functionality. It received positive feedback and has potential for streamlining data collection and analysis while providing immediate results to patients. Further development is needed to fully implement scoring and data export capabilities.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Laparoscopic anatomy of inguinal canalGergis Rabea
Since laparoscopy has been used in the treatment of patients with inguinal hernias, new interest has developed in the anatomy of the inguinal region of the posterior aspect of the abdominal wall. Anatomists and laparoscopists have published interesting articles on the surgical anatomy of this region, which they call the laparoscopic inguinal anatomy
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
Surgical Anatomy of Breast and Approach to Breast Carcinoma. Basic idea on the significance of important surgical anatomy landmarks/ fact of the breast. Ideas/approach to identify red flags of breast carcinoma. Compare breast carcinoma and aberrant benign causes.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Laparoscopic anatomy of inguinal canalGergis Rabea
Since laparoscopy has been used in the treatment of patients with inguinal hernias, new interest has developed in the anatomy of the inguinal region of the posterior aspect of the abdominal wall. Anatomists and laparoscopists have published interesting articles on the surgical anatomy of this region, which they call the laparoscopic inguinal anatomy
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
Surgical Anatomy of Breast and Approach to Breast Carcinoma. Basic idea on the significance of important surgical anatomy landmarks/ fact of the breast. Ideas/approach to identify red flags of breast carcinoma. Compare breast carcinoma and aberrant benign causes.
TMPA-2017: Evolutionary Algorithms in Test Generation for digital systemsIosif Itkin
TMPA-2017: Tools and Methods of Program Analysis
3-4 March, 2017, Hotel Holiday Inn Moscow Vinogradovo, Moscow
Evolutionary Algorithms in Test Generation for digital systems
Yuriy Skobtsov, Vadim Skobtsov, St.Petersburg Polytechnic University
For presentation follow the link: https://www.youtube.com/watch?v=gUnKmPg614k
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The ionization state of a chemical, reflected in pKa values, affects lipophilicity, solubility, protein binding and the ability of a chemical to cross the plasma membrane. These properties govern the pharmacokinetic parameters such as absorption, distribution, metabolism, excretion and toxicity and thus pKa is a fundamental chemical property and is used in many models of chemical toxicity.
Experimentally determining pKa is not feasible for high-throughput assays. Predicting pKa is challenging and existing models have been developed only using restricted chemical space (e.g., anilines, phenols, benzoic acids, primary amines) and lack of a generalized model impedes ADME modeling.
No free and open source models exist for heterogeneous chemical classes, however, several proprietary programs exist. In this work, pKa open data bundled with DataWarrior (http://www.openmolecules.org/) were used to develop predictive models for pKa. After data cleaning, there were ~3100 and ~3900 monoprotic chemicals with an acidic or basic pKa, respectively. 1D and 2D chemical descriptors (AlogP, Topological polar surface area, etc) in addition to 12 fingerprints (presence or absence of a chemical group) were generated using PaDEL software. Three datasets were used: acidic, basic and acidic and basic combined.
13 datasets were examined, the 1D/2D descriptors and 12 fingerprints. Using the Extreme Gradient Boosting algorithm showed that the MACCS and Substructure Count fingerprints yielded the best results, with models showing an R-Squared of ~0.78 and a RMSE of 1.42.
Recently, Deep Learning models have showed remarkable progress in image recognition and natural language processing. To determine if the Deep Learning algorithms would increase model performance we examined the datasets and found that the Deep Learning models were somewhat superior than Extreme Gradient Boosting with an R-Squared of ~0.80 and an RMSE of ~1.38.
This work does not reflect U.S. EPA policy.
In-silico structure activity relationship study of toxicity endpoints by QSAR...Kamel Mansouri
Several thousand chemicals were tested in hundreds of toxicity-related in-vitro high-throughput screening (HTS)
bioassays through the EPA’s ToxCast and Tox21 projects. However, this chemical set only covers a portion of the chemical
space of interest for environmental risk assessment, leading to a need to fill data gaps with other methods. A cost effective
and reliable approach to fullfill this task is to build quantitative structure-activity relationships (QSARs).
In this work, a subset of 1877 chemicals from ToxCast were used to build QSAR models. These models will be applied
to predict values for multiple ToxCast assays in a larger environmental database of ~30K chemical structures.
Based on a clustering study by Sipes et al. (2013), the initial molecular targets of this effort consisted of a set of 18
NovaScreen G-protein coupled receptor (GPCR) assays. These assays are part of the aminergic category that showed the
highest number of actives within the ToxCast portfolio. Classification methods including SOM, SVM, PLSDA and kNN, were
tested. These methods were coupled to variable selection techniques such as genetic algorithms that were applied in order
to select the best representative molecular descriptors based on statistical fitness functions. The obtained models were
validated and their prediction ability measured. The models that showed good results will be applied within the limits of
their established chemical space defined by the applicability domain.
Evaluation of Processing Technologies for Umbilical Cord Blood Sararajputsa
An evaluation of three UCB processing technologies was performed to compare product purity and potency as defined by characterization markers. The technologies were PrepaCyte-CB (BioE, Minnesota), AXP AutoXpress Platform (GE Healthcare, New Jersey), and Sepax (Biosafe, Switzerland). These technologies were compared to SLCBB’s manual Hetastarch method. For more details visit: http://www.cryobanksindia.com/moms-corner/case-studies/
Evaluation of Processing Technologies for Umbilical Cord BloodSararajputsa
Cryobanks India, a premier Umbilical Cord Blood company ensures a healthy future for your baby. For more details visit: http://www.cryobanksindia.com/moms-corner/case-studies/
Modelling and Control of Drinkable Water Networks. Presentation at the 1st technical workshop of the FP7 research project EFFINET in Limassol, Cyprus, 5-6 June 2013. The main developments within WP2 are presented: Understanding the water demand patterns, development of time-series models for the water demand, formulation and solution of Model Predictive Control (MPC) problems for the water network and quantification of the effect that the prediction errors have on the optimal solution and on the closed-loop behaviour of the controlled system.
Deep learning methods applied to physicochemical and toxicological endpointsValery Tkachenko
Chemical and pharmaceutical companies, and government agencies regulating both chemical and biological compounds, all strive to develop new methods to provide efficient prioritization, evaluation and safety assessments for the hundreds of new chemicals that enter the market annually. While there is a lot of historical data available within the various agencies, organizations and companies, significant gaps remain in both the quantity and quality of data available coupled with optimal predictive methods. Traditional QSAR methods are based on sets of features (fingerprints) which representing the functional characteristics of chemicals. Unfortunately, due to both data gaps and limitations in the development of QSAR models, read-across approaches have become a popular area of research. Successes in the application of Artificial Neural Networks, and specifically in Deep Learning Neural Networks, has delivered a new optimism that the lack of data and limited feature sets can be overcome by using Deep Learning methods. In this poster we will present a comparison of various machine learning methods applied to several toxicological and physicochemical parameter endpoints. This abstract does not reflect U.S. EPA policy.
1. Converting Paper to Digital
Carolinas Health Informatics Program
Practicum Project
John Horan
2. Carolinas Comfort Scale
Presentation Outline
Introduction of the Carolinas Comfort Scale (CCS)
Project Scope and Requirements
Research and Development
Application Demonstration
Potential Impact of Application
Questions and General Discussion
3. What is it?
• CCS is survey used to help physicians and patients
assess Quality of Life both pre and post hernia repair
with mesh
• Developed by physicians and researchers from
Carolinas Laparoscopic and Advanced Surgery
Program (CLASP)
• CLASP has become a leader in minimally invasive
surgery by focusing on Patient Care, Research, and
Education.
4. How it was developed
• Developed by comparing Carolina Comfort Scale
results against the SF-36 questionnaire which is
considered the gold standard for measuring Quality of
Life for patients who have undergone hernia repair
surgery
• Results of the study published in the Journal of
American College of Surgeons
http://www.ncbi.nlm.nih.gov/pubmed/18387468
• CCS was found to better assess the quality of life
and satisfaction of patients who have undergone
surgical hernia repair better than the generic SF-36.
5. Carolinas Comfort Scale
CSS Usage
The CCS survey is currently
used by surgeons in 19 US
states, 39 Countries, and
has been translated into
multiple languages.
6. Carolinas Comfort Scale
A physician from the United Kingdom will
use the CCS in Nottingham City Hospital
which covers 64 general practices and
provides care to 330,000 patients annually.
The CCS will be used as a support tool for
screening eligibility for inguinal hernia
repair surgery funded by the Nottingham
City Hospital.
French physicians will launch a research
trial using the CCS involving 30 university hospital
teams in France. The study is sponsored by the
French government.
8. Carolinas Comfort Scale
How the Survey Works
• Patients fill out the paper
based survey
• Question responses are
scored using an algorithm
developed by CLASP
surgeons and researchers
that score five endpoints
• Activity, Sensation, Pain,
Movements and the Total
Score.
9. Carolinas Comfort Scale
SAS Scoring Algorithm Sample
Primary Endpoint #1: Activity Score PROC SORT data= CCS.Responses; by SYMPTOMATIC; RUN;
Compare mean/median scores for each of the 23 questionnaire items (1a, 1b, 2a, PROC MEANS NOPRINT data= CCS.Responses;
2b, 2c, etc) for lightweight vs. heavyweight mesh. This will provide a summary for VAR q2c q3c q4c q5c q6c q7c q8c;
all of the 23 questions for each comparative group. OUTPUT OUT=CCS.AvgMOVEMENT MEAN=m1-m7;
PROC SORT data= CCS.Responses; by CURRENTMESHTYPE; RUN; BY SYMPTOMATIC;
PROC MEANS NOPRINT data= CCS.Responses; WHERE FOLLOWUPTIMEPOINT = ‘POSTOP’;
VAR q1a q1b q2a q2b q2c q3a q3b q3c q4a q4b q4c q5a q5b q5c q6a q6b RUN;
q6c q7a q7b q7c q8a q8b q8c; Primary Endpoint #5: Total Score
OUTPUT OUT=CCS.AvgAll MEAN=m1-m23; Compare mean/median scores for QOL scores collapsed across
by CURRENTMESHTYPE ; pain/sensation/movement & activity for symptomatic vs. non-symptomatic
RUN ; patients. This will provide an overall report based on the mean for all 23
Primary Endpoint #2: Sensation Score questionnaire items.
Broader Endpoint #2: Compare mean/median scores for sensation collapsed across /*Combine result data files from examples #2, #3 and #4. This combination represents
activity (1a, 2a, 3a, 4a, 5a, 6a, 7a, 8a) for symptomatic vs. non-symptomatic patients. all scores collapsed across pain/sensation/movement.*/
This will provide a report that specifically focuses in on the sensation of mesh post PROC APPEND BASE=ccs.avgSENSATION DATA=ccs.avgPAIN FORCE; run;
implantation pertaining to a specific activity for each comparative group. PROC APPEND BASE=ccs.avgSENSATION DATA=ccs.avgMOVEMENT FORCE;
PROC SORT data= CCS.Responses; by SYMPTOMATIC; RUN; run;
PROC MEANS NOPRINT data= CCS.Responses; PROC MEANS NOPRINT data= CCS.avgSENSATION;
VAR q1a q2a q3a q4a q5a q6a q7a q8a; VAR m1 m2 m3 m4 m5 m6 m7 m8;
OUTPUT OUT=CCS.AvgSensation MEAN=m1-m8; OUTPUT OUT=CCS.QOLall MEAN=m1-m23;
BY SYMPTOMATIC; by SYMPTOMATIC; RUN ;
RUN; Compare mean/median scores for QOL scores collapsed across
Primary Endpoint #3: Pain Score pain/sensation/movement & activity for symptomatic vs. non-symptomatic
Broader Endpoint #3: Compare mean/median scores for pain collapsed across patients. This will provide an overall report based on the mean for all 23
activity (1b, 2b, 3b, 4b, 5b, 6b, 7b, 8b) for symptomatic vs. non-symptomatic questionnaire items using the Wilcoxon signed-rank test.
patients. This will provide a report that details the level of pain that is experienced PROC APPEND BASE=ccs.avgSENSATION DATA=ccs.avgPAIN FORCE; run;
by the patients pertaining to a specific activity either pre or post-operatively for PROC APPEND BASE=ccs.avgSENSATION DATA=ccs.avgMOVEMENT FORCE;
each comparative group. run;
PROC SORT data= CCS.Responses; by SYMPTOMATIC; RUN; DATA CCCS.meanALL;
PROC MEANS NOPRINT data= CCS.Responses; SET CCS.avgSENSATION;
VAR q1b q2b q3b q4b q5b q6b q7b q8b; RUN;
OUTPUT OUT=CCS.AvgPAIN MEAN=m1-m8; PROC NPAR1WAY WILCOXON data=ccs.meanALL;
BY SYMPTOMATIC; 8
WHERE FOLLOWUPTIMEPOINT = ‘PREOP’; CLASS SYMPTOMATIC;
RUN; 7 VAR m1 m2 m3 m4 m5 m6 m7 m8;
Primary Endpoint #4: Movement Score OUTPUT OUT = CCS.wilcoxonresults;
Compare mean/median scores for movement collapsed across activity (2c, 3c, 4c, RUN;
5c, 6c, 7c, 8c) for symptomatic vs. non-symptomatic patients. This will provide a PROC SORT data=ccs.wilcoxonresults; by SYMPTOMATIC; RUN;
report that details movement limitations either pre or post-operatively for each PROC MEANS
comparative group.
10. What CLASP wanted
• An electronic version of the CCS survey
• Electronic version of survey needs to be easily
distributed to current and future users on a variety of
platforms
• To minimize risk survey needs to function as a
standalone application so CLASP does not take on the
risk or expense of data collection and data
management.
• Current users need to have the ability to print PDF
versions of the completed survey with results and have
the ability to export data for patient records and further
analysis.
11. Additional Considerations
• Security of patient information
• Data collection and storage
• Branding of application to bring recognition to the
research and work that CLASP has done to create the
Carolina Comfort Scale
• Ability to control the use and monitor usage of the
application
• Ability to update application as future changes are
developed
12. Additional Considerations Continued
• Decrease turn around time of data analysis
• Make data collection and sharing easier
• Create application that would require very little if any
additional support
• Make application and results generation easy to use
and export for current users
13. Development options
• Research into existing tools and solutions
• REDCap
• Survey Monkey
• WebSurvey Toolbox
• To meet customer requirements separate versions of
the electronic survey would have to be developed for
each platform using several different tools
• Android: Android SDK or Eclipse
• Apple: XCODE
• Web: Eclipse, Netbeans, etc.
• Development costs and management would be
expensive and time consuming if separate platform
development was undertaken
14. Carolinas Comfort Scale
A solution exists to meet all
the needs!
• Adobe leader in development of
Rich Internet Applications
• Using Adobe’s development
tools applications can be
developed and then distributed to
a variety of platforms
16. Carolinas Comfort Scale
• Is Flash a good choice for development
of this application?
• Benefits of Adobe Flash vs. HTML5
• Popularity: estimated that world
wide over 90% of internet users
have Flash installed on their
desktop computers
• Many users find it to be easier to
vs. use than other development options
that exist with HTML5
• Drawbacks of using Flash
• Not support on Apple devices,
however Adobe provides several
tools to convert flash based
application for use on IOS
17. Application Development
• A tested and successful design already existed in the paper format of
the survey
• Screen elements were designed in Photoshop and then imported into
Adobe Catalyst. In Catalyst the screen elements were given functionality
and page transitions were defined
• The project was then imported into Flash builder where additional
functionality was added and it was then compiled for testing on the
Blackberry Playbook and Adobe Air platforms
• The customer was sent an Adobe Air version of the prototype
application to evauluate and additional edits to the screen layout were
made
• The Adobe Air and Playbook tablet prototype was then demonstrated
before the Department of Minimally Invasive Surgery at there monthly
team meeting
20. Results
• Response to the application was very positive
• When prompted for feedback on the application the only question was
could it have the ability to export the data. I had missed demonstrating
the data export screen in my presentation
• When scoring the paper survey the algorithm has to take into account
that patients may neglect to answer a question or that they may select
more than one choice for a question. These issues can be prevented in
the application by limiting question responses to one selection and by
requiring that users answer each question before the results are
generated.
• Converting the survey to electronic forms give the customer multiple
options for distribution and the ability to manage their intellectual
property
21. Results Continued
• Use of the application would allow Physicians to have immediate result
that that they could share with their patients
• Provides patients with additional information
• Streamlines the workflow of data collection and analysis
• Provides an example of how other paper based surveys and forms can
be converted into applications in a cost effective manner
• Next steps develop the full scoring and export functionality into the
application
Application developments Choices Research into existing Solutions Survey Monkey or similar tools Risk of exposure of patient data Lack of flexibility, not able to brand or function as standalone application Data collection, transfer and storage risks RedCap Lack of flexibility Cannot function as standalone application needs to be hosted and CLASP would have to store the data Limited support from Vanderbilt would require an FTE to manage Web Survey Tool Kit Good option allows surveys to be created using a JSP and Java Servlets Could function as a standalone application No current support of development plans does not function on with newer version of Java JDK or Apace Webserver Choice of Development Platforms To meet customers’ requirements application would have to have ability to function as a hosted web application, mobile compatible website or smart phone or tablet application Possibility exists that each version would have to be developed on separate IDEs, Android SDK, Eclipse, Netbeans, XCODE, etc Development cost would be high Version and change management would be complicate
Benefits of using Adobe for development Flexibility of creating applications for multiple platforms Applications can be developed once and ported to Adobe Air, IOS, Android or Blackberry without having to develop an individual application for each platform Also allows the flexibility to convert the application into Flash which can then be loaded onto a customer’s website. Adobe Object Oriented programming language is very similar to javascript with additional support for graphics and other functionalities Flexabilty development team does not have to exclude people who may not be code savy Round trip development workflow Photoshop to Catalyst to Flash builder
Why flash is good It is not going away overnight and Adobe is supporting the converting of Flash to HTML5 with tools like Wallaby(Flash to HTML5 convertor) Adobe is also developing a product called Adobe Edgewhich is a web development tool that uses HTML5, Javascript, and CSS3 HTML5 is the only alternative to Flash and currently it too is not consistently supported on all devices an
Benefits of using Adobe for development Flexibility of creating applications for multiple platforms Applications can be developed once and ported to Adobe Air, IOS, Android or Blackberry without having to develop an individual application for each platform Also allows the flexibility to convert the application into Flash which can then be loaded onto a customer’s website. Adobe Object Oriented programming language is very similar to javascript with additional support for graphics and other functionalities Flexabilty development team does not have to exclude people who may not be code savy Round trip development workflow Photoshop to Catalyst to Flash builder