Technical Improvements Research Articles

New Astronomical Observatory Design for the Detection and Tracking of Satellite Objects: The Satellite Robotic Observatory (SRO)

Robotic Astronomical Observatories (RAOs) have provided very good results in different research projects in astrophysics/astronomy. Their applications in the detection, tracking, and identification of near-Earth objects have contributed to the identification of potentially dangerous objects for our security, such as near-Earth Objects (NEOs), near-Earth Asteroids (NEAs), meteors, and comets, whose trajectory changes can cause an impact on our planet. If advances in astrometry techniques (measuring the position and trajectory of Earth-orbiting objects) and photometry (variation in light curves) are considered together with the new sensors that work in the optical and near-infrared spectral ranges, a new observatory system that allows for the detection of nearby satellite objects in different spectral ranges and with better-defined optics can be developed. The present paper describes the design of a new observatory applied to the surveillance and tracking of satellites and other debris objects, the Satellite Robotic Observatory (SRO). Starting from general constraints from astronomy observatories, the design process has been determined, considering the main objectives, the necessary sensors, and several technical improvements that have contributed to a final configuration proposed for the SRO. The result is the design of a portable observatory model that can host at least two sensors to track and monitor satellite objects simultaneously.

High-dimensional Bayesian likelihood normalisation for CRESST's background model

Using CaWO4 crystals as cryogenic calorimeters, the CRESST experiment searches for nuclear recoils caused by the scattering of potential Dark Matter particles. A reliable identification of a potential signal crucially depends on an accurate background model. In this work, we introduce an improved normalisation method for CRESST's model of electromagnetic backgrounds, which is an important technical step towards developing a more accurate background model. Spectral templates based on Geant4 simulations are normalised via a Bayesian likelihood fit to experimental background data. Contrary to our previous work, no explicit assumption of partial secular equilibrium is required a priori, which results in a more robust and versatile applicability. This new method also naturally considers the correlation between all background components. Due to these purely technical improvements, the presented method has the potential to explain up to 82.7 % of the experimental background within [1 keV,40 keV], an improvement of at most 18.6 % compared to our previous method. The actual value is subject to ongoing validations of the included physics.

Smart Zone-Based Vehicle Speed Retarding System Utilizing Radio Frequency (RF) in Electronic Vehicles

The proposed system aims in designing an efficient automatic wireless vehicle speed control in low-speed zones using RF communication. The advent of new high-speed technology and the growing computer capacity provided realistic opportunity for new robot controls and realization of new methods of control theory. This technical improvement together with the need for high performance robots created faster, more accurate and more intelligent robots using new robots control devices, new drivers and advanced control algorithms. The proposed method uses RF transmitter and receiver modules for establishing wireless communication, DC motors for the vehicle movement controller. The status of the project will display on LCD display. The controlling device of the whole system is a Microcontroller to which RF receiver module, DC motors are interfaced through a motor driver. Whenever the vehicle enters into a low-speed zone, the data from RF transmitter of low-speed zone will be received by the vehicle system. The microcontroller in the vehicle system automatically slows down the speed to the speed limit of that zone. The microcontroller checks the data with the program embedded in it and performs appropriate actions on the electric motors. The microcontroller is programmed using Embedded C language.

A IMPLANTAÇÃO DA METODOLOGIA 5S EM UMA CÉLULA DE MONTAGEM DE UMA INDÚSTRIA METALÚRGICA

The 5S methodology originates from Japan and is based on the application of five concepts: Seiri, Seiton, Seiso, Seiketsu, and Shitsuke. The 5S method focuses on organizing different sectors of a company based on organization, standardization, cleanliness, and discipline. It is a behavioral improvement program characterized by fostering teamwork, organizing the work environment, preserving employee well-being, maintaining productivity, and emphasizing cleanliness and organization. The objective of this work is to describe the implementation of the 5S methodology through the physical rearrangement in a medium-sized metallurgical industry. The research, characterized as a case study in a company in the interior of the state of São Paulo, is carry out applied and qualitative approach, presenting the implementation of a 5S improvement project through physical rearrangement. The choose of the 5S methodology is due to the fact that consolidating, enhancing, or creating an organizational routine facilitates the adoption of the studied concepts in a real case within a medium-sized industry that manufactures and sells fitness equipment. The implementation of the 5S program began with the approval of the management, achieved through awareness demonstrated by photographic evidence showing the current status of the company. This project’s implementation was necessary due to the evident problems arising from a lack of organization, cleanliness, and the conditions where the products were found in the sector. Its implementation led to a significant improvement in production processes in terms of quality, efficiency, and productivity, as well as enhancements in visual aspects and workplace conditions. It can be concluded that the 5S Program is a simple philosophy that is easy to implement, but its results entirely depend on the level of engagement of the people involved. Although challenges exist in the implementation process, particularly of a behavioral nature, technical improvements were also observed, resulting in a more positive work environment and a more efficient industrial routine. Despite still having many actions to be taken, it is considered that the 5S Program was successful in its implementation.

High Density Isochronal Repolarisation Mapping (iREM) and Reentry Vulnerability Estimation for Scar-related VT Ablation: Mechanistic Basis, Clinical Application and Challenges.

Alterations in repolarisation gradients and increased heterogeneity are key electrophysiological determinants of ventricular arrhythmogenesis across a variety of aetiologies with and without structural heart disease. High-density repolarisation mapping to localise these repolarisation abnormalities could improve characterisation of the individual arrhythmogenic substrate and inform more targeted ablation. Yet, due to challenges posed by intrinsic features of human cardiac repolarisation itself as well as technical and practical limitations, they are not routinely assessed, and traditional substrate mapping techniques remain strictly limited to determining conduction abnormalities. Here, we provide an overview of the mechanistic role of repolarisation alterations in ventricular re-entry arrhythmias followed by a description of a clinical workflow that enables high-density repolarisation mapping during VT ablations using existing clinical tools. We describe step-by-step guidance of how-to set-up and generate repolarisation maps illustrating the approach in case examples of structural normal and abnormal hearts. Furthermore, we discuss how repolarisation mapping could be combined with existing substrate mapping approaches, including isochronal late activation mapping, to delineate sites of increased re-entry vulnerability, that may represent targets for ablation without the requirement for VT induction. Finally, we review challenges and pitfalls and ongoing controversies in relation to repolarisation mapping and discuss the need for future technical and analytical improvements in repolarisation mapping to integrate into ventricular substrate mapping strategies. Repolarisation mapping remains investigational and future research efforts need to be focused on prospective trials to establish the additional diagnostic value and its role in clinical ablation procedures.

How Can Institutional and Technical Improvements Enhance Copyright Protection in the Digital Economy?

How Can Institutional and Technical Improvements Enhance Copyright Protection in the Digital Economy?

Artificial Intelligence Approach to Business Process Re-Engineering the Information Flow of Warehouse Shipping Orders: An Italian Case Study

Artificial intelligence is revolutionizing and significantly shaping the work environment. It not only presents an innovative and unique challenge, but it also creates numerous opportunities in various sectors. This study aims to examine a case of artificial intelligence use in the logistics sector, specifically the implementation of text recognition algorithms that use advanced artificial intelligence technology to perform tasks and activities typically carried out by human operators. The implementation under analysis was carried out at an Italian company in Tolentino, in the province of Macerata. The implementation of this tool focuses on the ability to autonomously read shipping notes, with the aim of simplifying the flow of information in the goods receipt phase and reducing the workload of warehouse staff. As illustrated in the following chapters, when artificial intelligence follows several trainings, technical improvements and structural changes in shipping notes, the flow is greatly simplified, significantly facilitating this logistics phase.

Evaluating village financial governance in top tourism destinations

Village fund management is important for village economy and welfare. Village funds in Gresik Regency, Indonesia In particular, for the 2022 period, the revenue budget is IDR. 2,355,638,000 in Pangkahkulon village, while Rp. 9,865,701,000 for Sekapuk village, demonstrating the principles of accountability and transparency for effective and sustainable development. Accountability and transparency in village fund management ensure clear financial reporting, community participation, and openness of information, despite still facing obstacles such as lack of resources and regulations. Lack of community participation reduces accountability, transparency in achieving good financial governance in 3 villages in Gresik Regency. This study proposes to assess the impact of financial governance in Sekapuk, Pangkahkulon, and Sidokumpul Villages, focusing on accountability, transparency, and community participation. Despite progress, challenges including resource constraints and regulatory changes remain. This study provides in-depth insights into the effectiveness of village financial management systems, emphasizing the importance of community participation in improving accountability and transparency and building public trust. This study explores the implementation of good financial governance in three Gresik villages, focusing on accountability, transparency, and community participation. The study design uses a phenomenological approach to understand perceptions related to transparency and accountability in village fund management in Gresik Tourism Villages through interviews and observations. Primary data were collected from village officials, and analysis was conducted using NVivo 12 Plus, prioritizing transparency and community participation. This study found that accountability in Gresik Tourism Villages requires a transparent and efficient financial system. The SISKEUDES application experienced technical problems that affected reporting, so technical improvements and staff training were needed. Transparency and community participation in meetings and discussion forums are key to increasing trust and effectiveness in village fund management. Thus, in achieving Good Financial Governance in Gresik Tourism Villages, a financial system that is accountable, transparent, and involves community participation is needed. Information technology, regular training, and supervision with NGOs are important for efficiency and transparency, and discussion forums strengthen community trust.

Selective Sentinel Node Dissection in Melanoma with Trends and Future Directions.

Starting with its earliest descriptions, melanoma has been recognized as a tumor with a predilection for metastasis to regional lymph nodes. This tendency led to initial recommendations for very aggressive early surgical management of the regional nodal basin. However, those recommendations were the source of much controversy over nearly a century, until the minimally invasive surgical technique of sentinel lymph node (SLN) biopsy was developed by Morton, Cochran and colleagues. This technique has been evaluated in a series of prospective clinical trials, which have clarified its role and the management of lymph nodes in this disease. Current controversies relating to SLN biopsy include optimal selection of patients for the procedure, the role of gene expression profiling in initial melanoma management, and the potential therapeutic effects of SLN biopsy-based management. In addition, the SLN appears to be a rich source of data relating to the host-tumor interface and the immune microenvironment, which may advance our understanding of the biology of melanoma. Finally, although the surgical technique is well developed at this point, there may be additional technical improvements that are possible as well.

Feasibility of telementoring during robot-assisted minimally invasive esophagectomy.

Introduction Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE. Methods The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was impact of the technology on conveying and understanding instructions. Results Between December 2021 and December 2022, nine RAMIE procedures were proctored using the telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n=21, 96%). Most proctor instructions were aimed at improving surgical exposure (n=9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team. Conclusion Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation. Study registration number: 21/322 Date of registration: 14-5-2021.

Lessons learnt from a real-time attribution and contextualisation trial in a National Meteorological and Hydrological Service

Abstract When a record hot month occurs, timely and credible attribution and contextualisation information can enhance public understanding and future preparedness. This is particularly effective if provided in real time by a National Meteorological and Hydrological Service (NMHS). Many NMHSs are working to integrate research-based attribution methods into their operational services. In this study, researchers and climate service staff collaborated to assess the feasibility of delivering such information swiftly and aligned with standard NMHS data and procedures. The record warm July (winter) temperatures of Tasmania, Australia in 2023 were chosen to illustrate the trial. Rapid results were available three days after the event. Approximately half of the unusual warmth was attributed to climate change, with the likelihood of breaking the previous record at least 17 times higher in the current climate compared to a stationary pre-industrial climate (14% vs. 0.4%). The warming trend became evident in the 1980s, and by 2060, average July temperatures in Tasmania match the record temperature of July 2023 under a high emissions scenario. However, average July minimum temperatures were not well modelled, necessitating the addition of a higher-resolution forecast-based attribution method. In subsequent analysis, almost all the forecast temperature anomaly, and reduced storm activity, was attributable to climate change. Statistical analysis revealed that a weak El Niño partly offset the unusual warmth. To expedite these additional approaches, information drawn from real-time forecasts could be used. Lessons learnt from this trial include technical improvements to align better with NMHS protocols including using consistent datasets and baselines, and refining and automating the method suite. Logistical and communication enhancements included training staff to run the suite, improving communication materials, and developing delivery channels. These learnings provide key considerations for NMHSs as they move towards providing timely and credible climate attribution and contextualisation information as part of their operational services.

Assessment of radiation pneumonitis and predictive factors in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy.

Radiation pneumonitis (RP) is a dose-limiting toxicity associated with increased mortality for patients with non-small cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT). This study aims to assess the incidence of symptomatic RP (grade 2-5), rate of recovery and associated predictive factors. We performed a retrospective population-based study including 602 patients with NSCLC who were treated with CRT between 2002 and 2016. RP and rate of recovery were analysed using Common Terminology Criteria for Adverse Events version 4.0. Stepwise logistic regression was performed to analyse potential predictive factors for the two endpoints RP grade ≥ 2 and RP grade ≥ 3. A total of 136 (23%) patients developed symptomatic RP and 37 (6%) developed RP grade ≥ 3. A total of 67 (71%) recovered, whereas the remaining 27 (29%), with the major proportion of patients belonging to the RP grade ≥ 3 group, suffered from prevailing sequelae. On multivariable analysis, the selected model for predicting RP grade ≥ 2 included the factors V20, smoking status, average fractions per week and chemotherapy agent. V20 and age were selected factors for RP grade ≥ 3. The results suggest that regardless of all proposed factors predictive for RP, the most important influenceable significant factor still is dose to the lung. The main aim should be to avoid RP grade ≥ 3, where a substantial proportion of patients suffer from prevailing sequalae. Consequently, the technical improvement and precision of radiotherapy delivery should continue to focus on lung sparing techniques also in the ongoing immunotherapy-containing schedules where the risk of pneumonitis may be increased. e factor still is dose to the lung. Consequently, the technical improvement and precision of radiotherapy delivery should continue to focus on lung sparing techniques also in the ongoing immunotherapy-containing schedules where the risk of pneumonitis may be increased.

Analysis of two reperfusion techniques in uterine transplantation in an experimental model.

Uterine transplantation was developed for the treatment of absolute uterine factor infertility. As it is a new modality of transplantation, there is still room for technical improvement. A factor that impacts graft survival in organ transplantation is the warm ischemia time. In uterine transplantation specifically, at least two vascular anastomoses are performed on each side of the uterus, and the graft revascularization takes place when the vascular clamps of the arteries and veins are released on both sides simultaneously. For this reason, the warm ischemia time in uterine transplant is expected to be considerably long. The purpose of this study was to compare the sequential technique of uterine graft revascularization, which aims to reduce the warm ischemia time of the procedure, with the simultaneous revascularization technique. For the procedure, the uterine auto-transplantation technique was performed using 10 non-pregnant adult ewes weighing about 45 kg, divided into two groups: simultaneous revascularization group (5 animals) and sequential revascularization group (5 animals). To evaluate the groups, we analyzed the procedure and warm ischemia times, graft macroscopy, hemodynamic, laboratory, and histological parameters of the uterus. The sequential revascularization technique group had similar surgical procedure times, and the warm ischemia time was significantly shorter with medians of 32 min in the sequential group versus 72 min in the simultaneous group (p < 0.008). The graft macroscopy and hemodynamic, laboratory, and histological parameters evaluated were similar between the groups. The sequential revascularization technique proved to reduce the warm ischemia time in the sheep uterine auto-transplantation model without compromising graft viability.

Indications of digital literacy during Latino-focused, community-based COVID-19 testing implementation.

We sought to characterize indicators of digital literacy among persons testing for COVID-19 and community health workers (CHWs) providing testing via a digital platform in low-income, majority-Latino communities in California. From March 2021 to March 2022, we trained CHWs to provide community-based COVID-19 testing that relied on a digital platform for registration, recording and reporting of results. Among community members, we examined factors associated with accessing test results digitally and time to results receipt. Among CHWs, we evaluated factors associated with self-reported difficulty using the digital platform and improvement post-training. Overall, 5044 community members were tested for COVID-19. Accessing results digitally vs non-digitally was associated with younger age (Odds Ratio [OR]: 1.02 [95% Confidence Interval [CI], 1.01-1.03], for each year decrease), rural residence (OR:1.61 [95% CI, 1.30-1.99]), and providing an email address at registration (OR: 2.18 [95% CI, 1.80-2.65]). The likelihood of providing an email address at registration was increased among younger, non-Latino, English-speaking, female, and rural testers. Among persons accessing results digitally, median time from testing to result receipt was 41 min, with increased time associated with rural residence and older age. Among 42 CHWs surveyed, 29 (68%) reported technology-related challenges when providing testing: those reporting challenges were more likely to be older and rural CHWs. Rural CHWs were less likely to report technical skill improvement post-training. Email provision may be an indicator of digital literacy among persons testing for COVID-19 in low-income, majority-Latino communities. Rural and older CHWs may need more intensive digital training. Efforts to improve digital literacy in underserved communities are likely needed to realize the full potential of community-based health interventions that utilize digital platforms.

Clinical evaluation of a novel therapeutic single-use gastroscope: a pilot feasibility study.

The trend toward disposable products in gastrointestinal endoscopy, including single-use endoscopes, remains undeterred, even though crucial questions of sustainability and performance have not been sufficiently studied. The first therapeutic single-use gastroscope (Ambu aScope Gastro Large) was recently approved in Europe, but clinical data to support its use is currently unavailable. We aimed to evaluate the performance of the Ambu aScope Gastro Large in routine procedures requiring a large working channel. Between January and May 2024, consecutive patients with an indication for therapeutic gastroscope use were included prospectively. The primary aim was to assess the intraprocedural technical success rate. Eight gastrointestinal bleedings, two pancreatic necrosectomies, four foreign body removals, four stent implantations, and two cryoablations were performed. The technical success rate was achieved in 16 out of 19 (84%) patients. Three crossovers to standard endoscopes occurred. Clinical success was achieved in all cases where the primary aim was achieved (85%). No adverse events were reported. The therapeutic single-use gastroscope demonstrated feasibility in various therapeutic procedures, however, a crossover rate of 16% and an average user quality assessment score of 3.2 on the Likert scale suggest that further technical improvements of the device are necessary.

Feasibility of a Cardiac Magnetic Resonance Protocol for "off-on" Cardiac Resynchronization Therapy Evaluation.

Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain. To assess the feasibility of a CRT "off-on" protocol during CMR and measure the acute effects of CRT interruption on LV function. Patients underwent CMR before (pre-CRT) and 6 months after (post-CRT) an MR-conditional CRT defibrillator implantation. The post-CRT scan included two complete sets of cine images, one with inactive (post-CRTOFF) and one with active CRT (post-CRTON), maintaining a continuous connection between device and programmer. Out of 29 enrolled patients, 8 (28%) had complete and analyzable post-CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (n = 10), poor image quality (n = 7), and lack of patient cooperation (n = 4). LV ejection fraction significantly increased between pre-CRT scan (28.1%) and both post-CRTOFF (37.9%; p = 0.046) and post-CRTON CMR (35.0%; p = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post-CMR scan period. A CRT "off-on" protocol during CMR studies can be safely executed in patients with an MR-conditional CRT defibrillator. However, technical improvements are needed to facilitate high-quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy.

Cardiac diffusion-weighted and tensor imaging: a Society for Cardiovascular Magnetic Resonance (SCMR) special interest group consensus statement

Thanks to recent developments in Cardiovascular magnetic resonance (CMR), cardiac diffusion-weighted magnetic resonance is fast emerging in a range of clinical applications. Cardiac diffusion-weighted imaging (cDWI) and diffusion tensor imaging (cDTI) now enable investigators and clinicians to assess and quantify the 3D microstructure of the heart. Free-contrast DWI is uniquely sensitized to the presence and displacement of water molecules within the myocardial tissue, including the intra-cellular, extra-cellular and intra-vascular spaces. CMR can determine changes in microstructure by quantifying: a) mean diffusivity (MD) –measuring the magnitude of diffusion; b) fractional anisotropy (FA) – specifying the directionality of diffusion; c) helix angle (HA) and transverse angle (TA) –indicating the orientation of the cardiomyocytes; d) E2A and E2A mobility – measuring the alignment and systolic-diastolic mobility of the sheetlets, respectively.This document provides recommendations for both clinical and research cDWI and cDTI, based on published evidence when available and expert consensus when not. It introduces the cardiac microstructure focusing on the cardiomyocytes and their role in cardiac physiology and pathophysiology. It highlights methods, observations and recommendations in terminology, acquisition schemes, post-processing pipelines, data analysis and interpretation of the different biomarkers. Despite the ongoing challenges discussed in the document and the need for ongoing technical improvements, it is clear that cDTI is indeed feasible, can be accurately and reproducibly performed and, most importantly, can provide unique insights into myocardial pathophysiology.

Greenness visibility in urban living environments as pathway to promote health and well-being: Mapping spatial differentiation in Flanders (Belgium) based on viewshed analysis

A substantial body of evidence links green space to positive health outcomes. Beyond the availability of dedicated green spaces such as parks and the overall presence of vegetation and trees, visual exposure to greenery has also been shown to be important for well-being. Enhancing visual access to greenery may thus represent a pathway to promoting health and well-being. However, at regional or national scales, insights into disparities in visual access to greenery remain scarce. Most research and policy efforts rely on two-dimensional (top-down) data, which often fails to accurately capture the amount of greenery visible from individual perspectives, such as from within homes.This study builds on the work of Labib et al. [20], who developed a high-resolution (5 m grid) Viewshed Greenness Visibility Index (VGVI) for the Greater Manchester area (UK). By introducing technical improvements that significantly increased computational efficiency, we extended this approach to create a comprehensive VGVI map for Flanders, the northern region of Belgium. The resulting map enabled a broad assessment of VGVI disparities across Flanders. Our findings reveal evidence of distributive environmental injustice, as demonstrated by a strong negative correlation (Spearman's Rho = -0.48) between neighbourhood deprivation levels and VGVI scores. In Flanders, residents of more deprived neighbourhoods are exposed to significantly lower levels of visible greenery.We further explored the differences and similarities between traditional top-down greenness mapping and VGVI, which provides an eye-level perspective. Although a strong positive correlation was observed at the regional scale (Pearson's r = 0.80), this relationship weakens at the local level. Our findings suggest that VGVI analysis is particularly valuable at smaller geographic scales, making it especially relevant for research or spatial policies that address disparities in individual living conditions or target specific locations, such as schools, nurseries, hospitals, retirement homes, and community centres.

Diagnostic strategies for chronic lateral ankle instability: a narrative review.

Diagnosing chronic lateral ankle instability (CLAI) involves a comprehensive evaluation encompassing medical history, physical findings, and imaging examination. The optimal method of diagnosis of CLAI remains controversial. Therefore, the objective of this review was to summarize the current literatures regarding recent evolution and technical improvement of diagnostic methods for CLAI. A literature regarding the diagnosis of CLAI was reviewed on PubMed, including articles written in English until May 2024. In the manual examination for the diagnosis of CLAI, the anterior drawer test is the standard evaluation for lateral ligament insufficiency. The anterolateral drawer test, meanwhile, which focuses more on lateral instability biomechanically, has also been performed. Ultrasonography is a point-of-care tool that is less invasive than stress radiography and can dynamically assess ligament integrity, making the diagnosis of CLAI more accurate and convenient. Magnetic resonance imaging (MRI) is a useful modality that allows extensive preoperative evaluation of ligamentous properties and associated osteochondral damage, and it is essential in the preoperative diagnosis of CLAI. A combination of physical examination and imaging studies is especially important to more accurately diagnose CLAI. Future research should focus on standardizing testing and measurement methods to objectively define CLAI.

Cerebral Microcirculation: Progress and Outlook of Laser Doppler Flowmetry in Neurosurgery and Neurointensive Care.

Laser Doppler flowmetry (LDF) is a well-established technique for the investigation of tissue microcirculation. Compared to skin, the use in the human brain is sparse. The measurement of cerebral microcirculation in neurointensive care and during neurosurgery is challenging and requires adaptation to the respective clinical setting. The aim of the review is to present state of the art and progress in neurosurgery and neurointensive care where LDF has proven useful and can find clinical importance in the investigation of cerebral microcirculation. The literature in the field is summarized and recent technical improvements regarding LDF systems and fiber optical probe designs for neurosurgical and neurocritical care described. By combining two signals from the LDF unit, the measurement of the microcirculation (Perfusion) and gray whiteness (TLI) of the brain tissue, the full potential of the device is achieved. For example, a forward-looking LDF-probe detects high-risk hemorrhage areas and gray-white matter boundaries along intraoperative trajectories during stereotactic neurosurgery. Proof of principles are given for LDF as a guidance tool in deep brain stimulation implantation, brain tumor needle biopsies, and as long-term monitoring device in neurocritical care. With well-designed fiber optical probes, surgical fixation, and signal processing for movement reduction, LDF monitoring of the cerebral microcirculation is successful up to 10 days. The use of LDF can be combined with other physiological measurement techniques, for example, fluorescence spectroscopy for identification of glioblastoma during tumor surgery. Fiber optics can also be used during magnetic resonance imaging (MRI). Despite the many advantages, fiber optical LDF has not yet reached its full potential in clinical neuro-applications. Multicenter studies are required to further evaluate LDF in neurosurgery and neurointensive care. In conclusion, the present status of LDF in neurosurgery and neurointensive care has been reviewed. By combining Perfusion and TLI with tailored probe designs the full potential of LDF can be achived in measuring cerebral microcirculation. This includes guidance during DBS implantation and needle biopsies, and long-term monitoring in neurocritical care.