Mixed reality simulation of rasping procedure in artificial cervical disc replacement (ACDR) surgery

<p>Abstract</p> <p>Background</p> <p>Until quite recently spinal disorder problems in the U.S. have been operated by fusing cervical vertebrae instead of replacement of the cervical disc with an artificial disc. Cervical disc replacement is a recently approved procedure in the U.S. It is one of the most challenging surgical procedures in the medical field due to the deficiencies in available diagnostic tools and insufficient number of surgical practices For physicians and surgical instrument developers, it is critical to understand how to successfully deploy the new artificial disc replacement systems. Without proper understanding and practice of the deployment procedure, it is possible to injure the vertebral body. Mixed reality (MR) and virtual reality (VR) surgical simulators are becoming an indispensable part of physicians’ training, since they offer a risk free training environment. In this study, MR simulation framework and intricacies involved in the development of a MR simulator for the rasping procedure in artificial cervical disc replacement (ACDR) surgery are investigated. The major components that make up the MR surgical simulator with motion tracking system are addressed. </p> <p>Findings</p> <p>A mixed reality surgical simulator that targets rasping procedure in the artificial cervical disc replacement surgery with a VICON motion tracking system was developed. There were several challenges in the development of MR surgical simulator. First, the assembly of different hardware components for surgical simulation development that involves knowledge and application of interdisciplinary fields such as signal processing, computer vision and graphics, along with the design and placements of sensors etc . Second challenge was the creation of a physically correct model of the rasping procedure in order to attain critical forces. This challenge was handled with finite element modeling. The third challenge was minimization of error in mapping movements of an actor in real model to a virtual model in a process called registration. This issue was overcome by a two-way (virtual object to real domain and real domain to virtual object) semi-automatic registration method.</p> <p>Conclusions</p> <p>The applicability of the VICON MR setting for the ACDR surgical simulator is demonstrated. The main stream problems encountered in MR surgical simulator development are addressed. First, an effective environment for MR surgical development is constructed. Second, the strain and the stress intensities and critical forces are simulated under the various rasp instrument loadings with impacts that are applied on intervertebral surfaces of the anterior vertebrae throughout the rasping procedure. Third, two approaches are introduced to solve the registration problem in MR setting. Results show that our system creates an effective environment for surgical simulation development and solves tedious and time-consuming registration problems caused by misalignments. Further, the MR ACDR surgery simulator was tested by 5 different physicians who found that the MR simulator is effective enough to teach the anatomical details of cervical discs and to grasp the basics of the ACDR surgery and rasping procedure</p

Методи та програмні засоби фізичної симуляції

Об’єктом дослідження є фізичний рушій для наукової симуляції. У дослідженні розглянуто основні типи фізичної симуляції та задачі, які вони вирішують, наведено детальний опис та порівняльний аналіз програмних застосунків фізичної симуляції таких, як PhysX, Bullet та Femap, визначено їх переваги та недоліки в контексті використання для наукового дослідження об’єктів і систем. У випадку наукової симуляції, оригінальність задачі або об’єкта дослідження спричиняє необхідність модифікації вихідного програмного коду фізичного рушія, що значно впливає на складність та швидкість проведення наукового дослідження. Тому  необхідною є розробка рушія, фізична модель якого може бути легко модифікована без втручання у вихідний код шляхом налаштування набору програмних модулів. Метою роботи є підвищення ефективності використання фізичного рушія для створення наукових симуляцій. Сформульовані вимоги до розробки нового багатоцільового наукового фізичного рушія, що забезпечує середовище для проведення експериментальних досліджень на основі симуляцій. Бібл. 26, іл. 3, табл.

Методи та програмні засоби фізичної симуляції

У даному дослідженні розглянуто основні типи фізичної симуляції та задачі, які вони вирішують. Наведено детальний опис та порівняльний аналіз програмних застосунків фізичної симуляції таких, як PhysX, Bullet та Femap, визначено їх переваги та недоліки в контексті використання для наукового дослідження об’єктів і систем. Універсального рішення, яке задовольняло б усім типам задач, на сьогоднішній день не існує. У випадку наукової симуляції, оригінальність задачі або об’єкта дослідження спричиняє необхідність модифікації вихідного програмного коду фізичного рушія, що значно впливає на складність та швидкість проведення наукового дослідження. Тому необхідною є розробка рушія, фізична модель якого може бути легко модифікована без втручання у вихідний код шляхом налаштування набору програмних модулів. Сформульовані вимоги до розробки нового наукового фізичного рушія

P14.02 An electronic behaviour diary: Monitoring the effects of advanced obstetric surgical skills training

Objective: Training should lead to improvements in the quality of clinical care delivery. It is essential to follow up participants after a training intervention to monitor changes in behaviour associated with adoption of lessons learned into clinical practice. We introduced an electronic diary to facilitate monitoring whilst minimising effort for participants. Method: An electronic diary was created using a freely available on-line platform. Following a training intervention on advanced obstetric surgical skills, obstetric residents from Kenya were invited to pilot completing the diary after their labour ward shifts. Entries were anonymised. Participants were asked to enumerate the times they utilised specific skills, or to state why they had been unable to do so, using tick box options. Reflections on skills used were entered using free comments. Results: All participants reported changed behaviours, for example, improved surgical knot-tying, safer needle handling, separate closure of uterine incision angles and techniques for delivery of the impacted fetal head. 6 reported conducting vaginal breech birth and 6 performed vacuum-assisted birth. All reported improvements in use of the safe surgical checklist, obtaining consent and respectful maternity care. 7 had participated in newborn resuscitation. Reflections suggested participants experienced improved levels of confidence and satisfaction when implementing new skills. Conclusion: This pilot study has demonstrated the feasibility of monitoring clinical behaviour change following training using an electronic platform. Monitoring the effect of training is essential to prove that training results in improvements to clinical practice. We plan to roll out this intervention following future training interventions

P14.01 An example of too much too soon? A review of caesarean sections performed in the first stage of labour in Kenya

Objective: Caesarean Section (CS) has potential short and long-term complications and is associated with excess maternal death. Decisions to perform (CS) are frequently made by inexperienced and unsupported non-specialist doctors, sometimes resulting in inappropriate decision-making and surgery. Our study assesses decision-making for CS in the first stage of labour in Kenya. Method: A panel of one UK and six Kenyan expert obstetricians reviewed clinical data extracted from 87 case-notes, that were randomly selected from a series obtained from seven referral hospitals in five Kenyan counties over six months in 2020. Following a preliminary review of the data and email discussion, an online panel was convened to discuss outstanding cases where consensus was yet to be reached. Agreement was reached by the panel in all but 5 cases. Results: In 41.3% cases, CS was considered appropriate, including 8% where CS was performed too late. The decision to delivery interval exceeded 2 h in 58.6% cases, including 16 cases of non-reassuring fetal status. In 10.3% it was considered that due to delay, further reassessment should have occurred. In 9.1% the CS was done too soon. There was insufficient information available to make a full assessment in 21.8% of cases. In 11.5% the CS was inappropriate. Conclusion: This review demonstrates that unnecessary caesarean sections are being performed, while some with appropriate indications are subject to delays. There is need for improved support for decision-making, coupled with improved record-keeping, improved quality of fetal monitoring during labour and more timely surgery when necessary

P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Objective: Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya. Method: A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach. Results: Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff. Conclusion: Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels

Modular soft pneumatic actuator system design for compliance matching

The future of robotics is personal. Never before has technology been as pervasive as it is today, with advanced mobile electronics hardware and multi-level network connectivity pushing âsmartâ devices deeper into our daily lives through home automation systems, virtual assistants, and wearable activity monitoring. As the suite of personal technology around us continues to grow in this way, augmenting and offloading the burden of routine activities of daily living, the notion that this trend will extend to robotics seems inevitable. Transitioning robots from their current principal domain of industrial factory settings to domestic, workplace, or public environments is not simply a matter of relocation or reprogramming, however. The key differences between âtraditionalâ types of robots and those which would best serve personal, proximal, human interactive applications demand a new approach to their design. Chief among these are requirements for safety, adaptability, reliability, reconfigurability, and to a more practical extent, usability. These properties frame the context and objectives of my thesis work, which seeks to provide solutions and answers to not only how these features might be achieved in personal robotic systems, but as well what benefits they can afford. I approach the investigation of these questions from a perspective of compliance matching of hardware systems to their applications, by providing methods to achieve mechanical attributes complimentary to their environment and end-use. These features are fundamental to the burgeoning field of Soft Robotics, wherein flexible, compliant materials are used as the basis for the structure, actuation, sensing, and control of complete robotic systems. Combined with pressurized air as a power source, soft pneumatic actuator (SPA) based systems offers new and novel methods of exploiting the intrinsic compliance of soft material components in robotic systems. While this strategy seems to answer many of the needs for human-safe robotic applications, it also brings new questions and challenges: What are the needs and applications personal robots may best serve? Are soft pneumatic actuators capable of these tasks, or âusefulâ work output and performance? How can SPA based systems be applied to provide complex functionality needed for operation in diverse, real-world environments? What are the theoretical and practical challenges in implementing scalable, multiple degrees of freedom systems, and how can they be overcome? I present solutions to these problems in my thesis work, elucidated through scientific design, testing and evaluation of robotic prototypes which leverage and demonstrate three key features: 1) Intrinsic compliance: provided by passive elastic and flexible component material properties, 2) Extrinsic compliance: rendered through high number of independent, controllable degrees of freedom, and 3) Complementary design: exhibited by modular, plug and play architectures which combine both attributes to achieve compliant systems. Through these core projects and others listed below I have been engaged in soft robotic technology, its application, and solutions to the challenges which are critical to providing a path forward within the soft robotics field, as well as for the future of personal robotics as a whole toward creating a better society

Biomechanics of human movement

Douglas College for Biomechanics, based on Open Stax Physics and Anatomy and Physiology. This is a custom textbook catered to the needs of kinesiology students enrolled in a first-year biomechanics course.open accessbiomechanicshuman kineticsPublished. This PDF is a representation of the book as at October 9, 2021. The online version may have been updated. For the most recent version, please visit the online book linked in this record

Food and eating in fiction since 1950 with particular reference to the writing of Angela Carter, Doris Lessing, Michele Roberts and Alice Thomas Ellis.

PhDEating is a fundamental activity. What people eat, how and with whom, what they feel about food, what they do or do not want to eat and why - even who they eat - are of crucial significance in any reading of human behaviour. In this thesis, I consider the diverse and complex uses of food and eating in fiction since 1950, especially that written by women. I argue both that food and eating carry much of the meaning of a novel or story and that the acts of cooking, feeding and eating depicted are inseparable from issues of power and control: individually, interpersonally, culturally, politically. My discussion centres on the writing of Angela Carter, Doris Lessing, Michele Roberts and Alice Thomas Ellis. Drawing on psychoanalytic theory, sociology, anthropology, Foucault, Bakhtin and others, the thesis aims to construct an interdisciplinary perspective which both resists reductive interpretations and emphasises the centrality, complexity and diversity of food and eating in literature in our culture. I begin with an examination of the ambiguities of maternal feeding and nurturing, moving on to explore the links between appetite, eating and sexuality. I explore cannibalism and vampirism as manifestations of oppression, but also as indicating insatiable emptiness and transgressive appetite. The body itself is crucial, and my argument considers the paradox of not eating as control/enslavement, also tracing self-starvation as a positive route towards wholeness and connection. The last part of my argument focuses on social eating, examining conventions, rituals and food itself in connection with power relations, and finally considers how we might truly speak of food and eating in the context of society as a whole