Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

The Effects of Remotely Piloted Aircraft Command and Control Latency during Within-Visual-Range Air-To-Air Combat

The type of military missions conducted by remotely piloted aircraft continues to expand into all facets of operations including air-to-air combat. While future within-visual-range air-to-air combat will be piloted by artificial intelligence, remotely piloted aircraft will likely first see combat. The purpose of this study was to quantify the effect of latency on one-versus-one, within-visual-range air-to-air combat success during both high-speed and low-speed engagements. The research employed a repeated-measures experimental design to test the various hypothesis associated with command and control latency. Participants experienced in air-to-air combat were subjected to various latency inputs during one-versus-one simulated combat using a virtual-reality simulator and scored on the combat success of each engagement. This research was pursued in coordination with the Air Force Research Laboratory and the United States Air Force Warfare Center. The dependent variable, combat score, was derived through post-simulation analysis and scored for each engagement. The independent variables included the input control latency (time) and the starting velocity of the engagement (high-speed and low-speed). The input latency included six different delays (0.0, 0.25, 0.50, 0.75, 1.0, and 1.25 seconds) between pilot input and simulator response. Each latency was repeated for a high-speed and low-speed engagement. A two-way repeated-measures analysis of variance was used to determine whether there was a statistically significant difference in means between the various treatments on combat success and determine if there was an interaction between latency and fight speed. The results indicated that there was a statistically significant difference between combat success at the various latency levels and engagement velocity. There was a significant interaction effect between latency and engagement speed, indicating that the outcome was dependent on both variables. As the latency increased, a significant decrease in combat success occurred, decreasing from .539 with no latency, to .133 at 1.250 seconds of latency during high-speed combat. During low-speed combat, the combat success decreased from .659 with no latency, to .189 at 1.250 seconds of latency. The largest incremental decrease occurred between 1.00 and 1.25 seconds of latency for high-speed and between 0.75 and 1.00 at low-speed. The overall decrease in combat success during a high-speed engagement was less than during the low-speed engagements. The results of this study quantified the decrease in combat success during within-visual range air-to-air combat and concluded that, when latency is encountered, a high-speed (two-circle) engagement is desired to minimize adverse latency effects. The research informs aircraft and communication designers of the decrease in expected combat success caused by latency. This simulation configuration can be utilized for future research leading to methods and tactics to decrease the effects of latency

The Shape of Damping: Optimizing Damping Coefficients to Improve Transparency on Bilateral Telemanipulation

This thesis presents a novel optimization-based passivity control algorithm for hapticenabled bilateral teleoperation systems involving multiple degrees of freedom. In particular, in the context of energy-bounding control, the contribution focuses on the implementation of a passivity layer for an existing time-domain scheme, ensuring optimal transparency of the interaction along subsets of the environment space which are preponderant for the given task, while preserving the energy bounds required for passivity. The involved optimization problem is convex and amenable to real-time implementation. The effectiveness of the proposed design is validated via an experiment performed on a virtual teleoperated environment. The interplay between transparency and stability is a critical aspect in haptic-enabled bilateral teleoperation control. While it is important to present the user with the true impedance of the environment, destabilizing factors such as time delays, stiff environments, and a relaxed grasp on the master device may compromise the stability and safety of the system. Passivity has been exploited as one of the the main tools for providing sufficient conditions for stable teleoperation in several controller design approaches, such as the scattering algorithm, timedomain passivity control, energy bounding algorithm, and passive set position modulation. In this work it is presented an innovative energy-based approach, which builds upon existing time-domain passivity controllers, improving and extending their effectiveness and functionality. The set of damping coefficients are prioritized in each degree of freedom, the resulting transparency presents a realistic force feedback in comparison to the other directions. Thus, the prioritization takes effect using a quadratic programming algorithm to find the optimal values for the damping. Finally, the energy tanks approach on passivity control is a solution used to ensure stability in a system for robotics bilateral manipulation. The bilateral telemanipulation must maintain the principle of passivity in all moments to preserve the system\u2019s stability. This work presents a brief introduction to haptic devices as a master component on the telemanipulation chain; the end effector in the slave side is a representation of an interactive object within an environment having a force sensor as feedback signal. The whole interface is designed into a cross-platform framework named ROS, where the user interacts with the system. Experimental results are presented

Medical telerobotics and the remote ultrasonography paradigm over 4g wireless networks

Medical telerobotic systems provide a framework for performing interventional and diagnostic procedures remotely utilizing communication networks. Over the past decade, various systems have demonstrated the feasibility and the significance of telerobotics, some of which have been already adopted in clinical practice. In this study, we elaborate on the potential and discuss associated challenges focusing on the enabling technologies, namely robotic manipulation, telecommunications, and vision systems. A case study of an end-to-end mobile teleechography software platform using the MELODY robotic system is presented, investigating the capability of commercially available 4G (and beyond) wireless networks to communicate clinically lossless medical video for remote diagnosis purposes. Performance analysis demonstrates that medical video transmission approaching the clinical standards of in-hospital examination while conforming to strict delay requirements is achievable