Muscle Activity Correlation With Surgeons’ Self-Reported Workload And Performance In Robotic Training

Studies have shown that muscle activity levels reflect work demands of operators performing physically and mentally tasks. Identifying work demands during the robotic surgery training is essential to ensure usability of teleoperation equipment and prevent surgeon musculoskeletal injuries and fatigue. The purpose of this project is to use physiological muscle activity sensors (electromyography (EMG)) to measure surgeons’ work demands during robotic training and to quantify the relationship of these metrics. Eight surface EMG sensors were used to collect upper body muscle activity. Signals from eight participants (all right-hand dominant) during multiple training sessions were collected while performing simulated robotic assisted tasks on the da Vinci skills simulator. Subjective workload measurements (i.e. NASA-TLX) and performance scores were also collected. The results showed muscle activity for neck, shoulder, and left forearm are significantly correlated with self-perceived workload (p\u3c0.05), especially the left forearm. This may be due to the usage (e.g., holding objects steady) or lack of positioning awareness of participants’ non-dominant hand during the training. The results also showed left bicep activity is negatively correlated with performance score, which suggests that participants’ non-dominant arm training and usage may lead to higher performance score. These results provide insight to surgeons’ workload and to help optimize their performance

Use of non-technical skills can predict medical student performance in acute care simulated scenarios

Background Though the importance of physician non-technical (NT) skills for safe patient care is recognized, NT skills of medical students, our future physicians, has received little attention. This study aims to investigate the relationship of medical student NT skills and clinical performance during acute care team simulation (ACTS). Methods Forty-one medical students participated in ACTS. A nurse confederate facilitated and evaluated clinical performance. Two raters assessed participants’ NT skills using an adapted NT assessment tool and overall NT skills score was calculated. Regressions predicting clinical performance using NT constructs were conducted. Results Overall NT skills score significantly predicted students’ clinical performance (r2 = 0.178, p = 0.006). Four of the five individual NT constructs also significantly predicted performance: communication (r2 = 0.120, p = 0.027), situation awareness (r2 = 0.323, p < 0.001), leadership (r2 = 0.133, p = 0.019), and decision making (r2 = 0.163, p = 0.009). Conclusions Medical student NT skills can predict clinical performance during ACTS. NT skills assessments can be used for targeted education for better feedback to students

Eye-Tracking Metrics Predict Perceived Workload in Robotic Surgical Skills Training

Objective: The aim of this study is to assess the relationship between eye-tracking measures and perceived workload in robotic surgical tasks. Background: Robotic techniques provide improved dexterity, stereoscopic vision, and ergonomic control system over laparoscopic surgery, but the complexity of the interfaces and operations may pose new challenges to surgeons and compromise patient safety. Limited studies have objectively quantified workload and its impact on performance in robotic surgery. Although not yet implemented in robotic surgery, minimally intrusive and continuous eye-tracking metrics have been shown to be sensitive to changes in workload in other domains. Methods: Eight surgical trainees participated in 15 robotic skills simulation sessions. In each session, participants performed up to 12 simulated exercises. Correlation and mixed-effects analyses were conducted to explore the relationships between eye-tracking metrics and perceived workload. Machine learning classifiers were used to determine the sensitivity of differentiating between low and high workload with eye-tracking features. Results: Gaze entropy increased as perceived workload increased, with a correlation of .51. Pupil diameter and gaze entropy distinguished differences in workload between task difficulty levels, and both metrics increased as task level difficulty increased. The classification model using eye-tracking features achieved an accuracy of 84.7% in predicting workload levels. Conclusion: Eye-tracking measures can detect perceived workload during robotic tasks. They can potentially be used to identify task contributors to high workload and provide measures for robotic surgery training. Application: Workload assessment can be used for real-time monitoring of workload in robotic surgical training and provide assessments for performance and learning

Human matrix metalloproteinases: An ubiquitarian class of enzymes involved in several pathological processes

Human matrix metalloproteinases (MMPs) belong to the M10 family of the MA clan of endopeptidases. They are ubiquitarian enzymes, structurally characterized by an active site where a Zn(2+) atom, coordinated by three histidines, plays the catalytic role, assisted by a glutamic acid as a general base. Various MMPs display different domain composition, which is very important for macromolecular substrates recognition. Substrate specificity is very different among MMPs, being often associated to their cellular compartmentalization and/or cellular type where they are expressed. An extensive review of the different MMPs structural and functional features is integrated with their pathological role in several types of diseases, spanning from cancer to cardiovascular diseases and to neurodegeneration. It emerges a very complex and crucial role played by these enzymes in many physiological and pathological processes

Copper as a signal for alginate sythesis in Pseudomonas syringae pv. Syringae

Plant-associated pseudomonads are commonly exposed to copper bactericides, which are applied to reduce the disease incidence caused by these bacteria. Consequently, many of these bacteria have acquired resistance or tolerance to copper salts. We recently conducted a survey of 37 copper-resistant (Cu^r) Pseudomonas spp., including P. cepacia, P. fluorescens, P. syringae, and P. viridiflava, and found that a subset of the P. syringae strains showed a dramatic increase in exopolysaccharide (EPS) production on mannitol-glutamate medium containing CuSO4 at 250 mg/ml. A modified carbazole assay indicated that the EPS produced on copperamended media contained high levels of uronic acids, suggesting that the EPS was primarily alginic acid. Uronic acids extracted from selected strains were further confirmed to be alginate by demonstrating their sensitivity to alginate lyase and by descending paper chromatography following acid hydrolysis. Subinhibitory levels of arsenate, cobalt, lithium, rubidium, molybdenum, and mercury did not induce EPS production, indicating that alginate biosynthesis is not induced in P. syringae cells exposed to these heavy metals. A 200-kb plasmid designated pPSR12 conferred a stably mucoid phenotype to several P. syringae recipients and also increased their resistance to cobalt and arsenate. A cosmid clone constructed from pPSR12 which conferred a stably mucoid phenotype to several P. syringae strains but not to Pseudomonas aeruginosa was obtained. Results obtained in this study indicate that some of the signals and regulatory genes for alginate production in P. syringae differ from those described for alginate production in P. aeruginosa.Peer reviewedPlant Patholog

Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room

Objective: The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). Background: MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. Method: Surgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. Results: Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability. Conclusion: Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. Application: Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams

Cancer Risk Factors and Screening Behavior Among Korean Americans in the SF Bay Area

Background: Korean Americans (KA) have the highest prevalence of death from cancer among Asian American ethnic groups in the U.S. This KA prevalence rate is also substantially higher than that of non-Hispanic whites, yet little is known about their cancer risk factors. This paper is one of the first studies to explore cancer risk factors and screening behaviors of Korean Americans in the San Francisco Bay Area. Methods: A survey instrument was created using items from the California Health Interview Survey (CHIS) from 2009-2012, which were translated into Korean. A cross-sectional survey assessing the prevalence of cancer risk factors and screening behaviors was conducted in-person, through telephone, and online using a community-based sampling strategy of 342 KAs across the SF Bay Area. These results were then compared to the results of CHIS 2007-2012 for Koreans, all Asians in California, and all of California. Simple and multiple logistic regression were also conducted to evaluate the association between several socioeconomic and cultural factors and cancer screening outcomes for colorectal cancer screening, mammography, and Pap smears. Results: In this sample, 30% of women 21 years and older had never received a Pap smear, 18% of women 40 years and older had never received a mammogram, and 24% of participants 50 years and older had never received colorectal cancer screening. Further analyses found that among women who are aged 21 years and older, not being a college graduate (Odds Ratio (OR): 3.59, 95% Confidence Interval [95% CI] 1.22, 10.57) was associated with higher odds of not receiving a Pap smear. Younger age was associated with never receiving colorectal screening (OR: 0.39, 95% CI 0.19, 0.79). Not having insurance (OR: 3.22, 95% CI 1.36, 7.62) and preference for a Korean physician (OR: 9.89, 95% CI 1.30, 75.18) were associated with higher odds of receiving no colorectal screening. Sex, having a college degree, or Limited English Proficiency (LEP) were not found to have any association with never receiving colorectal cancer screening. Conclusions: Very few studies assessing health disparities such as cancer risk factors and screening prevalence in KAs exist. Further studies in this vulnerable group exploring risk factors and screening rates for other cancers are encouraged to identify specific areas that can be targeted for improved health outcomes