Best practice considerations on the assessment of robotic assisted surgical systems:results from an international consensus expert panel

Background Health technology assessments (HTAs) of robotic assisted surgery (RAS) face several challenges in assessing the value of robotic surgical platforms. As a result of using different assessment methods, previous HTAs have reached different conclusions when evaluating RAS. While the number of available systems and surgical procedures is rapidly growing, existing frameworks for assessing MedTech provide a starting point, but specific considerations are needed for HTAs of RAS to ensure consistent results. This work aimed to discuss different approaches and produce guidance on evaluating RAS. Methods A consensus conference research methodology was adopted. A panel of 14 experts was assembled with international experience and representing relevant stakeholders: clinicians, health economists, HTA practitioners, policy makers, and industry. A review of previous HTAs was performed and seven key themes were extracted from the literature for consideration. Over five meetings, the panel discussed the key themes and formulated consensus statements. Results A total of ninety-eight previous HTAs were identified from twenty-five total countries. The seven key themes were evidence inclusion and exclusion, patient- and clinician-reported outcomes, the learning curve, allocation of costs, appropriate time horizons, economic analysis methods, and robotic ecosystem/wider benefits. Conclusions Robotic surgical platforms are tools, not therapies. Their value varies according to context and should be considered across therapeutic areas and stakeholders. The principles set out in this paper should help HTA bodies at all levels to evaluate RAS. This work may serve as a case study for rapidly developing areas in MedTech that require particular consideration for HTAs.</p

The Search for Supersymmetry at the Tevatron Collider

We review the status of searches for Supersymmetry at the Tevatron Collider. After discussing the theoretical aspects relevant to the production and decay of supersymmetric particles at the Tevatron, we present the current results for Runs Ia and Ib as of the summer of 1997. To appear in the book "Perspectives in Supersymmetry", edited by G.L. Kane, World Scientific.Comment: 84 pages with 31 figures imbedded using psfig.tex. Uses sprocl.st

Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD?

Item does not contain fulltextThis study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3)~whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99~children ages 6–12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).17 p

Does Baylisascaris procyonis Phylogeny Correlate with That of the Raccoon (Procyon lotor)

Baylisacaris procyonis, commonly known as the raccoon roundworm, is a parasite that inhabits the small intestine of the North American raccoon (Procyon lotor). Although humans do not typically become the definitive host, humans can become infected through handling soil containing eggs. B. procyonis can induce serious health complications in cases of human infection, including degenerative retinal and behavioral changes, coma, and even death. High prevalence of B. procyonis in a raccoon population increases the probability of transference to human hosts. In our study, we analyzed the genetic structure of B. procyonis harvested from raccoons of southwestern Ohio, and compared this to the genetic structure of the raccoons they inhabited. It is our hypothesis that the genetic structuring of the roundworms is the same as the genetic structuring of the raccoons. We isolated DNA from the roundworms using the method outlined in the DNA Minikit (Qiagen). Our research team isolated DNA from each roundworm sample and sent it to the Plant-Microbe Genomics Facility at The Ohio State University for gene amplification and sequencing. We built phylogenetic trees using these sequences, and compared these trees to some constructed for the raccoons. The correlations drawn between the raccoon and B. procyonis phylogenetic trees will help us better understand the relationship between the two species

Baylisascaris procyonis Impacts Raccoon (Procyon lotor) Diets

Raccoons (Procyon lotor) are the definitive host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is responsible for a dangerous neurological disease known as larva migrans encephalopathy. Raccoons are omnivorous animals and rely on various food items. Dietary analyses help determine how a raccoon changes its diet in response to environmental features. Raccoons eat whatever food resource is most convenient and abundant. Parasite infections can potentially affect host eating habits in order to keep the host alive and active longer. In this study, we analyzed the diets of necropsied raccoons from ten townships of Clark and Greene Counties by examining their stomach contents. We categorized stomach contents by separating out plant material, vertebrate tissue, and invertebrate tissue. We measured the total stomach mass and the mass of plant material alone in order to compare and obtain a percentage of plant material in the raccoons’ diet. We conducted two chi-squared tests for equality of distributions. We tested the null hypotheses that raccoons from townships with high prevalence (\u3e60%) have the same vertebrate tissue and plant tissue prevalence as raccoons from townships with low roundworm prevalence

Microwave Current Imaging in Passive HTS Components by Low-Temperature Laser Scanning Microscopy (LTLSM)

We have used the LTLSM technique for a spatially resolved investigation of the microwave transport properties, nonlinearities and material inhomogeneities in an operating coplanar waveguide YBa_2Cu_3O_{7-\delta} (YBCO) microwave resonator on an LaAlO_3 (LAO) substrate. The influence of twin-domain blocks, in-plane rotated grains, and micro-cracks in the YBCO film on the nonuniform rf current distribution were measured with a micrometer-scale spatial resolution. The impact of the peaked edge currents and rf field penetration into weak links on the linear device performance were studied as well. The LTLSM capabilities and its future potential for non-destructive characterization of the microwave properties of superconducting circuits are discussed.Comment: 8 pages, 9 figures, 2-column format, presented at High Temperature Superconductors in High Frequency Fields 2004, Journal of Superconductivity (in press

Baylisascaris procyonis prevalence in raccoons (Procyon lotor) and its relation to landscape features

Raccoons (Procyon lotor) are the final host for raccoon roundworm (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease known as larva migrans encephalopathy. Land fragmentation occurs when natural environments are broken up by urban or agricultural landscapes. Raccoons thrive in urban environments, while raccoons in agricultural settings forage over larger areas than raccoons in urban settings do. Land fragmentation affects concentrations of B. procyonis parasites in intermediate hosts. We calculated the prevalence of raccoon roundworm in 9 townships of Greene and Clark Counties by necropsying 226 raccoon intestines. Prevalence is defined as the number of raccoons infected with roundworm divided by the total number of raccoons sampled. We determined that the prevalence of B. procyonis from Beavercreek township is significantly lower than the other townships (χ2 = 25.19, p-value = 0.0007). Prevalence of raccoon roundworm in this region is lower than many areas in the Midwestern United States, suggesting the need for further research to determine reasons for the lower prevalence in the Ohio region

Does Baylisascaris procyonis Impact Raccoon (Procyon lotor) Genetics?

Raccoons (Procyon lotor) are the final host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease, known as larva migrans encephalopathy. Phylogenetic trees illustrate co-evolutionary events between species living in a symbiotic relationship with each other. Throughout the coevolution of host and parasite, many aspects of a population affect the way the members interact with one another and with symbiotic species. In order to evaluate the relationship between host and parasite in regards to diet, we isolated DNA from intestinal wall tissue, amplified a portion of exon 2 from MHC II, and sent our samples to Ohio State University for sequencing. We calculated heterozygosities for the nine townships we surveyed. We used a chi-squared test for equality of distributions to test whether raccoons from townships with above 60% prevalence have different heterozygosity for this locus than other raccoons. These data will help us to understand the relationship between raccoons and raccoon roundworm

Rivaroxaban for Venous Thromboembolism Prophylaxis in Abdominoplasty: A Multicenter Experience

BACKGROUND: Abdominoplasty, a commonly performed aesthetic procedure, is considered to have an increased risk of venous thromboembolism (VTE) events. At present, routine VTE chemoprophylaxis following abdominoplasty remains controversial. OBJECTIVES: This study evaluates the authors' experience with rivaroxaban, an oral Factor Xa inhibitor, for VTE prophylaxis in abdominoplasty patients. METHODS: A retrospective case series was conducted. All patients who underwent abdominoplasty and received rivaroxaban were included. The prophylactic dose was 10 mg daily for 7 days, beginning 12 hours postoperatively. Patient demographics, comorbidities, and type of surgery were recorded. The primary outcome measured was hematologic complication, including VTE, hematoma requiring operative evacuation, and need for blood transfusion. RESULTS: From September 2012 until July 2014, 132 patients (122 women and 10 men) underwent abdominoplasty surgery and received rivaroxaban postoperatively. Mean patient age was 43.7 years, and mean body mass index was 27.1. One hundred twenty-five patients also underwent abdominal muscle plication. Eleven patients underwent a fleur de lis vertical skin resection component. One hundred patients underwent concomitant abdominal liposuction, while 79 patients also had back liposuction. Only 1 patient had a symptomatic VTE event. Three patients had a hematoma requiring operative evacuation, and all went on to heal without sequelae. Two patients received a blood transfusion for anemia during their course of rivaroxaban. CONCLUSIONS: Oral rivaroxaban administration for chemoprophylaxis in abdominoplasty patients is safe, with low rates of symptomatic VTE and hematoma formation. The authors continue routine use of the medication for patients at increased risk for VTE events. LEVEL OF EVIDENCE 4: Risk