Development of a Virtual Laparoscopic Trainer using Accelerometer Augmented Tools to Assess Performance in Surgical training

Previous research suggests that virtual reality (VR) may supplement conventional training in laparoscopy. It may prove useful in the selection of surgical trainees in terms of their dexterity and spatial awareness skills in the near future. Current VR training solutions provide levels of realism and in some instances, haptic feedback, but they are cumbersome by being tethered and not ergonomically close to the actual surgical instruments for weight and freedom of use factors. In addition, they are expensive hence making them less accessible to departments than conventional box trainers. The box trainers in comparison, although more economical, lack tangible feedback and realism for handling delicate tissue structures. We have previously reported on the development of a modified digitally enhanced surgical instrument for laparoscopic training, named the Parkar Tool. This tool contains wireless accelerometer and gyroscopic sensors integrated into actual laparoscopic instruments. By design, it alleviates the need for both tethered and physically different shaped tools thereby enhancing the realism when performing surgical procedures. Additionally the software (Valhalla) has the ability to digitally record surgical motions, thereby enabling it to remotely capture surgical training data to analyse and objectively evaluate performance. We have adapted and further developed our initial single training tool method as used with a laparoscopic pyloromyotomy scenario, to an enhanced method using multiple Parkar wireless tools simultaneously, for use in several different case scenarios. This allows the use and measurement of right and left handed dexterity with the benefit of using several tasks of differing complexity. The development of a 3D tissue-surface deformations solution written in OpenGL gives us several different virtual surgical training scenario approximations to use with the instruments. The trainee can start with learning simple tasks e.g. incising tissue, grasping, squeezing and stretching tissue, to more complex procedures such as suturing, herniotomies, bowel anastomoses, as well as the original pyloromyotomy as used in the first model

Occupational safety considerations with hydrazine fuels

A simple pharmacokinetic model and a specially designed dermal vapor exposure chamber which provides respiratory protection were used to determine the rate of penetration of hydrazine and 1,1-dimethylhydrazine (UDMH) vapor through the skin of rats. Parameters for the pharmacokinetic model were determined from intravenous and inhalation exposure data. The model was then used to estimate the skin permeation coefficient for hydrazine or UDMH vapor from the dermal-vapor exposure data. This analysis indicates that UDMH vapor has a relatively high permeability through skin (0.7 cm/hr), a value somewhat higher than was obtained for hydrazine by the same procedure (0.09 cm/hr). Based on these skin permeability results, a skin-only vapor exposure limit giving protection equivalent to the inhalation Threshold Limit Value (TLV) could be calculated. The current TLV's for UDMH and hydrazine are 0.5 and 0.1 ppm, respectively. The corresponding skin-only TLV equivalents, for personnel wearing respiratory protection, are 32 ppm for UDMH and 48 ppm for hydrazine. Should the proposed lowering to the TLV's for these compounds to 0.01 ppm be adopted, the equivalent skin-only TLV's would become 0.64 ppm for UDMH and 4.8 for hydrazine

Attitudes toward depression among Japanese non-psychiatric medical doctors: A cross-sectional study

Abstract Background: Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed nonpsychiatric doctors’ attitude toward depression. Methods: The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (GP)network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis. Results: We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs. Conclusions: Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan

Critical properties of an aperiodic model for interacting polymers

We investigate the effects of aperiodic interactions on the critical behavior of an interacting two-polymer model on hierarchical lattices (equivalent to the Migadal-Kadanoff approximation for the model on Bravais lattices), via renormalization-group and tranfer-matrix calculations. The exact renormalization-group recursion relations always present a symmetric fixed point, associated with the critical behavior of the underlying uniform model. If the aperiodic interactions, defined by s ubstitution rules, lead to relevant geometric fluctuations, this fixed point becomes fully unstable, giving rise to novel attractors of different nature. We present an explicit example in which this new attractor is a two-cycle, with critical indices different from the uniform model. In case of the four-letter Rudin-Shapiro substitution rule, we find a surprising closed curve whose points are attractors of period two, associated with a marginal operator. Nevertheless, a scaling analysis indicates that this attractor may lead to a new critical universality class. In order to provide an independent confirmation of the scaling results, we turn to a direct thermodynamic calculation of the specific-heat exponent. The thermodynamic free energy is obtained from a transfer matrix formalism, which had been previously introduced for spin systems, and is now extended to the two-polymer model with aperiodic interactions.Comment: 19 pages, 6 eps figures, to appear in J. Phys A: Math. Ge

Extension of PRISM by Synthesis of Optimal Timeouts in Fixed-Delay CTMC

We present a practically appealing extension of the probabilistic model checker PRISM rendering it to handle fixed-delay continuous-time Markov chains (fdCTMCs) with rewards, the equivalent formalism to the deterministic and stochastic Petri nets (DSPNs). fdCTMCs allow transitions with fixed-delays (or timeouts) on top of the traditional transitions with exponential rates. Our extension supports an evaluation of expected reward until reaching a given set of target states. The main contribution is that, considering the fixed-delays as parameters, we implemented a synthesis algorithm that computes the epsilon-optimal values of the fixed-delays minimizing the expected reward. We provide a performance evaluation of the synthesis on practical examples

Impact assessment of interregional government transfers in Brazil: an input-output approach

Redistributive policies carried out by the central government through interregional government transfers is a relevant feature of the Brazilian federal fiscal system. Regional shares of the central government revenues in the poorer regions have been recurrently smaller than the shares of central government expenditures in those regions. Appeal to core-periphery outcomes could be made, as São Paulo, the wealthiest state in the country, concentrated, in 2005, over 40% of total Federal tax revenue, receiving less than 35% of Federal expenditures. These figures suggest a redistribution of public funds from the spatial economic core of the economy to the peripheral areas. This paper investigates the role interregional transfers play in the redistribution of activities in the country, using an interregional input-output approach. Counterfactual simulations allow us to estimate some costs and benefits, for the core and periphery respectively, from such fiscal mechanisms.Interregional government transfers, input-output analysis, impact analysis, Brazilian economy

The experiences of carers looking after people with Parkinson's disease who exhibit impulsive and compulsive behaviours: an exploratory qualitative study

BACKGROUND: Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping, and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families. The aim of this qualitative study is to understand the experiences of carers who were confronted by the development of these behaviours. DESIGN: An exploratory qualitative study. METHODS: Using a convenience sampling approach, 13 carers were recruited to participate in semi-structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed used a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. RESULTS: Five main themes were identified: (1) realisation - developing awareness of ICB symptoms and their causes; (2) reacting - confronting and attempts to manage ICBs; (3) reaching out - help-seeking and selective disclosure; (4) reframing - shifting perspectives on ICBs over time; and (5) resignation - impact on relationships and facing the future. CONCLUSIONS: The profound impact of ICBs on quality of life, relationships, and economic stability was clear in the carers' accounts. Possible avenues for future clinical research are suggested. RELEVANCE TO CLINICAL PRACTICE: The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education are always part of practice

Training deep neural density estimators to identify mechanistic models of neural dynamics

Mechanistic modeling in neuroscience aims to explain observed phenomena in terms of underlying causes. However, determining which model parameters agree with complex and stochastic neural data presents a significant challenge. We address this challenge with a machine learning tool which uses deep neural density estimators-- trained using model simulations-- to carry out Bayesian inference and retrieve the full space of parameters compatible with raw data or selected data features. Our method is scalable in parameters and data features, and can rapidly analyze new data after initial training. We demonstrate the power and flexibility of our approach on receptive fields, ion channels, and Hodgkin-Huxley models. We also characterize the space of circuit configurations giving rise to rhythmic activity in the crustacean stomatogastric ganglion, and use these results to derive hypotheses for underlying compensation mechanisms. Our approach will help close the gap between data-driven and theory-driven models of neural dynamics

Preparation, Characterization And Tests Of Incorporation In Stem Cells Of Superparamagnetic Iron Oxide

Superparamagnetic iron oxide nanoparticles (SPIONs) have been produced and used as contrast-enhancing agents in magnetic resonance imaging (MRI) for diagnostic use in a wide range of maladies including cardiovascular, neurological disorders, and cancer. The reasons why these SPIONs are attractive for medical purposes are based on their important and unique features. The large surface area of the nanoparticles and their manipulation through an external magnetic field are features that allow their use for carrying a large number of molecules such as biomolecules or drugs. In this scenario, the present work reports on the synthesis and characterization of SPIONs and in vitro MRI experiments to increase their capacity as probes for MRI applications on stem cells therapy. Initially, the SPIONs were prepared through the co-precipitation method using ferrous and ferric chlorides in acidic solution. The SPIONs were coated with two thiol molecules such as mercaptosuccinic acid (MSA) and cysteine (Cys) (molar ratio SPIONs: ligand = 1: 20), leading to the formation of a stable aqueous dispersion of thiolated nanoparticles (SH-SPIONs). The SH-SPIONs were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), and vibrating sample magnetometry (VSM). The results showed that the SH-SPIONs have a mean diameter of 14 nm and display superparamagnetic behavior at room temperature. Preliminary tests of incorporation of SH-SPIONs were evaluated stem cells. The results showed that the thiolated nanoparticles have no toxic effects for stem cells and successfully internalized and enhance the contrast in MRI.61