Mathematical model and experimental characterization of vertically stacked capacitive tactile sensors

Capacitive sensors are widely used in robotics for their compactness, high resolution, high sensitivity, and large dynamic range. In this article, we present a design solution for the manufacturing of capacitive tactile sensors with enhanced dynamic range and sensitivity. Herein, we adopted the approach of exploiting the vertical direction of the sensors by creating stacks of capacitors. The validation of the proposed model is conducted by means of finite element simulations and the effectiveness of stacked capacitors in suboptimal configurations has been experimentally tested by using inkjet printing and spin coating-based fabrication techniques. Results show that these sensors exhibit an enhanced dynamic range and sensitivity with respect to common single capacitors, for a given sensors area budget. Sensitivity increases of 235% passing from one-stack to two-stack capacitors (from 5.75 to 19.3 fF/kPa) and a growth of 23% from two-stack to three-stack capacitors (from 19.3 to 23.7 fF/kPa). These results suggest that the proposed methodology could be adopted for designing tactile sensors with higher spatial resolution and higher transduction sensitivity and dynamic range, in the perspective of an integration over large areas

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

La valutazione del Rischio Clinico percepito in un Blocco Operatorio:analisi sperimentale e progetto di intervento

Razionale. La finalit\ue0 dello studio consiste nell\u2019analisi delle attivit\ue0 infermieristiche in ambito operatorio e nella creazione di una mappatura delle criticit\ue0 organizzative e di processo tramite strumenti testati e validati in altre realt\ue0. Si proporr\ue0 un nuovo strumento di prevenzione del \u201crischio clinico\u201d ed un progetto didattico di aggiornamento professionale rivolto al personale infermieristico. Obiettivo. La gestione dei processi di rischio all\u2019interno di una struttura complessa quale un Blocco operatorio di chirurgia generale, rappresenta un difficile compito per infermieri e personale sanitario che vi lavora quotidianamente. obiettivo di questo lavoro \ue8 fornire informazioni relative e proporre un metodo integrato di formazione del personale e di controllo dei fattori di rischio utilizzando nuovi strumenti. Metodologia. utilizzo di metodiche di approccio al problema, come la SafetyWalkAround e l\u2019analisi FMEcA adattandole al contesto operativo. A livello di formazione si sono utilizzati strumenti di indagine conoscitiva come l\u2019intervista con questionario e il Focus group per la valutazione delle competenze e del livello culturale degli infermieri in materia. Risultati. Vengono descritti gli strumenti di indagine; si \ue8 creata una scheda di prevenzione del possibile \u201cevento avverso\u201d applicabile al contesto lavorativo. Si propone un corso di formazione al personale delineandone contenuti, modalit\ue0 e verifica. Conclusioni. gli strumenti proposti forniscono un validissimo aiuto nell\u2019identificazione delle criticit\ue0 strutturali e assistenziali. il loro utilizzo ha permesso di evidenziare punti critici e la relativa ricerca di soluzioni concrete. La proposta di un corso di formazione \ue8 stata pienamente accettata dal personale infermieristico, propenso a migliorarsi per fornire livelli assistenziali pi\uf9 alti

Radiofrequency (SECCA Procedure)

Many resource materials exist for the physician or surgeon evaluating and managing the patient with fecal incontinence. Much of the available information is embedded in the context of an overall textbook or compendium of colorectal surgery. There are a relatively limited amount of focused data for the practitioner who wishes to become familiar or updated with the latest relevant diagnostic and therapeutic information. Professor Mongardini is to be commended for having assembled in a cogent, succinct, and imminently readable textbook all of the abovementioned required details. He has selected 14 chapters each of which was authored by between one and fi ve experts. This book commences with a very surgeon-specifi c view of pelvic fl oor anatomy which I found readily comprehensible and clinically relevant. The second chapter which I also very much enjoyed reading is a description of physiology and physiopathology again written from the perspective of the practicing surgeon. Studying this chapter is an excellent prerequisite to digesting the subsequent four chapters each of which delves into a different but important facet of evaluation. Specifi cally, the chapters on endoanal ultrasound, magnetic resonance, anorectal manometry, and electromyography are all very up to date, highly descriptive, and again immediately useful in daily patient management. Reading these four chapters allows one a comprehensive overview of the optimal available current diagnostic tools. The remaining eight chapters describe virtually every currently available therapeutic modality by which the practitioner can try to assist the patient with fecal incontinence. The chapters include the gamut from pelvic fl oor rehabilitation and radiofrequency tissue remodeling to stomas and stem cells. In between these extremes are reviews of injectable and implantable agents, sacral neuromodulation, the artifi cial bowel sphincter and the more \u201cstandard\u201d surgical therapies of sphincter repair, post anal repair, and muscle transposition. The easy readability of the material in the textbook is further complimented by the high-quality illustrations and photographs. It is clear that each of the authors commands expertise in his or her respective chapter. It is also quite apparent that Professor Mongardini edited the material to allow for an easy narrative fl ow between chapters with minimal subject overlap but excellent subject juxtaposition and interplay. I am very grateful to Professor Mongardini for having invited me to author this Foreword. I highly commend this textbook to all physicians and surgeons who evaluate and/or manage patients with fecal incontinence. This book shall certainly occupy a prominent place in my personal library and will be enjoyed by all of my residents and fellows. Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCS (Ed) Chairman, Department of Colorectal Disease Director, Digestive Disease Center Cleveland Clinic Florida, US

Plume risk in videolaparoscopy and in endoscopic surgery

Approximately 90% of endoscopic and open surgical procedures generate some level of surgical smoke. (Ulmer B, 1998). Lasers and electrosurgery devices commonly used to cut, coagulate, vaporize, and ablate tissue are the \u201chot\u201d tools that cause targeted cells to heat to the point of rupturing the cellular membrane and spewing cellular contents into the air as surgical smoke. Through continuous exposure, the inhalation of surgical smoke can become harmful to the surgical team members. Plume can also be hazardous to patients during laparoscopy or other endoscopy procedures when the contaminants of surgical smoke are absorbed into the patient\u2019s vascular system. Research studies have repeatedly highlighted the hazards of surgical smoke during laser use so smoke evacuation has been accepted as a common practice. Unfortunately evacuation of smoke generated during electrosurgery has not been as widely accepted even though research has been definitive in proving inhalation hazards. One of the most interesting paper, by Tomita, demonstrated that using an electrosurgery device on one gram of tissue, inhaling the plume was equivalent to smoking 6 unfiltered cigarettes. This study demonstrated that plume generated during electrosurgical procedures has the potential to be twice as harmful as the smoke produced during laser surgeries. (Tomita et al., 1989) The bottom line is that all surgical smoke should be considered as harmful if not evacuated appropriately. Unfortunately many healthcare professionals are indifferent and do not feel the need to evacuate plume since they have been breathing it for years. The following toxic chemical byproducts have been identified in surgical smoke resulting from tissue pyrolysis: (Hoglan, 1995 and Ott, 1993) acrolein, acetonitrile acrylonitrile, methane phenol polycyclic aromatic hydrocarbons propene propylene pyridene pyrrole styrene toluene xylene, acetylene alkyl benzenes, benzene, butadiene, butane, carbon monoxide creosols, ethane, ethylene, formaldehyde, free radicals hydrogen, cyanide isobutene. Complete evacuation of surgical smoke is necessary because of these unwanted hazards and potential complications. Research has conclusively shown that surgical smoke is hazardous to the surgical team members who are exposed to it on a continual basis and hazardous to endoscopic patients when the plume is not evacuated. Also during endoscopic procedures the usage of electric tools to cut and coagulate is frequent, and this could represent a real problems for operators may be more than for the patients. At the present time it is not possible to find in literature papers about hazards of surgical smoke during endoscopic procedures even if they have to be considered definitely as surgical procedures. This implies the necessity of a deeper consciousness to the smokes risk and consequently a more care in operators and patients protection