An Abdominal Phantom with Tunable Stiffness Nodules and Force Sensing Capability for Palpation Training

Robotic phantoms enable advanced physical examination training before using human patients. In this paper, we present an abdominal phantom for palpation training with controllable stiffness liver nodules that can also sense palpation forces. The coupled sensing and actuation approach is achieved by pneumatic control of positive-granular jammed nodules for tunable stiffness. Soft sensing is done using the variation of internal pressure of the nodules under external forces. This paper makes original contributions to extend the linear region of the neo-Hookean characteristic of the mechanical behavior of the nodules by 140% compared to no-jamming conditions and to propose a method using the organ level controllable nodules as sensors to estimate palpation position and force with a root-means-quare error (RMSE) of 4% and 6.5%, respectively. Compared to conventional soft sensors, the method allows the phantom to sense with no interference to the simulated physiological conditions when providing quantified feedback to trainees, and to enable training following current bare-hand examination protocols without the need to wear data gloves to collect data.This work was supported in part by the Engineering and Physical Sciences Research Council (EPSRC) MOTION grant EP/N03211X/2 and EP/N03208X/1, and EPSRC RoboPatient grant EP/T00603X/

Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators

Validation of serum cytokines as potential biomarkers in acute dengue infection

Objectives: Serum IL-10, Macrophage inhibitory factor (MIF) and interferons have been found to be associated with fatal dengue. We set out to investigate the possibility of using these cytokine as biomarkers to predict severe dengue. Methods: Serum IL-10 levels were determined by quantitative ELISA in 215 adult patients with confirmed acute dengue infection (ADI). Serum IFNα and IFNγ levels were done in 79 patients. Serial recording of clinical features and laboratory investigations were done to determine clinical disease severity. Results: 33 (17.46%) patients were classified as severe dengue (SD). Serum IL-10 levels were significantly higher (p=0.0034) in patients with SD (median= 121.9, range= 24.98 to 3271 pg/ml) when compared to those with non SD (median= 78.28, range= 7.18 to 1343 pg/ml). In the 29 patients with paired serum samples, serum IL-10 levels rose in all 6 patients with SD whereas in 20/23 patients with non SD, serum IL-10 levels fell in the critical phase.  Although serum MIF values were higher in patients with SD (mean 70774, SD± 59874 pg/ml) when compared to those with non SD (mean 45362, SD± 26891 pg/ml), this was not statistically significant. The IFNγ levels were significantly higher (p=0.038) in patients with shock (median= 77.55, range= 18.21 to 468.4 pg/ml) when compared to those who did not develop shock (median= 35.25, range= 4.050 to 733.1 pg/ml). Conclusion: Serum IL-10 levels appear to be associated with SD. It would be crucial to investigate the possible role of this cytokine in the pathogenesis of SD

EQ-5D-3L Derived Population Norms for Health Related Quality of Life in Sri Lanka

Background Health Related Quality of Life (HRQoL) is an important outcome measure in health economic evaluation that guides health resource allocations. Population norms for HRQoL are an essential ingredient in health economics and in the evaluation of population health. The aim of this study was to produce EQ-5D-3L-derived population norms for Sri Lanka. Method A population sample (n =  780) was selected from four districts of Sri Lanka. A stratified cluster sampling approach with probability proportionate to size was employed. Twenty six clusters of 30 participants each were selected; each participant completed the EQ-5D-3L in a face-to-face interview. Utility weights for their EQ-5D-3L health states were assigned using the Sri Lankan EQ-5D-3L algorithm. The population norms are reported by age and socio-economic variables. Results The EQ-5D-3L was completed by 736 people, representing a 94% response rate. Sixty per cent of the sample reported being in full health. The percentage of people responding to any problems in the five EQ-5D-3L dimensions increased with age. The mean EQ-5D-3L weight was 0.85 (SD 0.008; 95%CI 0.84-0.87). The mean EQ-5D-3L weight was significantly associated with age, housing type, disease experience and religiosity. People above 70 years of age were 7.5 times more likely to report mobility problems and 3.7 times more likely to report pain/discomfort than those aged 18-29 years. Those with a tertiary education were five times less likely to report any HRQoL problems than those without a tertiary education. A person living in a shanty was 4.3 more likely to have problems in usual activities than a person living in a single house. Conclusion The population norms in Sri Lanka vary with socio-demographic characteristics. The socioeconomically disadvantaged have a lower HRQoL. The trends of population norms observed in this lower middle income country were generally similar to those previously reported in high income countries

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

The Wide-field Spectroscopic Telescope (WST) Science White Paper

The Wide-field Spectroscopic Telescope (WST) is proposed as a new facility dedicated to the efficient delivery of spectroscopic surveys. This white paper summarises the initial concept as well as the corresponding science cases. WST will feature simultaneous operation of a large field-of-view (3 sq. degree), a high multiplex (20,000) multi-object spectrograph (MOS) and a giant 3x3 sq. arcmin integral field spectrograph (IFS). In scientific capability these requirements place WST far ahead of existing and planned facilities. Given the current investment in deep imaging surveys and noting the diagnostic power of spectroscopy, WST will fill a crucial gap in astronomical capability and work synergistically with future ground and space-based facilities. This white paper shows that WST can address outstanding scientific questions in the areas of cosmology; galaxy assembly, evolution, and enrichment, including our own Milky Way; origin of stars and planets; time domain and multi-messenger astrophysics. WST's uniquely rich dataset will deliver unforeseen discoveries in many of these areas. The WST Science Team (already including more than 500 scientists worldwide) is open to the all astronomical community. To register in the WST Science Team please visit https://www.wstelescope.com/for-scientists/participat

Interprofessional education for internationally educated health professionals: an environmental scan

Mubashir Arain,1 Esther Suter,1 Sara Mallinson,1 Shelanne L Hepp,1 Siegrid Deutschlander,1 Shyama Dilani Nanayakkara,2 Elizabeth Louise Harrison,3 Grace Mickelson,4 Lesley Bainbridge,5 Ruby E Grymonpre2 1Workforce Research & Evaluation, Alberta Health Services, Edmonton, AB, 2College of Pharmacy, University of Manitoba, Winnipeg, MB, 3School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, 4Provincial Health Services Authority, Vancouver, BC, 5Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada Objective: The objective of this environmental scan was to identify Western Canadian interprofessional education (IPE) resources that currently exist for internationally educated health professionals (IEHPs). Methodology: A web-based search was conducted to identify learning resources meeting defined inclusion criteria with a particular focus on the resources available in the Western Canadian provinces. Information was extracted using a standardized template, and we contacted IEHP programs for additional information if necessary. Members of the research team reviewed preliminary findings, identified missing information from their respective provinces, and contacted organizations to fill in any gaps. Results: The scan identified 26 learning resources for IEHPs in Western Canadian provinces and 15 in other provinces focused on support for IEHPs to meet their profession-specific licensing requirements and to acquire knowledge and competencies relevant to working in the Canadian health care system. Most learning resources, such as those found in bridging programs for IEHPs, included an orientation to the Canadian health care system, components of cultural competence, and at least one aspect of interprofessional competence (eg, communication skills). None of the 41 learning resources provided comprehensive training for IEHPs to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework. Conclusion: The IEHPs learning resources in Western Canada do not cover all of the interprofessional competencies. This review points to the value of developing a comprehensive IPE curriculum, based on the six domains identified in the CIHC National Interprofessional Competency Framework. Keywords: health care personnel, human resource, collaborative practice, international medical graduates, Western Canadian province