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

Laparoscopic myomectomy of a large pedunculated fibroid: case report

A 37 year old para 0 + 0 presented with abdominal pain and progressive abdominal swelling. She had no menstrual complains. Abdominal examination revealed a large 30 week non-tender, firm and mobile mass. A pelvic / abdominal ultrasound confirmed a 15.7 x 9.9 cm pedunculated fibroid arising from the uterine fundus. A laparoscopic myomectomy was successfully undertaken, and the morcellated fragments weighed 1490 grams. East African Medical Journal Vol. 85 (7) 2008: pp. 362-36

Sjögren Syndrome Complicated by Mucosa-Associated Lymphoid Tissue Lymphoma and Lymphocytic Interstitial Pneumonia.

Sjögren syndrome (SS) is an autoimmune disease with exocrine glands dysfunction and multiorgan involvement. It is associated with increased risk of lymphoproliferative disorders, especially B-cell marginal zone lymphoma. While the role of F-18 Fluorodeoxyglucose position emission tomography/computed tomography (F-18 FDG PET/CT) for evaluation of lymphoma has been established, its use in patients with a chronic history of SS to evaluate for possible lymphoproliferative disorders or multiorgan involvement is limited. We present a case of chronic SS in which F-18 FDG PET/CT demonstrated FDG avid intraparotid and cervical lymph nodes pathologically proven to be mucosa-associated lymphoid tissue lymphoma. In addition, the patient had bibasilar cystic changes consistent with lymphocytic interstitial pneumonia

Regulation of informed consent: a focus on fertility treatments in Kenya

No Abstrac

Fusion of 6^{6}Li with 159^{159}Tb} at near barrier energies

Complete and incomplete fusion cross sections for $^{6}$Li+$^{159}$Tb have been measured at energies around the Coulomb barrier by the $\gamma$-ray method. The measurements show that the complete fusion cross sections at above-barrier energies are suppressed by $\sim$34% compared to the coupled channels calculations. A comparison of the complete fusion cross sections at above-barrier energies with the existing data of $^{11,10}$B+$^{159}$Tb and $^{7}$Li+$^{159}$Tb shows that the extent of suppression is correlated with the $\alpha$-separation energies of the projectiles. It has been argued that the Dy isotopes produced in the reaction $^{6}$Li+$^{159}$Tb, at below-barrier energies are primarily due to the $d$-transfer to unbound states of $^{159}$Tb, while both transfer and incomplete fusion processes contribute at above-barrier energies.Comment: Phys. Rev. C (accepted

Role of neutron transfer in the reaction mechanism of 9^9Be+169^{169}Tm, 181^{181}Ta, 187^{187}Re and 197^{197}Au systems

The contribution of one neutron stripping cross section to the total reaction cross section has been studied for $^9$Be projectile incident on $^{169}$Tm, $^{181}$Ta, $^{187}$Re and $^{197}$Au targets around Coulomb barrier energy. The measured one neutron stripping cross sections for these systems have been compared with the coupled channel calculations. The recently developed global set of optical model potential parameters for $^9$Be projectile has been used in the present calculations. The cumulative of measured complete fusion (CF), incomplete fusion (ICF), one neutron stripping and calculated non-capture breakup (NCBU) cross sections is found to explain almost the reaction cross sections for all the targets. A very small contribution from target inelastic states and elastic breakup may contribute to the remaining part. The percentage fraction of cross section for CF, ICF, one neutron stripping, and NCBU over reaction cross section show the dominance of neutron transfer and NCBU at below barrier energies while CF and ICF processes have the major contribution at above barrier energies.Comment: 12 pages, 3 figure

Role of the cluster structure of 7^7Li in the dynamics of fragment capture

Exclusive measurements of prompt $\gamma$-rays from the heavy-residues with various light charged particles in the $^7$Li + $^{198}$Pt system, at an energy near the Coulomb barrier (E/$V_b$ $\sim$ 1.6) are reported. Recent dynamic classical trajectory calculations, constrained by the measured fusion, $\alpha$ and $t$ capture cross-sections have been used to explain the excitation energy dependence of the residue cross-sections. These calculations distinctly illustrate a two step process, breakup followed by fusion in case of the capture of $t$ and $\alpha$ clusters; whereas for $^{6}$He + $p$ and $^{5}$He + $d$ configurations, massive transfer is inferred to be the dominant mechanism. The present work clearly demonstrates the role played by the cluster structures of $^7$Li in understanding the reaction dynamics at energies around the Coulomb barrier.Comment: 6 pages, 4 figures, Accepted for publication in Phys. Letts.

Differential Regulation of Circulating Levels of Molecular Chaperones in Patients Undergoing Treatment for Periodontal Disease

British Heart Foundation (grant PG/03/029

Association between COX-2 rs 6681231 Genotype and Interleukin-6 in Periodontal Connective Tissue. A Pilot Study

This study was partially undertaken at the UCL Eastman Dental Institute, which received a proportion of funding from the Department of Health’s National Institute of Health Research (NIHR) Biomedical Research Centres funding scheme