Design and integration of an instrumented knee prosthesis

Total knee arthroplasty is nowadays one of the most important orthopedic surgery. It consists of a procedure in which parts of the knee are replaced by a prosthesis. The largest indication for total knee arthroplasty is osteoarthritis, a knee disease that can cause the cartilage of the femur and tibia to wear away, so that the bones rub together with use. The major risk factors for osteoarthritis are aging and obesity. Both the life expectancy and the obesity rate are increasing in the developed countries, thus the number of estimated total knee arthroplasties is growing over the years. Although over one million of prosthetic joints are implanted every year in the developed countries, none of them contains sensors to help the orthopedic surgeons in improving the precision of the replacement surgery. The goal of this study is to design an electronic system to be embedded inside a total knee prosthesis, in order to measure the force applied to it and its kinematics. Providing the orthopedic surgeons with quantitative data on the biomechanics of the prosthetic knee can help them in improving the implant precision and, as a consequence, could reduce the risk of an early revision surgery. In the frame of this thesis, we worked with the F.I.R.S.T. prosthesis by Symbios Orthopedie SA, that was instrumented with sensors and electronics to measure, process and transmit force and kinematics data to an external reader. The constraints in the design have been established by the medical doctors and the prosthesis manufacturer and the technical solutions adopted are presented. In order to simplify a future approval for human tests, we decided to keep the shape of the knee artificial joint. To achieve that, we put all the sensors and the electronics inside the middle part of the prosthesis, constituted of a polyethylene insert located between the metallic parts of the artificial joint and whose function is to reduce the rubbing. An original encapsulation was designed to guarantee the bio-compatibility of the instrumented prosthesis and to avoid a potentially dangerous contact between the electronics and the human body. This should be ensured even in case of extreme wearing of the polyethylene insert, that can occur some years after the prosthesis implant and is one of the main indications for a revision surgery. The sensors were tested by using mechanical simulators of the knee joint and validated by means of reference sensors. Different demonstrators have been designed, from the first, with only the sensors located inside the prosthesis and all the electronics fabricated in a large-scale outside of it, to the last miniaturized versions, that can be entirely embedded inside the prosthesis. Moreover, an autonomous sensor for balancing the ligaments tension during the knee replacement surgery was designed, fabricated and tested. Such a device could be an important help for the medical doctors during the surgery to improve the precision of the implant and, being not-implantable, could easily obtain an approval for human clinical trials

Lightweight and Effective Convolutional Neural Networks for Vehicle Viewpoint Estimation From Monocular Images

Vehicle viewpoint estimation from monocular images is a crucial component for autonomous driving vehicles and for fleet management applications. In this paper, we make several contributions to advance the state-of-the-art on this problem. We show the effectiveness of applying a smoothing filter to the output neurons of a Convolutional Neural Network (CNN) when estimating vehicle viewpoint. We point out the overlooked fact that, under the same viewpoint, the appearance of a vehicle is strongly influenced by its position in the image plane, which renders viewpoint estimation from appearance an ill-posed problem. We show how, by inserting in the model a CoordConv layer to provide the coordinates of the vehicle, we are able to solve such ambiguity and greatly increase performance. Finally, we introduce a new data augmentation technique that improves viewpoint estimation on vehicles that are closer to the camera or partially occluded. All these improvements let a lightweight CNN reach optimal results while keeping inference time low. An extensive evaluation on a viewpoint estimation benchmark and on actual vehicle camera data shows that our method significantly outperforms the state-of-the-art in vehicle viewpoint estimation, both in terms of accuracy and memory footprint

A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table

BACKGROUND: The da Vinci® Table Motion (dVTM) comprises a combination of a unique operating table (Trumpf Medical™ TruSystem® 7000dV) capable of isocenter motion connected wirelessly with the da Vinci Xi® robotic platform, thereby enabling patients to be repositioned without removal of instruments and or undocking the robot. MATERIALS AND METHODS: Between May 2015 to October 2015, the first human use of dVTM was carried out in this prospective, single-arm, post-market study in the EU, for which 40 patients from general surgery (GS), urology (U), or gynecology (G) were enrolled prospectively. Primary endpoints of the study were dVTM feasibility, efficacy, and safety. RESULTS:Surgeons from the three specialties obtained targeting success and the required table positioning in all cases. Table movement/repositioning was necessary to gain exposure of the operating field in 106/116 table moves (91.3%), change target in 2/116 table moves (1.7%), achieve hemodynamic relief in 4/116 table moves (3.5%), and improve external access for tumor removal in 4/116 table moves (3.5%). There was a significantly higher use of tilt and tilt plus Trendelenburg in GS group (GS vs. U p = 0.055 and GS vs. G p = 0.054). There were no dVTM safety-related or adverse events. CONCLUSIONS: The dVTM with TruSystem 7000dV operating table in wireless communication with the da Vinci Xi is a perfectly safe and effective synergistic combination, which allows repositioning of the patient whenever needed without imposing any delay in the execution of the operation. Moreover, it is helpful in avoiding extreme positions and enables the anesthesiologist to provide immediate and effective hemodynamic relief to the patient when needed

Dissociation between the Perceptual and Saccadic Localization of Moving Objects

Visual processing in the human brain provides the data both for perception and for guiding motor actions. It seems natural that our actions would be directed toward perceived locations of their targets, but it has been proposed that action and perception rely on different visual information [1-4], and this provocative claim has triggered a long-lasting debate [5-7]. Here, in support of this claim, we report a large, robust dissociation between perception and action. We take advantage of a perceptual illusion in which visual motion signals presented within the boundaries of a peripheral moving object can make the object's apparent trajectory deviate by 45° or more from its physical trajectory [8-10], a shift several times larger than the typical discrimination threshold for motion direction [11]. Despite the large perceptual distortion, we found that saccadic eye movements directed to these moving objects clearly targeted locations along their physical rather than apparent trajectories. We show that the perceived trajectory is based on the accumulation of position error determined by prior sensory history-an accumulation of error that is not found for the action toward the same target. We suggest that visual processing for perception and action might diverge in how past information is combined with new visual input, with action relying only on immediate information to track a target, whereas perception builds on previous estimates to construct a conscious representation

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

L'informativa settoriale ai sensi dell'IFRS 8: analisi della letteratura e prassi operativa

All’interno del presente elaborato, sarà analizzato il principio contabile internazionale IFRS 8 – Operating Segments, riguardante l’informativa sui settori operativi. Tale standard, la cui emanazione ha sostituito il previgente IAS 14R del 1997, adotta un diverso approccio al fine dell’identificazione dei diversi settori operativi, in particolare il full management approach. Mediante tale metodo viene fornita ai lettori del bilancio la medesima prospettiva di osservazione utilizzata dal management per esaminare l’andamento generale dell’azienda, oltre a quello dei singoli settori, ai fini dell’allocazione delle risorse e della valutazione delle performance. Gli utilizzatori di bilancio hanno, quindi, la possibilità di vedere l’azienda “through the eyes of management”. Il rilievo dell’informativa settoriale deriva dall’inidoneità del bilancio nell’evidenziare le singole unità economiche elementari, poiché questo mostra l’azienda nel suo complesso, l’unicum aziendale. In questo modo, diviene necessario evidenziare il contributo che le singole aree gestionali apportano al risultato economico prodotto. Il fine del presente lavoro consiste nell’illustrare, innanzitutto, la disciplina inerente all’informativa settoriale, passando, poi, alla presentazione di alcuni risultati di ricerca circa l’impatto del principio contabile internazionale su un campione di società quotate presso la Borsa italiana, operanti in tre differenti settori. Il fine di questa analisi consiste nel verificare le modalità di applicazione del principio IFRS 8 da parte delle società, per poter enfatizzare eventuali differenze o carenze a livello informativo. Il primo capitolo verterà integralmente sullo studio e sull’analisi dell’IFRS 8; dopo aver inquadrato il ruolo ricoperto dall’informativa di settore nella comunicazione economico-finanziaria dell’impresa, sarà analizzato in dettaglio il Principio, sottolineando, al contempo, le differenze con il precedente IAS 14R e lo SFAS 131. Nel capitolo 2 si esamina, in primo luogo, l’informativa settoriale nel contesto nazionale, evidenziando gli aspetti più significativi delle poche norme civilistiche che disciplinano tale materia. In secondo luogo, verranno presentati diversi studi, ricerche e report, i quali documentano gli effetti dello standard IFRS 8 sulla presentazione, qualità, onerosità e altri profili rilevanti della segment disclosure fornita dalle società nei loro annual report. Nel terzo ed ultimo capitolo saranno esposti i risultati dell’indagine empirica, la quale è stata effettuata su un campione di società quotate in Italia, appartenenti ai settori “Servizi finanziari”, “Servizi pubblici” e “Tecnologia”. Lo scopo dell’indagine è quello di accertare l’applicazione del principio IFRS 8 – Operating Segments, evidenziando la struttura informativa adottata da ciascuna entità del campione, in modo tale da valutare e commentare le differenze riscontrate nel contenuto e nella presentazione dell’informativa di segmento

Vehicle classification from low-frequency GPS data with recurrent neural networks

The categorization of the type of vehicles on a road network is typically achieved using external sensors, like weight sensors, or from images captured by surveillance cameras. In this paper, we leverage the nowadays widespread adoption of Global Positioning System (GPS) trackers and investigate the use of sequences of GPS points to recognize the type of vehicle producing them (namely, small-duty, medium-duty and heavy-duty vehicles). The few works which already exploited GPS data for vehicle classification rely on hand-crafted features and traditional machine learning algorithms like Support Vector Machines. In this work, we study how performance can be improved by deploying deep learning methods, which are recently achieving state of the art results in the classification of signals from various domains. In particular, we propose an approach based on Long Short-Term Memory (LSTM) recurrent neural networks that are able to learn effective hierarchical and stateful representations for temporal sequences. We provide several insights on what the network learns when trained with GPS data and contextual information, and report experiments on a very large dataset of GPS tracks, where we show how the proposed model significantly improves upon state-of-the-art results

Maintenance and emergency management with an integrated indoor/outdoor navigation support

AbstractLarge and complex infrastructures as industry plants and hospitals are vulnerable to natural, man-made disasters, and causality events. In this paper, we present a solution addressing the guiding personnel during maintenance and/or emergency conditions. The aim is to reduce the time needed to react and to cope with organization and maintenance support, while facilitating communication, and indoor/outdoor navigation. The solution is based on the formalization of protocol, the modelling of knowledge for navigation, the algorithms and the development of a mobile application and corresponding server device for integrated indoor/outdoor navigation. The navigation algorithms are based on low costs mobile sensors and Adaptive Extended Kalman Filter. The solution has been validated and tried out within a large medical infrastructure, thus demonstrating the validity of the identified modalities and procedures, measuring the advantage from both qualitative and quantitative aspects. The indoor navigation solution has been compared with other former solutions based on classical Kalman and dead reckoning