Usability Evaluation of the Kinect in Aiding Surgeon Computer Interaction

Interest in Gesture-based interaction in the operating room (OR) environment is rising. The main advantage of introducing such an interface in the OR is that it enables direct interaction between computer and surgeon while ensuring asepsis, as opposed to asking an assistant to interact with the patient’s medical images. The purpose of this study was to determine whether a modern gesture-based interface using the Kinect is feasible and desirable during surgical procedures. After an extensive exploratory research phase including OR observations, interviews with surgeons and a questionnaire, a user-based usability evaluation was conducted with the open-source medical imaging toolkit MITO and the Microsoft Kinect. Healthcare professionals were asked to conduct prototypical tasks in a simulated OR environment in the University Medical Centre of Groningen. Obtained performance and usability measures were compared to a control condition where the participant gave instructions to an assistant, comparable to the current OR situation. Results of the usability evaluation indicated that surgeons were generally positive about gesture-based interaction and would like to use the tested system. Performance measures indicated that the current system was generally slower in executing the prototypical tasks compared to asking an assistant. However this was during their first encounter with such a novel technique; an expert user showed significant faster completion times. Another limitation of using the Kinect as gesture-based interaction technique is its reduced accuracy while conducting measurements on medical images for example. Due to the importance of accurate selection in clinical image viewers a second study was conducted on different selection techniques in order to determine which technique is most accurate and appropriate for gesture-based selection. Two popular selection techniques: ‘Dwell’ and ‘Push’ were compared to the current mouse condition. Furthermore two different spatial resolutions were compared due to the importance of a small interaction space above the patient. Results from this experiment indicated that the tested techniques are significantly less accurate and more time-costly than the mouse control condition. However there was a significant effect between the two different spatial resolutions, indicating the importance of higher resolution depth-cameras. Finally suggestions for usability improvements for the test-case system were proposed and important guidelines for future gesture-based interaction systems in the operating room. From these results we can conclude that the concept of gesture-based interaction using low-cost commercially available hardware, such as the Kinect, is feasible for operating room purposes. Although the accuracy is lower and execution times are slower compared to the current situation in which the surgeon directs an assistant, surgeons rate the usability of the tested system high, and would already prefer to use this system than asking an assistant due to the direct and sterile form of interaction. Furthermore training and future technological innovations such as higher resolution depth-camera’s can possibly improve the performance of gesture-based interaction.

Critical Casimir interactions between colloids around the critical point of binary solvents

Critical Casimir interactions between colloidal particles arise from the confinement of fluctuations of a near-critical solvent in the liquid gap between closely-spaced particles. So far, the comparison of theoretical predictions and experimental measurements of critical Casimir forces (CCFs) has focused on the critical solvent composition, while it has been lacking for off-critical compositions. We address this issue by investigating CCFs between spherical colloidal particles around the critical point of a binary solvent through a combination of experiments, previous Ising Monte Carlo simulation results and field-theoretical methods. By measuring the correlation length of the near-critical solvent and the pair potentials of the particles in terms of radial distribution functions and by determining the second virial coefficient, we test in detail theoretical predictions. Our results indicate that the critical Casimir theory gives quantitative correct predictions for the interaction potential between particles in a near critical binary mixture if weak preferential adsorption of the particle surface is taken into account

Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach

Contains fulltext : 219004.pdf (publisher's version ) (Open Access

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit

Vorapaxar in the secondary prevention of atherothrombotic events

Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)