Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care

Evaluation of Few-View Reconstruction Parameters for Illicit Substance Detection using Fast-Neutron Transmission Spectroscopy

We have evaluated the performance of an illicit substance detection system that performs image reconstruction using the Maximum Likelihood algebraic reconstruction algorithm, a few number of projections, and relatively coarse projection and pixel resolution. This evaluation was done using receiver operator curves and simulated data from the fast-neutron transmission spectroscopy system operated in a mode to detect explosives in luggage. The results show that increasing the number of projection angles is more important than increasing the projection resolution, the reconstructed pixel resolution, or the number of iterations in the Maximum Likelihood algorithm. A 100% detection efficiency with essentially no false positives is possible for a square block of RDX explosive, a projection resolution of 2 cm, a reconstructed pixel size of 2x2 cm, and five projection angles. For rectangular shaped explosives more angles are required to obtain the same system performance

Sex Differences in Measures of Wave Reflection and Aortic Arterial Stiffness in Response to Weight Machine Resistance Exercise

International Journal of Exercise Science 15(2): 1190-1201, 2022. While it has been demonstrated that acute resistance exercise (RE) alters measures of wave reflection and aortic arterial stiffness in young, healthy individuals, limited research has evaluated sex differences. Accordingly, we recruited moderately active, resistance-trained men (Age: 22 ± 3yrs, n=12) and women (23 ± 3yrs, n=10) to perform two randomized conditions consisting of an acute bout of weight machine RE or a quiet control (CON). Measures of aortic wave reflection and aortic stiffness were taken at baseline and 15 minutes following the RE (Recovery). At baseline, women had significantly higher heart rate (p = 0.05) and lower brachial systolic blood pressure (p = 0.009) compared to men. There were no significant three-way interactions for any variable. Significant condition by time interactions were noted for heart rate (Baseline: 65 ± 10bpm, Recovery: 87 ± 13bpm, p = 0.001), brachial systolic blood pressure (Baseline: 116 ± 9mmHg, Recovery: 123 ± 10mmHg, p = 0.014), and the augmentation index (AIx) normalized at 75bpm (Baseline: 7.7 ± 12.8%, Recovery: 15.5 ± 9.5%, p = 0.002) such that Recovery was augmented compared to Baseline following RE but not CON. There was also a significant main effect of time for augmentation pressure (Baseline: 4.1 ± 4.0mmHg, Recovery: 4.0 ± 3.6mmHg, p = 0.04) such that it decreased from Baseline to Recovery following RE but not the CON. There were no significant effects of sex, condition, or time on aortic arterial stiffness. Men and women have similar responses in measures of aortic wave reflection and aortic arterial stiffness following acute RE using weight machines

KI Systeme: Aktuelle Trends und Entwicklungen aus Perspektive der Technikfolgenabschätzung

Künstliche Intelligenz (KI) ist - ebenso wie damit verknüpfte Techniken wie maschinelles Lernen und Big Data - in aller Munde. Die große Dynamik und Tragweite dieser Entwicklungen zeigen sich bereits in zahlreichen Anwendungsgebieten von Wirtschaft, Gesellschaft und Wissenschaft. Technikfolgenabschätzung (TA) von KI hat in diesem Zusammenhang zunächst die Aufgabe, etwaige überzogene öffentliche Erwartungen und Befürchtungen in sachliche, realistische Perspektiven zu transformieren. In einem zweiten Schritt kann TA entlang begründbarer Entwicklungsziele von KI und legitimer gesellschaftlicher Wertvorstellungen Impulse für die weitere, wünschbare Gestaltung von KI geben. Wenn TA diese Orientierungsaufgabe nah am technologischen Kern wahrnimmt, findet sie dabei große gestalterische Freiräume in frühen Phasen der Technikentwicklung vor. Die damit zusammenhängenden Gedanken werden im vorliegenden Einleitungskapitel konkretisiert und auf die Beiträge zu diesem Themenschwerpunkt angewendet.Artificial intelligence (AI) is on everyone's lips - as well as the associated technologies of machine learning and big data. The enormous dynamics and consequences of these developments become already evident in numerous areas of application in business, society and science. In this context, technology assessment (TA) of AI initially has the task of transforming any excessive public expectations and fears to the factual level. In a second step, TA can provide impulses for the further, desirable design of AI based on reasonable development goals of AI and legitimate societal values. If TA conducts this orientation task close to the technological core, it can consider wide scopes of options for action in the early phases of technology development. Related thoughts are put into concrete terms in this article and will be related to the authors’ contributions to this topical focus

Impacts of Lower Thermospheric Atomic Oxygen on Thermospheric Dynamics and Composition Using the Global Ionosphere Thermosphere Model

The exchange of energy between the lower atmosphere and the ionosphere thermosphere system is not well understood. One of the parameters that is important in the lower thermosphere is atomic oxygen. It has recently been observed that atomic oxygen is higher in summer at ∼95 km. In this study, we investigate the sensitivity of the upper thermosphere to lower thermospheric atomic oxygen using the Global Ionosphere Thermosphere Model (GITM). We use the Whole Atmosphere Community Climate Model with thermosphere and ionosphere extension (WACCM‐X) to drive the lower atmospheric boundary of atomic oxygen in GITM between ∼95 and 100 km and compare the results with the current mass spectrometer incoherent scatter (MSIS) driven GITM. MSIS has higher atomic oxygen in the winter hemisphere while WACCM‐X has higher atomic oxygen in the summer hemisphere. The reversal of atomic oxygen distribution affects the pressure distribution between 100 and 120 km, such that the hemisphere with larger O number density has stronger equatorward winds, and lower temperature mainly due to adiabatic and radiative cooling. This affects thermospheric scale heights such that the hemisphere with more O has lower N2 and thus enhanced O/N2. This behavior is observed in the opposite hemisphere when MSIS is used as the lower boundary for GITM. Overall, O/N2 for WACCM‐X driven GITM matches better with the global ultraviolet imager (GUVI) data. We find that the impact of lower thermospheric atomic oxygen on upper thermosphere is not just through diffusive equilibrium but also through secondary effects on winds and temperature

Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry

BACKGROUND: Outcome prediction in dogs with immune‐mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified. OBJECTIVES: An online case registry was initiated to: prospectively survey canine IMHA presentation and management in the British Isles; evaluate 2 previously reported illness severity scores, Canine Hemolytic Anemia Score (CHAOS) and Tokyo and to identify independent prognostic markers. ANIMALS: Data from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012. METHODS: Outcome prediction by previously reported illness‐severity scores was tested using univariate logistic regression. Independent predictors of death in hospital or by 30‐days after admission were identified using multivariable logistic regression. RESULTS: Purebreds represented 89.1% dogs (n = 246). Immunosuppressive medications were administered to 88.4% dogs (n = 244), 76.1% (n = 210) received antithrombotics and 74.3% (n = 205) received packed red blood cells. Seventy‐four per cent of dogs (n = 205) were discharged from hospital and 67.7% (n = 187) were alive 30‐days after admission. Two dogs were lost to follow‐up at 30‐days. In univariate analyses CHAOS was associated with death in hospital and death within 30‐days. Tokyo score was not associated with either outcome measure. A model containing SIRS‐classification, ASA classification, ALT, bilirubin, urea and creatinine predicting outcome at discharge was accurate in 82% of cases. ASA classification, bilirubin, urea and creatinine were independently associated with death in hospital or by 30‐days. CONCLUSIONS AND CLINICAL IMPORTANCE: Markers of kidney function, bilirubin concentration and ASA classification are independently associated with outcome in dogs with IMHA. Validation of this score in an unrelated population is now warranted

Possible Evidence for Iron Sulfates, Iron Sulfides, and Elemental Sulfur at Gusev Crater, Mars, from Mer, Crism, and Analog Data

The Mossbauer (MB) spectrometers on the Mars Exploration Rovers (MER) Spirit (Gusev crater) and Opportunity (Meridiani Planum) have detected 14 Fe-bearing phases, and mineralogical assignments have been made for all except 3. Identified Fe2+-bearing phases are olivine, pyroxene, ilmenite, and troilite. Magnetite and chromite are present as mixed Fe(2+) and Fe(3+) phases. Identified Fe(3+) phase are jarosite, hematite, goethite, and nanophase ferric oxide (npOx). Fe(sup 0) (iron metal) is present as kamacite. Nanophase ferric oxide (npOx) is a generic name for octahedrally coordinated Fe(3+) alteration products that cannot be otherwise mineralogically assigned on the basis of MER data. On the Earth, npOx would include ferrihydrite, iddingsite, schwertmannite, akaganeite, and superparamagnetic hematite and goethite. The Mars Reconnaissance Orbiter CRISM instrument, a visible, near-IR hyperspectral imager (approximately 0.35 to 4 micron) enables mineralogical examination of Mars with a tool that is sensitive to H2O and to M-OH (M = Al, Si, Fe, Mg, etc.) at spatial resolution of about 20 m/pixel. We examined a CRISM image of the MER region of Gusev crater (Columbia Hills and plains to the west), looking for spectral evidence of the aqueous process apparent from the MER analyses. We also searched for spectral constraints for the mineralogical composition of our unidentified Fe-bearing phases and the forms of npOx present on Mars. We also consider evidence from analogue samples that the precursor for the goethite detected by MB in Clovis Class rocks is an iron sulfide. We suggest that there is some indirect evidence that elemental sulfur might be present to different extents in Clovis Class rocks, the Fe3Sulfate-rich soils, and perhaps even typical (Laguna Class) surface soils