Effects of Experience and Workplace Culture in Human-Robot Team Interaction in Robotic Surgery: A Case Study

International audienceRobots are being used in the operating room to aid in surgery, prompting changes to workflow and adaptive behavior by the users. This case study presents a methodology for examining human-robot team interaction in a complex environment, along with the results of its application in a study of the effects of experience and workplace culture, for human-robot team interaction in the operating room. The analysis of verbal and non-verbal events in robotic surgery in two different surgical teams (one in the US and one in France) revealed differences in workflow, timeline, roles, and communication patterns as a function of experience and workplace culture. Longer preparation times and more verbal exchanges related to uncertainty in use of the robotic equipment were found for the French team, who also happened to be less experienced. This study offers an effective method for studying human-robot team interaction and has implications for the future design and training of teamwork with robotic systems in other complex work environments

A quantitative deficiency in peripheral blood Vγ9Vδ2 cells is a negative prognostic biomarker in ovarian cancer patients.

International audienceVγ9Vδ2 cells are cytotoxic T cells that are able to recognize epithelial ovarian carcinoma (EOC) cells. Therefore, Vγ9Vδ2 cell-based adoptive transfer is an attractive therapy for EOC. However, the inefficient ex vivo expansion after specific stimulation of Vγ9Vδ2 cells from some patients and the relationships between Vγ9Vδ2 cells and clinical course of EOC are issues that remain to be clarified. Herein, peripheral blood mononuclear cells (PBMCs) from 60 EOC patients were stimulated with bromohydrin pyrophosphate (BrHPP) or zoledronate, which are specific agonists of Vγ9Vδ2 cells. The compounds differed in their efficacies to induce ex vivo Vγ9Vδ2 PBMC expansion, but 16/60 samples remained inefficiently expanded with both stimuli. Interestingly, the Vγ9Vδ2 cells in these low-responding PBMCs displayed before expansion (ex vivo PBMCs) an altered production of the pro-inflammatory cytokines IFN-γ and TNF-α, a decreased naive fraction and a reduced frequency. No evidence of an involvement of CD4(+)CD25(+)Foxp3(+) regulatory cells was observed. Importantly, our data also demonstrate that a Vγ9Vδ2 cell frequency of 0.35% or less in EOC PBMCs could be used to predict low responses to both BrHPP and zoledronate. Moreover, our data highlight that such a deficiency is not correlated with advanced EOC stages but is associated with more refractory states to platinum-based chemotherapy and is an independent predictor of shorter disease-free survival after treatment. These results are the first to suggest a potential contribution of Vγ9Vδ2 cells to the anti-tumor effects of chemotherapeutic agents and they strengthen interest in strategies that might increase Vγ9Vδ2 cells in cancer patients

Determinants of Refusal of A/H1N1 Pandemic Vaccination in a High Risk Population: A Qualitative Approach

International audienceBackground: Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine.Methodology/Principal Findings: We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu’s potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider.Conclusions/Significance: These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization

Tumeurs cérébrales primitive de l'adulte et exposition aux champs électromagnétiques (étude cas-témoins en Gironde)

Les connaissances épidémiologiques dans le domaine des tumeurs cérébrales sont encore limités et à ce jour, les facteurs étiologiques potentiels sont nombreux. Parmi eux, les facteurs environnementaux, notamment les expositions professionnelles constituent des hypothèses de premier intérêt. Certaines études réalisées en milieu professionnel tendent à mettre en évidence des risques plus élevés dans les industries et activités exposant aux Champ ElectroMagnétiques (CEM) et plus spécifiquement aux extrêmement Basses Fréquence (EBF). Une étude épidémiologique de type cas-témoins a été menée en population générale afin d'étudier l'association entre l'exposition environnementale et professionnelle aux CEM et la survenue de tumeurs cérébrales primitives de l'adulte dans le département de la Gironde. Une augmentation non significative du risque de tumeur cérébrale chez les sujets exposés professionnellement aux CEM ou aux EBF a pu être mise en évidence au cours de cette étude (RC=1,52 ; IC95%(0,92;2,51)) pour les CEM et RC=1,59 ; IC95% (0,97;2,61)pour les EBF). Cette augmentation devenaiet significative lorsqu'on analysait par type histologique : le risque de survenue de méningiome était 3 fois plus élevé chez les patients professionnellement exposés aux EBF (RC=3,02 ; IC95% (1,10;8,26)). Aucune relation dose-effet n'a été mise en évidence. La proximité d'une ligne électrique à haute tension à moins de 100 mètres du lieu de résidence était associé de manière significative à la survenue de tumeurs cérébrales (RC=1,51 ; IC95%(0,74;3,07)). Ce risque augmentait lorsque l'on considérait uniquement les méningiomes mais il demeurait non significatif (RC=2,99 ; IC95%(0,86;10,42)). Ces résultats sont à prendre avec précaution en raison de leur faible puissance. Néanmoins, il paraît nécessaire de poursuivre l'étude du rôle des CEM sur la survenue de tumeurs cérébrales et en particulier des méningiomes.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Carcinome canalaire infiltrant du sein avec résection incomplète (impact de la reprise des marges d'exérèse sur le risque de récidive locale à propos d'une série rétrospective de 1062 patientes)

Nous avons conduit une étude rétrospective monocentrique de 1992 à 2002 comparant trois populations de patientes : 206 patientes avec un carcinome canalaire infiltrant (CCI), traitement conservateur (TC), une ou plusieurs reprises chirurgicales pour marges non saines ; 248 avec un CCI, TC, marges non saines pas de reprise ; 608 avec un CCI, TC, marges saines pas de reprise. Les principaux facteurs de risque de maladie résiduelle sont une composante in situ extensive sur la tumeur initiale (p=0,008), plusieurs marges atteintes (p=0,02) et une atteinte de la marge par du carcinome in situ (p=0,006). Les patientes qui bénéficient le plus d'une reprise en terme de récidive locale homolatérale (RLH) sont les patientes qui ont des marges atteintes diffuses (p< 10-4). En cas de marges proches, la réalisation ou non d'une reprise n'a pas d'impact sur la RLH (p=0,065). L'approche millimétrique d'une marge saine est à abandonner du fait des limites inhérentes à l'examen anatomopathologique et à la multifocalité des tumeurs mammaires.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Involvement of ITIH5, a candidate gene for congenital uterovaginal aplasia (Mayer-Rokitansky-Küster-Hauser syndrome), in female genital tract development.

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Paraoxonase 1 (PON1) as a marker of short term death in breast cancer recurrence

International audienceObjective: To relate paraoxonase (PON1) activity to survival time and short term death in breast cancer recurrence. Design and methods: PON1 activity was measured by its rate of hydrolysis of two different substrates, paraoxon (PON) and phenylacetate (ARE) in 50 patients with recurrence of breast cancer. Results were compared between patients surviving more than one year after the analysis (22) and those who died within one year (28). Results: In a logistic regression analysis, ARE was negatively associated with early death (OR=0.10 [0.02-0.58], p=0.0109). PON did not reach significance (OR=0.43 [0.17-1.11], p=0.0826). In a multiple logistic regression analysis model, ARE was independently associated with early death (OR=0.12 [0.02-0.98], p=0.0476), besides interval time between diagnosis and recurrence (OR=0.54 [0.27-1.07], p=0.0781) and undernutrition (OR=3.95 [0.81-19.19], p=0.0883). Conclusion: Paraoxonase is a potential marker of survival in patients with breast cancer recurrence. (C) 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved

Influence of environmental and anthropogenic factors on the composition, concentration and spatial distribution of microplastics: A case study of the Bay of Brest (Brittany, France)

The concentration and spatial distribution of microplastics in the Bay of Brest (Brittany, France) was investigated in two surveys. Surface water and sediment were sampled at nine locations in areas characterized by contrasting anthropic pressures, riverine influences or water mixing. Microplastics were categorized by their polymer type and size class. Microplastic contamination in surface water and sediment was dominated by polyethylene fragments (PE, 53–67%) followed by polypropylene (PP, 16–30%) and polystyrene (PS, 16–17%) microparticles. The presence of buoyant microplastics (PE, PP and PS) in sediment suggests the existence of physical and/or biological processes leading to vertical transfer of lightweight microplastics in the bay. In sediment (upper 5 cm), the percentage of particles identified by Raman micro-spectroscopy was lower (41%) than in surface water (79%) and may explain the apparent low concentration observed in this matrix (0.97 ± 2.08 MP kg−1 dry sediment). Mean microplastic concentration was 0.24 ± 0.35 MP m−3 in surface water. We suggest that the observed spatial MP distribution is related to proximity to urbanized areas and to hydrodynamics in the bay. A particle dispersal model was used to study the influence of hydrodynamics on surface microplastic distribution. The outputs of the model showed the presence of a transitional convergence zone in the centre of the bay during flood tide, where floating debris coming from the northern and southern parts of the bay tends to accumulate before being expelled from the bay. Further modelling work and observations integrating (i) the complex vertical motion of microplastics, and (ii) their point sources is required to better understand the fate of microplastics in such a complex coastal ecosystem

A decision aid for the port placement problem in robot-assisted hysterectomy

Objective: In robot-assisted minimally invasive surgery, proper port positioning ensures that surgical tools have adequate access to the surgical site and avoids mid-surgery collisions of robotic arms. To date, several guidelines have been proposed for more accurate port placement. However, challenges remain due to variations in patient morphology, anatomy, and, in particular, organ displacement due to insufflation in certain laparoscopic procedures. The objective of this study was to design and develop a decision aid for optimal port placement in robot-assisted hysterectomy that accounts for patient variability and organ displacement due to insufflation. Methods: Three components were constructed: a robot model, a patient-specific model, and an optimization algorithm. The three components were integrated, and the system was verified using four different patients who underwent robotic hysterectomy. Once verified, two expert surgeons were asked to evaluate the decision aid for face and construct validity. A usability test was conducted using a torso phantom with target organs located in three different locations. Two expert surgeons performed a simulated hysterectomy task with and without the decision aid to evaluate performance and satisfaction. Results: The optimization algorithm was sensitive to individual differences in anatomy in the four patients. Expert surgeons successfully established face and construct validity. Usability test results showed a 28%–40% reduction in time to task completion with the optimized ports compared to expert-determined port locations without using the decision aid. Conclusions: The decision aid, based on an individualized patient-specific model, robot model, and optimization algorithm, was shown to be effective at addressing the challenges of displaced organs due to insufflation in robot-assisted hysterectomy. The face and construct validity of the decision aid was established by expert surgeons, while efficiency gains in task performance were demonstrated experimentally