Development of Sensing Systems for Improving Surgical Grasper Performance

Minimally invasive techniques play a vital and increasing role in modern surgery. In these procedures, surgical graspers are essential in replacing the surgeon’s fingertips as the main manipulator of delicate soft tissues. Current graspers lack haptic feedback, restricting the surgeon to visual feedback. Studies show that this can frequently lead to morbidity or task errors due to inappropriate application of force. Existing research has sought to address these concerns and improve the safety and performance of grasping through the provision of haptic feedback to the surgeon. However, an effective method of grasping task optimisation has not been found. This thesis explores new sensing approaches intended to reduce errors when manipulating soft tissues, and presents a novel tactile sensor designed for deployment in the grasper jaw. The requirements were first established through discussion with clinical partners and a literature review. This resulted in a conceptual approach to use multi-axis tactile sensing within the grasper jaw as a potential novel solution. As a foundation to the research, a study was conducted using instrumented graspers to investigate the characteristics of grasp force employed by surgeons of varying skill levels. The prevention of tissue slip was identified as a key method in the prevention of grasper misuse, preventing both abrasion through slip and crush damage. To detect this phenomena, a novel method was proposed based on an inductive pressure sensing system. To investigate the efficacy of this technique, experimental and computational modelling investigations were conducted. Computational models were used to better understand the transducer mechanisms, to optimise sensor geometry and to evaluate performance in slip detection. Prototype sensors were then fabricated and experimentally evaluated for their ultimate use in slip detection within a surgical grasper. The work concludes by considering future challenges to clinical translation and additional opportunities for this research in different domains

Evaluation of the personal health budget pilot programme

1. The personal health budget initiative is a key aspect of personalisation across health care services in England. Its aim is to improve patient outcomes, by placing patients at the centre of decisions about their care. Giving people greater choice and control, with patients working alongside health service professionals to develop and execute a care plan, given a known budget, is intended to encourage more responsiveness of the health and care system. 2. The personal health budget programme was launched by the Department of Health in 2009 after the publication of the 2008 Next Stage Review. An independent evaluation was commissioned alongside the pilot programme with the aim of identifying whether personal health budgets ensured better health and care outcomes when compared to conventional service delivery and, if so, the best way for personal health budgets to be implemented

Information Acquisition Differences between Experienced and Novice Time Trial Cyclists

Purpose: To use eye-tracking technology to directly compare information acquisition behavior of experienced and novice cyclists during a self-paced 10 mile (16.1 km) time-trial. Method: Two groups of novice (N=10) and experienced cyclists (N=10) performed a 10-mile self-paced time-trial (TT) on two separate occasions during which a number of feedback variables (speed, distance, power output, cadence, heart rate, and time) were projected within their view. A large RPE scale was also presented next to the projected information and participants. Participants were fitted with a head-mounted eye-tracker and heart rate monitor. Results: Experienced cyclists performed both time-trials quicker than novices (F1,18=6.8, P=.018) during which they primarily looked at speed (9 of 10 participants) whereas novices primarily looked at distance (6 of 10 participants). Experienced cyclists looked at primary information for longer than novices across the whole time-trial (24.5+/-4.2% vs. 34.2+/-6.1%, t18=4.2, P<0.001) and less frequently than novices during the last quarter of the time-trial (49+/-19 vs. 80+/-32, t18=-2.6, P=0.009). The most common combination of primary and secondary information looked at by experienced cyclists was speed and distance respectively. Looking at ten different primary-secondary feedback permutations, the novices were less consistent than the experienced cyclists in their information acquisition behavior. Conclusion: This study challenges the importance placed on knowledge of the endpoint to pacing in previous models, especially for experienced cyclists for whom distance feedback was looked at secondary to, but in conjunction with, information about speed. Novice cyclists have a greater dependence upon distance feedback, which they look at for shorter and more frequent periods of time than the experienced cyclists. Experienced cyclists are more selective and consistent in attention to feedback during time-trial cycling

Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter-defibrillator

Background: Most inappropriate shocks from the subcutaneous implantable cardioverter-defibrillator (S-ICD) are caused by cardiac oversensing. A novel sensing methodology, SMART Pass (SP; Boston Scientific Corporation, Natick, MA), aims to reduce cardiac oversensing. Objective: The purpose of this study was to evaluate the effect of SP on shocks in ambulatory patients with S-ICD. Methods: Patients implanted in 2015–2016 and enrolled in a remote patient monitoring system were included and followed for 1 year. Shocks were adjudicated by 3 independent blinded reviewers as appropriate or inappropriate. Shock incidence was calculated for patients with SP programmed enabled or disabled at implantation, censoring patients when SP programming changed or at the last transmission. The SP setting (enabled vs disabled) was modeled as a time-dependent Cox regression variable. Results: The cohort consisted of 1984 patients, and a total of 880 shocks were adjudicated. At implantation, SP was enabled in 655 patients (33%) and disabled in 1329 patients (67%). SP reduced the risk for the first inappropriate shock by 50% (P <.001) and the risk for all inappropriate shocks by 68% (P <.001) in multivariate analysis adjusted for age and device programming. The incidence of inappropriate shocks was 4.3% in the SP enabled arm vs 9.7% in the SP disabled arm. The incidence of appropriate shocks was similar (5.2

Early experiences of implementing personal health budgets.

The aim of this report is identify the challenges faced by project teams in implementing budgets and also any strategies and approaches that worked well. One of the overall aims of the evaluation is to provide lessons for successful implementation of personal health budgets in other areas should the policy be taken forward. This report provides early analysis in this regard. Over the period April to June 2010, interviews were conducted with personal health budget project leads in the 20 in‐depth sites. The interviews were semi‐structured, allowing project leads to discuss their implementation processes and other relevant issues. Each interview lasted approximately 1.5 hours. Interviews were transcribed and coded in accordance with the areas covered in the topic guide

Personal Health Budgets: Early experiences of budget holders. Fourth interim report.

Personal health budgets are being piloted in English primary care trusts (PCTs) between 2009 and 2012. This evaluation report looks at the early experiences of a small subsample of budget holders and their representatives. It reports in-depth interviews with 58 people from 17 PCTs, around three months after the offer of a personal health budget, about their experiences of personal health budgets so far

Personal health budgets: experiences and outcomes for budget holders at nine months. Fifth interim report.

Fifty-two people with long-term health problems were interviewed nine months after being offered a personal health budget, as were 13 carers of budget holders three and nine months after the offer of a budget. Together they were drawn from 17 of the Primary Care Trusts (PCTs) that are currently piloting personal health budgets in England. These interviews suggest there is widespread potential for personal health budgets to lead to improvements in health and well-being. However, these benefits risked being reduced by delays and other problems in implementing personal health budgets

Defective monocyte enzymatic function and an inhibitory immune phenotype in HIV-exposed uninfected African infants in the era of antiretroviral therapy

BACKGROUND: HIV-Exposed Uninfected (HEU) infants are a rapidly expanding population in sub-Saharan Africa, highly susceptible to encapsulated bacterial disease in the first year of life. The mechanism of this increased risk is still poorly understood. We investigated if HIV-exposure dysregulates HEU immunity, vaccine-antibody production and human herpes virus (HHV) amplify this effect. METHODS: 34 HIV-infected and 44 HIV-uninfected pregnant women were recruited into the birth cohort, followed up to 6 weeks of age; and 43 HIV-infected and 61 HIV-uninfected mother-infant pairs into a longitudinal infant cohort, at either: 5-7 to 14-15; or 14-15 to 18-23 weeks of age. We compared monocyte function, innate and adaptive immune cell phenotype, and vaccine-induced antibody responses between HEU and HU infants. RESULTS: We demonstrate altered monocyte phagosomal function and B cell subset homeostasis, and lower vaccine-induced anti-Haemophilus influenzae type b (Hib) and anti-Tetanus Toxoid (TT) IgG titers in HEU compared to HU infants. HHV infection was similar between HEU and HU infants. CONCLUSION: In the era of antiretroviral therapy (ART)-mediated viral suppression, HIV-exposure may dysregulate monocyte and B cell function, during the vulnerable period of immune maturation. This may contribute to the high rates of invasive bacterial disease and pneumonia in HEU infants

Evaluation of personal health budget pilot programme

In England, the personal health budget initiative is an important part of the current personalisation agenda for health care services. Its aim is to place patients at the heart of decisions about services they receive. The personal health budget initiative was first proposed in the 2008 NHS Next Stage Review as a process of giving patients greater control over services they receive and how their support is managed. A number of design principles underlie personal health budgets, including: 1. Patients should know the resource level available within the budget; 2. Patients should be encouraged to develop a support/care plan that details how the resource will be used to meet their identified needs; 3. Patients should decide how they would like the budget to be managed. In 2009, the Department of Health invited PCTs to become pilot sites for the personal health budget pilot programme. An evaluation was commissioned to run alongside in order to provide an account of the personal health budget process from the system and from the view of budget holders and carers. Initially, 64 pilot sites were involved in piloting personal health budgets and contributing to the evaluation. During the evaluation period, the pilot programme remained open and now there are 75 pilot sites implementing personal health budgets. Twenty sites from across the pilots were selected to be in-¬‐depth evaluation sites, with the remainder being wider cohort sites. The overarching aim of the evaluation was to identify whether personal health budgets ensured better health and care-¬‐related outcomes when compared to conventional service delivery and, if so, the best way they should be implemented