Collaborative Surgical Robots:Optical Tracking During Endovascular Operations

Endovascular interventions usually require meticulous handling of surgical instruments and constant monitoring of the operating room workspace. To address these challenges, robotic- assisted technologies and tracking techniques are increasingly being developed. Specifically, the limited workspace and potential for a collision between the robot and surrounding dynamic obstacles are important aspects that need to be considered. This article presents a navigation system developed to assist clinicians with the magnetic actuation of endovascular catheters using multiple surgical robots. We demonstrate the actuation of a magnetic catheter in an experimental arterial testbed with dynamic obstacles. The motions and trajectory planning of two six degrees of freedom (6-DoF) robotic arms are established through passive markerguided motion planning. We achieve an overall 3D tracking accuracy of 2.3 ± 0.6 mm for experiments involving dynamic obstacles. We conclude that integrating multiple optical trackers with the online planning of two serial-link manipulators is useful to support the treatment of endovascular diseases and aid clinicians during interventions

The ARMM System-Autonomous Steering of Magnetically-Actuated Catheters:Towards Endovascular Applications

Positioning conventional endovascular catheters is not without risk, and there is a multitude of complications that are associated with their use in manual surgical interventions. By utilizing surgical manipulators, the efficacy of remote-controlled catheters can be investigated in vivo. However, technical challenges, such as the duration of catheterizations, accurate positioning at target sites, and consistent imaging of these catheters using non-hazardous modalities, still exist. In this paper, we propose the integration of multiple sub-systems in order to extend the clinical feasibility of an autonomous surgical system designed to address these challenges. The system handles the full synchronization of co-operating manipulators that both actuate a clinical tool. The experiments within this study are conducted within a clinically-relevant workspace and inside a gelatinous phantom that represents a life-size human torso. A catheter is positioned using magnetic actuation and proportional-integral (PI) control in conjunction with real-time ultrasound images. Our results indicate an average error between the tracked catheter tip and target positions of 2:09 0:49 mm. The median procedure time to reach targets is 32:6 s. We expect that our system will provide a step towards collaborative manipulators employing mobile electromagnets, and possibly improve autonomous catheterization procedures within endovascular surgeries

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Formulação da estratégia do controle de impedância como um problema de controle ótimo.

A formulation of impedance control for redundant manipulators is developed as a particular case of an optimal control problem. This formulation allows the planning and design of an impedance controller that benets from the stability and eficiency of an optimal controller. Moreover, to circumvent the high computational costs of computing an optimal controller, a sub-optimal feedback controller based on the state-dependent Ricatti equation (SDRE) approach is developed. This approach is then compared with the quadratic programming (QP) control formulation, commonly used to resolve redundancy of robotic manipulators. Numerical simulations of a redundant planar 4-DOF serial link manipulator show that the SDRE control formulation offers superior performance over the control strategy based QP, in terms of stability, performance and required control effort.Uma formulação do controle de impedância para manipuladores redundantes é desenvolvida como um caso particular de um problema de controle ótimo. Essa formulação permite o planejamento e projeto de um controlador de impedância que se beneficia da estabilidade e eficiência de um controlador ótimo. Para evitar lidar com os elevados custos computacionais de se computar um controlador ótimo, um controlador em malha fechada sub-ótimo, baseado na abordagem das equações de Ricatti dependentes de estado (SDRE), é desenvolvido. Essa abordagem é comparada com a formulação de um controlador baseado em programação quadrática (QP), usualmente utilizado para resolver problemas de redundância em manipuladores robóticos. Simulações numéricas de um manipulador serial plano de quatro graus de liberdade mostram que o controlador baseado em SDRE oferece performance superior em relação a um controlador baseado em programação quadrática, em termos de estabilidade, performance e esforço de controle requerido do atuador

Digitalizing and capturing haptic feedback in virtual prototypes for User Experience design

The term User Experience (UX) is commonly associated with interactive computer-based systems. Companies operating in the consumer market are recently discovering the importance of designing UX, and in particular multisensory UX, of any kind of system, and not necessarily high-tech products. One of the most effective ways to design UX is to enable users interacting with the prototype of the system during the design process, and in particular already during its initial stages. These prototypes should provide the same experience occurring while interacting with the corresponding real product. To this aim Virtual Prototypes (VPs) may be effectively used, especially in the early design stages when the activities are still in progress and changes are frequent. Multisensory UX can be effectively designed through VPs only if all the senses involved in the real interaction are recreated into the virtual simulation. To date, despite a growing interest of research and industry in the development and use of VPs, many applications are still limited to visual and sound simulations. This paper focuses on the use of VPs to design multisensory UX, concentrating on the introduction of the sense of touch in the simulation. The methodological approach as well as the development of a case study are described in the paper

The ARMM System: Demonstrating Clinical Feasibility in Steering Magnetically Actuated Catheters in Endovascular Applications

During a minimally-invasive surgical intervention, robot-assisted surgery may prove to offer a greater range of motion of surgical instruments and improved ergonomics for the surgeon, when compared to manual actuation techniques. Previously, we have developed the Advanced Robotics for Magnetic Manipulation (ARMM) system, which consists of two 6-degrees-of-freedom (DOF) surgical robots. Furthermore, we described the tracking, dynamics, and motions of these robots, indicating an overall 3D tracking accuracy of 2.4±0.4 mm and a mean joint velocity error of 1.23 rad/s. In this work, we aim to demonstrate fully autonomous control of these robots in a clinically-relevant environment