bluuebunny/crossref_metadata_2025_split huggingface dataset:
Device for Safely Closing Trocar Sites in Minimally Invasive Abdominal Surgery
Authors: de la Torre Roger A. , Ghosh Jaya 
Published: October 2017

Laparoscopic and robotic surgeries of the abdomen require a trocar to facilitate entry and removal of instrumentation. Some of these trocars are 5mm or less, but some trocars for these surgeries are larger, with 8mm to 15mm trocars commonly used. One of the well-known problems seen in minimally invasive surgery to the abdomen is the resulting defect left in the abdominal wall following removal of the trocars. Occasionally, especially after removal of larger trocars, a defect is left that is large enough to allow omentum or segments of small intestine to become entrapped within the resulting space in the abdominal wall. These trocar site hernias can cause pain, but they also may lead to small bowel obstruction and bowel ischemia or even infarction, perforation and death. The likelihood of a trocar site hernia is increased when the minimally invasive procedure requires removal of an organ or a mass. This often requires dilatation of the trocar site opening.1,2,3
Re-operation to reduce and repair trocar site hernias adds significant cost to the healthcare system. Two separate studies report that incidence of trocar site hernias are in the ranges of 0.65%–2.8%4 and 1.5%–1.8%5,6. Based on a 2016 report published by the American Society for Metabolic and Bariatric Surgery (ASMBS), 196,0007 bariatric procedures were performed in 2015. Assuming an average incidence rate of 1.7%, and based on the cost analysis provided by a 2008 case study8, in bariatric surgery alone, it is estimated that the treatment and hospitalization of such hernias adds an additional $86.2M to healthcare costs.
Several methods and devices exist to prevent the occurrence of trocar site hernias. However, closing superficial fascia externally is difficult, especially in obese patients, and often requires extending the skin incision significantly. Most instruments to close the potential hernia site involve introducing a hollow needle with a built-in, grasping device through tissue on one side of the defect and into the abdominal cavity. This puts internal structures at risk for potential injury. One end of suture is introduced with this needle and then using a separate instrument through a different trocar this suture is held while the needle is removed. The needle device is then re-introduced through tissue on the opposite side of the defect, and the suture is handed back to the needle device and pulled out completing a U-stitch to close the potential hernia site. If a surgeon inserts a finger into the abdomen along the trocar site to guide the needle, there is the potential for injury to the surgeon’s finger.
Therefore, we set about to design a device to close trocar site defects that would work efficiently, while being safe from injury to the patient or the surgeon, and preferably without the need for a separate instrument through a different trocar to assist.
Conceptual Design of Flex-DBS, a Mechanically Reconfigurable Deep Brain Stimulation Probe
Authors: Johnson Gregory , Lehto Lauri , Mangia Silvia , Gröhn Olli , Michaeli Shalom , Kodandaramaiah Suhasa 
Published: October 2017

Deep Brain Stimulation (DBS) has demonstrated outstanding results for the treatment of medically intractable Parkinson’s disease (PD), essential tremor and other neurological and psychiatric disorders, such as Obsessive Compulsive Disorder (OCD) and major depression [1,2]. Despite widespread proliferation, efficacy of DBS treatment is limited primarily because of two key limitations as shown in Fig. 1: (a) non-specific activation of regions implicated in DBS side effects, and (b) inefficient neurostimulation due to complex anatomical structure and axonal orientations of target regions. Thus, there is a need to develop approaches to DBS that achieve more precise target selection and efficient activation of axonal pathways within the brain.
Recent efforts in target selection has focused on shaping the stimulation field by using multichannel electrodes for current steering [3]. These multichannel electrodes are limited to cylindrical lead configuration and can only correct for small spatial localization errors, and they do not utilize the direction of the electrical field’s gradients to stimulate neurons depending on their orientation (mainly orientation of axons). Thus, there is a critical need for new electrode architectures that enable both spatial steering and stimulation field orientation tuning capabilities. Here we present the Flex-DBS, a novel DBS electrode lead architecture that harnesses recent advances in flexible probe fabrication and precision guidance strategy to mechanically reconfigure electrodes in three dimensional orientations within anatomically complex brain tissue. Further, it incorporates dense arrays of electrodes with each lead that allow stimulation field orientation tuning.
Recognizing Sit-Stand and Stand-Sit Transitions for a Bionic Knee Exoskeleton
Authors: Liu Xiuhua , Zhou Zhihao , Wang Qining 
Published: October 2017

Sit-to-stand and stand-to-sit transitions (STS), as one of the most demanding functional task in daily life, are affected by aging or stroke and other neurological injuries. Lower-limb exoskeletons can provide extra assistance for affected limbs to recover functional activities [1]. Several studies presented locomotion mode recognition of sitting, standing and STS, or only STS, or static modes [2–6]. They are based on fusing information of the mechanical sensors worn on the human body, e.g. inertial measurement unit (IMU) [2–4], plantar pressure force [5], barometric pressure[2], EMG [6]. However, most of them put sensors on the human body and did not show experiments integrated with exoskeletons. Since the physical interaction between the exoskeleton and human body, the recognition method might be different when wearing a real exoskeleton.
To deal with these problems, in this study we proposed a recognition method about STS based on the multi-sensor fusion information of interior sensors of a light-weight bionic knee exoskeleton (BioKEX). A simple classifier based on Support Vector Machine (SVM) was used considering the computational cost of the processing unit in exoskeleton.
The Paediatric Metered Dosage Inhaler (pMDI) Sleeve Attachment
Authors: Beukes Giancarlo L. , Levin Michael , Sivarasu Sudesh 
Published: October 2017

Asthma is a chronic disease that causes fixed airflow obstruction, swelling and inflammation of the lung airways. This results in shortness of breath, wheezing and coughing [1]. 3.9 million People in South Africa are estimated to suffer from the disease and 1.5% of this total die as a result, annually [2]. The disease is the 3rd most common cause of child hospitalisation in South Africa.
In developing countries, the most common and affordable treatment option for asthma would be the standard metered dosage inhaler (MDI) [3, 4]. MDI’s provide a range of medications (including airway dilators and anti-inflammatories) contained within the aerosol canisters.
A large number of paediatric and geriatric patients suffering from asthma are unable to produce the necessary force required to activate the standard MDI. The study investigated fingertip pinch (action carried out when activating an MDI) strengths to determine the activation force deficit for paediatric patients [5]. In addition, patients using a standard MDI are unable to track the number of dosages remaining in the aerosol canisters [5]. The study presents a solution to the above mentioned patient limitations. A sleeve attachment was developed to reduce the required activation force of a standard MDI and track patient medication adherence. Additional features included height adjustability for varied MDI sizes (55mm to 90mm in length) and paediatric patient aesthetic appeal.
Tactile Feedback Wearable During a Surgical Simulation Task: Pilot Study Indicates No Distraction, Frustration or Performance Decrement for Users
Authors: Lowndes Bethany , Abdelrahman Amro , Yu Denny , Lachman Nirusha , Hallbeck Susan 
Published: October 2017

With advancements in surgical techniques, patients have experienced improvements in health and recovery outcomes. However, about 87% of laparoscopic surgeons [1] and an increasing number of surveyed allied health professionals [2, 3] report musculoskeletal symptoms. Medical practitioners and human factors engineers have highlighted the “hostile” and “dangerous” operating room (OR) environment [1, 4, 5]. With increasing technology and surgical case complexity, physical demands for surgical team members will continue to increase due to circumstances such as technology restricting posture, taking up working space and more team members working around smaller surgical incisions [6]. There is widespread concern that these medical professionals’ work is unsustainable for safe and healthy patients and surgical team members.
Surgical team members can benefit from posture improvement during surgery; however, direct postural feedback may be difficult during their work due to the high visual and auditory stimuli during surgery. The tactile modality has been recently explored as a method to provide additional information without interfering with cognitive resources dedicated to visual and auditory pathways [7]. Tactile devices have successfully been implemented in high-stress environments, e.g., military, healthcare, and rehabilitation with a resulting improvement in performance [8–11]. Vibrotactile feedback has been specifically implemented in the healthcare field for improved performance by 31–75% anesthesiologists during simulated tasks [10]. Additionally, it has contributed to improved postural control in rehabilitation patients[11]. Despite success in other application areas, the potential of tactile devices for improving healthcare workers’ safety and performance remains unexplored. This study is a part of a larger project to design a wearable device that provides realtime vibrotactile feedback for preventing fatigue and musculoskeletal disorders for healthcare workers in the workplace.
This specific aim of this study is to measure distraction, frustration, and performance during a surgical simulation task performed with and without vibrotactile feedback. This is a test of initial feasibility of vibrotactile feedback for use in training proper ergonomics for surgical team members. The researchers hypothesize that there will be some distraction with the vibrotactile feedback wearable but no frustration or performance degradation during the basic simulation task.
A Socially Assistive Robot to Help With Getting Dressed
Authors: Woiceshyn Leo , Wang Yuchi , Nejat Goldie , Benhabib Beno 
Published: October 2017

Getting dressed is a universally performed daily activity, and has a substantial impact on a person’s well-being. Choosing appropriate outfits to wear is important, as clothes protect a person from elements in the environment, and act as a barrier against harsh surfaces [1]. Studies have shown strong correlation between clothing choices and perceptions of sociability, emotional stability, and impression formation (e.g., [2]). This activity, however, can be difficult for some individuals, as they may lack the required reasoning and judgement required [3]. They include children with intellectual and learning disabilities [4] (e.g., Down syndrome [5], dyspraxia [6], autism spectrum disorder [7]), and older adults suffering from dementia including Alzheimer’s disease [8,9], or HIV-associated neurocognitive disorders [10].
In this paper, we present the development of a novel autonomous robotic clothing recommendation system to provide appropriate clothing options, which are personalized to a user’s wardrobe. This research expands on our previous work on socially assistive robots providing assistance with other daily activities, including meal eating [11] and playing Bingo games [12]. Currently, a few smartphone applications exist for providing outfit choices (e.g., [13,14]); however, unlike our proposed system, they are fashion-focused and not able to adapt online to a user’s preferences. Furthermore, by utilizing a socially assistive robot, we provide a more engaging interaction.
We utilize the small Nao social robot, Leia, to guide and interact with a user in order to obtain information regarding his/her preferences, the activity for which the clothing will be worn, as well as the environment in which the activity will take place in order to make outfit recommendations, Fig. 1.
Design of an Eye Speculum With Vibrational Anesthesia for Pain Management
Authors: Ruhala Laura , Malitz David , Elpers Brad , Megal Aaron , Perry Megan 
Published: October 2017

An eye speculum is a device that holds the eyelids and lashes out of the way during ophthalmologic procedures. As described by Lam, et. al, ophthalmological surgical pain is usually controlled using eye drops [1]. However, in many cases the major source of pain or discomfort for the patients is not due to the surgery itself, but rather due to the eye speculum forcing the eye lids open [1]. Eyeball and eyelid physiological variation from patient to patient can cause variations in patient pain, and make it difficult for one speculum design to universally work for most patients [1]. Some eye specula include tubes for aspiration that is used to remove excess tear production on the eyeball surface. As aspirating speculum may aggravate dry eyes after surgery, the aspirating capabilities are ideally optional and at the discretion of the surgeon [2].
Fayers, et. al., found that vibration-assisted anesthesia during upper eyelid surgery had a beneficial pain reduction effect [3]. Additionally, vibrational anesthesia has been used in cosmetic and dental facial procedures [4, 5], but the inclusion of a vibrational anesthetic component to an eye speculum is novel.
A new eye speculum was design to minimize eye speculum patient pain, and be more universal with respect to patient eye shapes. It allows single-handed use by the surgeon, and optional eyeball aspiration. Most uniquely, it also incorporates an optional vibrational anesthesia component. The educational pedagogical aspects of this project were previously described by one of the authors. [6]
A Novel Two-Degree-of-Freedom Mechatronic Bed for Insomnia Treatment
Authors: Zavrel Erik A. , Ebben Matthew R. 
Published: October 2017

The population prevalence of insomnia has been surveyed numerous times and is among the most common medical complaints. This common problem has wide ranging psychological and physiological health consequences.
Ample anecdotal evidence exists that motion promotes sleep: automobile and train passengers are routinely observed becoming drowsy and falling asleep [1]. The sleep-inducing effect of motion has long been appreciated in the scientific community as well. For example, rocking effectively produces sleep in infants [2]. Sleepiness is also a primary symptom of motion sickness and in some cases may be its sole manifestation [3]. To date, three studies have attempted to determine whether vestibular stimulation promotes sleepiness in adults. Two of these studies involved rocking beds. In one study, investigators found that regular, periodic motion achieved using a rocking bed reduced sleep onset latency (SOL) and increased REM in normal sleepers [4]. In another study, normal sleepers napped in a swinging bed of the same design. The study showed that rocking motion promotes sleep onset and transition to deeper, more restful stages of sleep [5]. In another study, investigators employed electrical stimulation of the inner ear in an attempt to decrease SOL, finding a significant reduction in a subset of participants whose SOL was elevated at baseline [6]. This illustrates that insomniacs may be particularly responsive to vestibular stimulation.
The non-pharmacological promotion of sleep is an active commercial pursuit with numerous related patents filed and commercial products introduced in recent years; however, existing devices suffer serious shortcomings. Previous experimental and current commercial designs intended for adults function(ed) as a pendulum, requiring a custom bed (and associated custom linens) along with a special overarching scaffolding installation to suspend the bed [7]. An advanced robotic infant seat [8], while elegantly designed, utilizes active load support, severely limiting the maximum weight capacity and excluding the possibility that a similar implementation could be used for adults. Phillips Respironics developed the SleepWave, a non-invasive (clip-on) device to electrically stimulate the vestibular nerve to generate the sensation of motion, which has undergone promising clinical trials but is not yet commercially available [9].
The motivation for a mechatronic bed as a treatment for insomnia is based on the demonstrated link between motion-induced vestibular stimulation and sleep induction. To date, no design has been proposed that is practical to implement or capable of being incorporated into existing beds: cost, necessary dedicated physical space, and convenience represent substantial barriers to acceptance.
Reconstruction of Brachytherapy Catheters and Needles Using EM Sensor-Based Navigation System
Authors: Liang Fan , Traughber Bryan , Musiz Raymond , Ellis Rodney , Podder Tarun K. 
Published: October 2017

Brachytherapy is one the most effective treatment modalities for both gynecological (GYN) cancer and prostate cancer. The clinical outcome of brachytherapy, both high-dose-rate (HDR) and low-dose-rate (LDR), depends on the precision of the desired or planned dose distribution and delivery. In HDR procedure, the accuracy of reconstruction of catheters or needles (e.g. Syed catheter or Simon-Heyman capsule for GYN or needles for prostate) from CT images can significantly affect the accuracy of dose distribution in the treatment (dosimetric) plan, which can result in unwanted clinical outcome. In current practice, an authorized medical physicist manually reconstructs the catheters or needles for dosimetric plan, which determines the position and dwell time for the radiation source for delivering the prescription dose to the target volume sparing organs at risk (OARs) as much as possible. It is not only challenging but also time consuming for reconstructing all the catheters or needles (ranging 15–20) manually, slice-by-slice in CT images. As shown in Fig. 1, the needles on the right (HDR catheters) have created so much artifacts in CT images that it is almost impossible to reconstruct those applicators (catheters/ needles) manually. Additionally, the reconstruction can be operator dependent and can be inaccurate and inconsistent.
In this study, we have investigated the applicability of electromagnetic (EM) sensor-based navigation for fast and accurate reconstruction of HDR catheters and needles.
Identifying risk for type 2 diabetes in different age cohorts: does one size fit all?
Authors: Alva Maria L , Hoerger Thomas J , Zhang Ping , Gregg Edward W 
Published: October 2017

ObjectiveTo estimate age-specific risk equations for type 2 diabetes onset in young, middle-aged, and older US adults, and to compare the performance of simple equations based on readily available demographic information alone, against enhanced equations that require both demographic and clinical information (fasting plasma glucose, high-density lipoprotein, and triglyceride levels).Research design and methodsWe estimated the probability of developing diabetes by age group using data from the Coronary Artery Risk Development in Young Adults (for ages 18–40 years), Atherosclerosis Risk in Communities (for ages 45–64 years), and the Cardiovascular Health Study (for ages 65 years and older). Simple and enhanced equations were estimated using logistic regression models, and performance was compared by age group. Thresholds based on these risk equations were evaluated using split-sample bootstraps and calibrating the constant of one age cohort to others.ResultsSimple risk equations had an area under the receiver-operating curve (AUROC) of 0.72, 0.79, 0.75, and 0.69 for age groups 18–30, 28–40, 45–64, and 65 and older, respectively. The corresponding AUROCs for enhanced equations were 0.75, 0.85, 0.85, and 0.81. Risk equations based on younger populations, when applied to older cohorts, underpredict diabetes incidence and risk. Conversely, risk equations based on older populations overpredict the likelihood of diabetes in younger cohorts.ConclusionsIn general, risk equations are more successful in middle-aged adults than in young and old populations. The results demonstrate the importance of applying age-specific risk equations to identify target populations for intervention. While the predictive capacity of equations that include biomarkers is better than of those based solely on self-reported variables, biomarkers are more important in older populations than in younger ones.
Improving handover between triage and locality wards in a large mental health trust
Authors: Debelle Alice , Dashwood Mark , Bird Louisa , Rao Ranga , Reilly Thomas 
Published: October 2017

BackgroundSouth London and Maudsley NHS Foundation Trust is the largest mental health trust in the UK, serving four boroughs in South East London. In 2014, the ‘triage ward’ system was introduced in three boroughs. Similar to an acute medical admission unit, the triage ward would rapidly assess and treat all new admissions. The patients would either be discharged or admitted to a ‘locality ward’ for further treatment.ProblemThe unforeseen consequences of the ‘triage ward’ system were duplications and omissions of medical tasks on receiving wards, which affected efficiency and quality of care. This was due to a lack of formal medical handover. We aimed to improve efficiency and patient safety by formalising the junior doctor handover between triage and locality wards, ensuring every patient transferred had a documented handover in their electronic notes.MethodWe consulted our colleagues with a survey, ascertaining their views on the current system, the need for a more formalised system and what form that system should take. Using their feedback, we devised a handover template, to be completed for all patients transferred to locality wards. We then rolled the project out to the other two boroughs using the same methodology.ResultsA follow-up survey showed improvement in our baseline results and that the majority of transferred patients were formally handed over. Serious incident data showed a decrease in incident rates pre-intervention and post-intervention. The intervention was sustained a year later. The transfer of the intervention to other sites was problematic.DiscussionThe project showed the lack of handover was a concern shared by colleagues, and they considered our template a useful way of addressing this. The results suggested that the intervention was sustainable despite frequent rotations of staff. The difficulties in transferring an intervention to new sites are discussed.