Area-Coverage Planning for Spray-based Surface Disinfection with a Mobile Manipulator.

The use of robots has significantly increased to fight highly contagious diseases like SARS-COV-2, Ebola, MERS, and others. One of the important applications of robots to fight such infectious diseases is disinfection. Manual disinfection can be a time-consuming, risky, labor-intensive, and mundane, and humans may fail to disinfect critical areas due to the resulting fatigue. Autonomous or semi-autonomous mobile manipulators mounted with a spray nozzle at the end-effector can be very effective in spraying disinfectant liquid for deep disinfection of objects and surfaces. In this paper, we present an area-coverage planning algorithm to compute a path that the nozzle follows to disinfect surfaces represented by their point clouds. We project the point cloud on a plane and produce a polygon on which we generate multiple spray paths using our branch and bound-based tree search area-coverage algorithm such that the spray paths cover the entire area of the polygon. An appropriate spray path is chosen using a robot capability map-based selection criterion. We generate mobile manipulator trajectories using successive refinement-based parametric optimization so that the paths for the nozzle are followed accurately. Thereafter, we need to make sure that the joint velocities of the mobile manipulator are regulated appropriately such that each point on the surface receives enough disinfectant spray. To this end, we compute the time intervals between the robot path waypoints such that enough disinfectant liquid is sprayed on all points of the point cloud that results in thorough disinfection of the surface, and the particular robot path is executed in the minimum possible time. We have implemented the area-coverage planning and mobile manipulator motion planning on five test scenarios in simulation using our ADAMMS-SD (Agile Dexterous Autonomous Mobile Manipulation System for Surface Disinfection) robot. We benchmark our spray path generation algorithm with three competing methods by showing that the generated paths are significantly more efficient in terms of area coverage and reducing disinfectant wastage. We also show the time interval computation between successive waypoints results in thorough disinfection of surfaces.

Patient satisfaction and resident postgraduate year status.

PURPOSE: Patient satisfaction has been recognized as an important variable affecting healthcare behavior. However, there are limited data on the relationship between doctor post-graduate year (PGY) status and patient satisfaction with provider interpersonal skills and humanistic qualities. The authors aims to assess this relationship using an American Board of Internal Medicine (ABIM) questionnaire. DESIGN/METHODOLOGY/APPROACH: Participants were: patients attending a primary care clinic at a large urban academic hospital; and physicians treating them. The survey questionnaire was the ABIM patient satisfaction instrument; ten questions pertaining to humanistic qualities and communication skills with responses from poor to excellent. Mann Whitney U test and multi-variable logistic regression analyses were used to explore score differences by PGY level. FINDINGS: The postgraduate year one (PGY1) had higher patient-satisfaction levels compared to PGY2/PGY3 residents. The PGY1 level residents were more likely to score in the 90th percentile and this remained constant even after adjusting for confounders. RESEARCH LIMITATIONS/IMPLICATIONS: The research was a single-center study and may have been subject to confounding factors such as patient personality types and a survey ceiling effect. The survey's cross-sectional nature may also be a potential limitation. Practical implications - Patient satisfaction varies significantly with PGY status. Though clinical skills may improve with increasing experience, findings imply that interpersonal and humanistic qualities may deteriorate. ORIGINALITY/VALUE: The study is the first to assess patient satisfaction with PGY status and provides evidence that advanced trainees may need support to keep their communication skills and humanistic qualities from deteriorating as stressors increase to ensure optimal patient satisfaction.

The association of the Friesinger score and pulse pressure in an urban South Asian patient population: pulse pressure, an independent predictor of coronary artery disease.

Increase in pulse pressure has been shown to be predisposing factor for Coronary Artery Disease (CAD) in diverse patient populations but its relationship with the severity of CAD, particularly in the South Asians immigrant population of United States has not been demonstrated. We performed a single-center, cross-sectional study. Pulse pressure was calculated by the difference between the systolic and diastolic brachial blood pressures, and the Friesinger score (FS) was used to quantify the severity of CAD with the score of 5 used as a cutoff for extensive disease. We also sought to assess the correlation between the Friesinger score and the 10-year cardiovascular event (CVD) risk as calculated by the Framingham score. Odds ratios and 95% confidence intervals for the associations between explanatory variables and a high Friesinger score were estimated using multivariate logistic regression models. P values below .05 were considered to be statistically significant. Statistical analysis was performed using STATA version 10 software package (College Station, TX). The mean pulse pressure was significantly higher in participants with an FS of > or =5 compared with participants with an FS of <5 (63 vs. 46 mm Hg; P = .004). In univariate analysis, a pulse pressure > or =40 mm Hg was associated with a five-fold increased odds of a higher FS compared with a pulse pressure <40 mm Hg (P = .039), which was unchanged in multivariate analysis. In multivariate analysis, even after adjustment for presence of hypertension, a 10 mm Hg increase in pulse pressure was associated with a 1.97-fold increased odds of a higher FS (95% CI 1.22-3.71, P = .009). The mean Framingham score was higher in participants with a higher FS, but this difference was not significant (32.7 vs. 20.3; P = .1139). Our study demonstrates that pulse pressure, a well-established marker of vascular health, is a significant independent predictor of the severity of CAD as assessed by coronary angiography in South Asians.