Implementing a Barcode-Based Whole-Life Cycle Management Process to Improve Robotic Instrument Tracking.

Minimally invasive surgery can involve the use of robotics to improve patient outcomes. Some robotic systems require special instruments with a designated number of uses. In China, during the reprocessing of the robotic instruments, health care personnel determined that the existing tracking processes were inadequate. They conducted a quality improvement project with the goal of establishing a barcode-based standardized process for tracking robotic instruments. They implemented technology that generated a unique identifier each time a robotic instrument was reprocessed after use. Nurses scanned the identifier when surgeons used the instrument. The findings included the increased accuracy of use documentation and decreases in untraceable sterilization and use records, charging concerns, and average daily and monthly inventory times. An increase in adverse event reports associated with robotic instruments also was noted. The use of barcode technology for robotic instrument tracking continues at the facility and may be expanded for additional specialty instruments.

Measuring the performance of an artificial intelligence-based robot that classifies blood tubes and performs quality control in terms of preanalytical errors: A preliminary study.

OBJECTIVES: Artificial intelligence-based robotic systems are increasingly used in medical laboratories. This study aimed to test the performance of KANKA (Labenko), a stand-alone, artificial intelligence-based robot that performs sorting and preanalytical quality control of blood tubes. METHODS: KANKA is designed to perform preanalytical quality control with respect to error control and preanalytical sorting of blood tubes. To detect sorting errors and preanalytical inappropriateness within the routine work of the laboratory, a total of 1000 blood tubes were presented to the KANKA robot in 7 scenarios. These scenarios encompassed various days and runs, with 5 repetitions each, resulting in a total of 5000 instances of sorting and detection of preanalytical errors. As the gold standard, 2 experts working in the same laboratory identified and recorded the correct sorting and preanalytical errors. The success rate of KANKA was calculated for both the accurate tubes and those tubes with inappropriate identification. RESULTS: KANKA achieved an overall accuracy rate of 99.98% and 100% in detecting tubes with preanalytical errors. It was found that KANKA can perform the control and sorting of 311 blood tubes per hour in terms of preanalytical errors. CONCLUSIONS: KANKA categorizes and records problem-free tubes according to laboratory subunits while identifying and classifying tubes with preanalytical inappropriateness into the correct error sections. As a blood acceptance and tube sorting system, KANKA has the potential to save labor and enhance the quality of the preanalytical process.

[Overview of the Development of Spatial Positioning Accuracy Testing Technology for Surgical Robots].

Characteristics of two major categories of RA equipment which defined in the standard are interpreted firstly. Few representative RA equipment in current market and their key product features are introduced. Then, classifications of different indexes of spatial positioning accuracy are declared, the difficulties of performing testing process on each indexes are further explained. Meanwhile, different kinds of three dimensional coordinate measuring equipment that are cutting edge at present stage are introduced with their main methods of use explained. According to characteristics of three dimensional coordinate measuring equipment on the market, proper measuring equipment for testing certain index of spatial positioning accuracy and corresponding experiment method are introduced.

Overview of the Development of Spatial Positioning Accuracy Testing Technology for Surgical Robots / 中国医疗器械杂志

Characteristics of two major categories of RA equipment which defined in the standard are interpreted firstly. Few representative RA equipment in current market and their key product features are introduced. Then, classifications of different indexes of spatial positioning accuracy are declared, the difficulties of performing testing process on each indexes are further explained. Meanwhile, different kinds of three dimensional coordinate measuring equipment that are cutting edge at present stage are introduced with their main methods of use explained. According to characteristics of three dimensional coordinate measuring equipment on the market, proper measuring equipment for testing certain index of spatial positioning accuracy and corresponding experiment method are introduced.

Telerobotic Endovascular Interventions and Their Potential for Cerebrovascular Treatment.

After the introduction of the first robotic-assisted surgical procedures, the technology soon reached the world of endovascular specialists, giving rise to several publications about robotic-assisted endovascular therapy. Compared with conventional procedures, robotic-assisted procedures can be more accurate and reduce radiation exposure. The latest commercially available endovascular robotic system is the CorPath GRX, which can be operated remotely. Robotic-assisted approaches have proved applicable in the fields of coronary and peripheral vascular intervention and neurointervention. Remote intervention has already proved feasible in the coronary and peripheral vascular systems and, according to expert opinion, could revolutionize acute stroke management as well. We review current knowledge about robotic-assisted therapies and remote interventions, and the future prospects and pitfalls.

Mini-review: Robotic wheelchair taxonomy and readiness.

Robotic wheelchair research and development is a growing sector. This article introduces a robotic wheelchair taxonomy, and a readiness model supported by a mini-review. The taxonomy is constructed by power wheelchair and, mobile robot standards, the ICF and, PHAATE models. The mini-review of 2797 articles spanning 7 databases produced 205 articles and 4 review articles that matched inclusion/exclusion criteria. The review and analysis illuminate how innovations in robotic wheelchair research progressed and have been slow to translate into the marketplace.

Bodily ownership of an independent supernumerary limb: an exploratory study.

Can our brain perceive a sense of ownership towards an independent supernumerary limb; one that can be moved independently of any other limb and provides its own independent movement feedback? Following the rubber-hand illusion experiment, a plethora of studies have shown that the human representation of "self" is very plastic. But previous studies have almost exclusively investigated ownership towards "substitute" artificial limbs, which are controlled by the movements of a real limb and/or limbs from which non-visual sensory feedback is provided on an existing limb. Here, to investigate whether the human brain can own an independent artificial limb, we first developed a novel independent robotic "sixth finger." We allowed participants to train using the finger and examined whether it induced changes in the body representation using behavioral as well as cognitive measures. Our results suggest that unlike a substitute artificial limb (like in the rubber hand experiment), it is more difficult for humans to perceive a sense of ownership towards an independent limb. However, ownership does seem possible, as we observed clear tendencies of changes in the body representation that correlated with the cognitive reports of the sense of ownership. Our results provide the first evidence to show that an independent supernumerary limb can be embodied by humans.

Nurses' perspectives of taking care of patients with Coronavirus disease 2019: A phenomenological study.

The pandemic of Coronavirus disease 2019 (COVID-19) has brought significant pressure on nurses globally as they are the frontline of care. This study aimed to explore the experiences and challenges of nurses who worked with hospitalised patients with COVID-19. In this qualitative study, a purposive sample of 14 nurses participated in in-depth telephone interviews. Data were analysed using Colaizzi's phenomenological method. Five key themes emerged: (1) physical and psychological distress of nurses, (2) willingness to work, (3) the essential role of support mechanisms, (4) educational and informational needs of nurses and (5) the role of modern technology in COVID-19 care. Although the provision of care led to physical and psychological distress among nurses, with their commitment and professional obligation, it is a new experience that leads to personal satisfaction. Guilty feeling related to inefficiency of care, witnessing the suffering of patients, discomfort associated with wearing personal protective equipment (PPE), work-related issues (e.g., long hour shifts), negative impact to the family and rejection by others are the leading distress factors. Religious beliefs, including keeping trust in good and bad merits, have become a strong coping mechanism. Addressing distress among nurses is essential. The reported learning needs of nurses included skills related to donning and doffing PPE, skills in performing nursing procedures and breaking bad news. Nurse managers need to pay special attention to expanding training opportunities as well as support mechanisms, for example, welfare, appreciations and counselling services for nurses. Modern technology, particularly robots and telecommunication, can perform an essential role in COVID-19 care. The establishment of timely policies and strategies to protect health workers during a national disaster like COVID-19 is needed.

Quantifying the automated vehicle safety performance: A scoping review of the literature, evaluation of methods, and directions for future research.

Vehicle automation safety must be evaluated not only for market success but also for more informed decision-making about Automated Vehicles' (AVs) deployment and supporting policies and regulations to govern AVs' unintended consequences. This study is designed to identify the AV safety quantification studies, evaluate the quantification approaches used in the literature, and uncover the gaps and challenges in AV safety evaluation. We employed a scoping review methodology to identify the approaches used in the literature to quantify AV safety. After screening and reviewing the literature, six approaches were identified: target crash population, traffic simulation, driving simulator, road test data analysis, system failure risk assessment, and safety effectiveness estimation. We ran two evaluations on the identified approaches. First, we investigated each approach in terms of its input (required data, assumptions, etc.), output (safety evaluation metrics), and application (to estimate AVs' safety implications at the vehicle, transportation system, and society levels). Second, we qualitatively compared them in terms of three criteria: availability of input data, suitability for evaluating different automation levels, and reliability of estimations. This review identifies four challenges in AV safety evaluation: (a) shortcomings in AV safety evaluation approaches, (b) uncertainties in AV implementations and their impacts on AV safety, (c) potential riskier behavior of AV passengers as well as other road users, and (d) emerging safety issues related to AV implementations. This review is expected to help researchers and rulemakers to choose the most appropriate quantification method based on their goals and study limitations. Future research is required to address the identified challenges in AV safety evaluation.

Integration of automated vehicles in mixed traffic: Evaluating changes in performance of following human-driven vehicles.

The introduction of Automated Vehicles (AVs) into the transportation network is expected to improve system performance, but the impacts of AVs in mixed traffic streams have not been clearly studied. As AV's market penetration increases, the interactions between conventional vehicles and AVs are inevitable but by no means clear. This study aims to create new knowledge by quantifying the behavioral changes caused when conventional human-driven vehicles follow AVs and investigating the impact of these changes (if any) on safety and the environment. This study analyzes data obtained from a field experiment by Texas A&M University to evaluate the effects of AVs on the behavior of a following human-driver. The dataset is comprised of nine drivers that attempted to follow 5 speed-profiles, with two scenarios per profile. In scenario one, a human-driven vehicle follows an AV that implements a human driver speed profile (base). In scenario two, the human-driven vehicle follows an AV that executes an AV speed profile. In order to evaluate safety, these scenarios are compared using time-to-collision (TTC) and several other driving volatility measures. Likewise, fuel consumption and emissions are used to investigate environmental impacts. Overall, the results show that AVs in mixed traffic streams can induce behavioral changes in conventional vehicle drivers, with some beneficial effects on safety and the environment. On average, a driver that follows an AV exhibits lower driving volatility in terms of speed and acceleration, which represents more stable traffic flow behavior and lower crash risk. The analysis showed a remarkable improvement in TTC as a result of the notably better speed adjustments of the following vehicle (i.e., lower differences in speeds between the lead and following vehicles) in the second scenario. Furthermore, human-driven vehicles were found to consume less fuel and produce fewer emissions on average when following an AV.

Reliability of robotic transcranial magnetic stimulation motor mapping.

Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps using neuronavigational and neuroanatomical images. Motor maps are individualized representations of the primary motor cortex (M1) topography that may reflect developmental and interventional plasticity. Results of TMS motor map reliability testing have been variable, and robotic measures are undefined. We aimed to determine the short- and long-term reliability of robotic TMS motor maps. Twenty healthy participants underwent motor mapping at baseline, 24 h, and 4 wk. A 12 × 12 grid (7-mm spacing) was placed over the left M1, centered over the hand knob area. Four suprathreshold stimulations were delivered at each grid point. First dorsal interosseous (FDI) motor-evoked potentials (MEPs) were analyzed offline to generate map characteristics of area, volume, center of gravity (COG), and hotspot magnitude. Subsets of each outcome corresponding to 75%, 50%, and 25% of each map were determined. Reliability measures including intraclass correlation coefficient (ICC), minimal detectable change (MDC), and standard error of measure (SEM) were calculated. Map volume, COG, and hotspot magnitude were the most reliable measures (good-to-excellent) over both short- and long-term sessions. Map area reliability was poor-to-moderate for short- and long-term sessions. Smaller map percentile subsets showed decreased variability but only minimal improvements in reliability. MDC for most outcomes was >50%. Procedures were well tolerated with no serious adverse events. Robotic TMS motor mapping is relatively reliable over time, but careful consideration of specific outcomes is required for this method to interrogate plasticity in the human motor system.NEW & NOTEWORTHY Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps-individualized representations of the primary motor cortex (M1) topography-that may reflect developmental and interventional plasticity. This study is the first to evaluate short- and long-term relative and absolute reliability of TMS mapping outcomes at various M1 excitability levels using novel robotic neuronavigated TMS.

Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking.

Background and Objectives: Dropped head syndrome (DHS) is characterized by apparent neck extensor muscle weakness and difficulty in extending the neck to raise the head against gravity. DHS affects forward vision and eating behavior, and hence impairs quality of life. However, standardized treatment of DHS has not yet been established. The purpose of this preliminary study is to seek for a possibility of effective non-surgical, conservative treatment for DHS, by applying a robotic treatment. Materials and Methods: A wearable exoskeleton type robot suit hybrid assistive limb (HAL) was applied to three patients with DHS. A course of HAL treatment included 10 sessions of gait training using HAL. One session lasted about an hour. Case 1 completed the course twice, the first time in two weeks (one session per day) and second time in 10 months (one session per month). Case 2 and Case 3 completed the course once in 10 weeks (one session per week) and in 6 months (one session per 2.5 weeks), respectively. Immediate and lasting effects of HAL on the reduction of cervical sagittal vertical alignment (SVA) during gait was evaluated using a motion capture system. Results: Case 1 showed improvement of cervical alignment during gait after the HAL courses of both different frequencies. Case 2 did not show improvement of cervical alignment during gait. Case 3 showed improvement of cervical kyphosis but not of cervical sagittal alignment during gait. Conclusions: The results of the preliminary study suggest that gait training using HAL may be an effective option of conservative treatment for a part of DHS patients. They also suggest that a lack of immediate effects on the cervical alignment and a lack of ability to perform compensatory trunk motion may indicate a non-responding patient. Generalization of the results requires further research with more cases.

Microbiological validation of a robot for the sterile compounding of injectable non-hazardous medications in a hospital environment.

Objectives: To design and execute a comprehensive microbiological validation protocol to assess a brand-new sterile compounding robot in a hospital pharmacy environment, according to ISO and EU GMP standards. Methods: Qualification of the Class-A inner environment of the robot was performed through microbial air and surface quality assessment utilising contact plates, swabs and particulate matter monitoring. To evaluate the effectiveness of the microbial decontamination process (UV rays) challenge test against Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis spores and Candida albicans was used. The challenge Media Fill test was used to validate the aseptic processing. Results: After 3 hours, no microorganisms retained viability. Monitoring inside the equipment evidenced complete absence of microorganisms. The Media Fill test was always negative. Conclusions: According to our results, the APOTECAunit meets the requirements for advanced aseptic processing in the hospital pharmacies and the pharmaceutical industry in general, providing advantages in terms of safety for patients compared with conventional procedures of parenteral preparation production. The protocol has demonstrated to be a comprehensive and valuable tool in validating, from a microbial point of view, a sterile-compounding technology. This study might represent an important benchmark in developing a contamination control strategy, as required, for example, in the Performance Qualification of the GMP in the case of drug manufacturing.

Design and Realization of an Efficient Large-Area Event-Driven E-Skin.

The sense of touch enables us to safely interact and control our contacts with our surroundings. Many technical systems and applications could profit from a similar type of sense. Yet, despite the emergence of e-skin systems covering more extensive areas, large-area realizations of e-skin effectively boosting applications are still rare. Recent advancements have improved the deployability and robustness of e-skin systems laying the basis for their scalability. However, the upscaling of e-skin systems introduces yet another challenge-the challenge of handling a large amount of heterogeneous tactile information with complex spatial relations between sensing points. We targeted this challenge and proposed an event-driven approach for large-area skin systems. While our previous works focused on the implementation and the experimental validation of the approach, this work now provides the consolidated foundations for realizing, designing, and understanding large-area event-driven e-skin systems for effective applications. This work homogenizes the different perspectives on event-driven systems and assesses the applicability of existing event-driven implementations in large-area skin systems. Additionally, we provide novel guidelines for tuning the novelty-threshold of event generators. Overall, this work develops a systematic approach towards realizing a flexible event-driven information handling system on standard computer systems for large-scale e-skin with detailed descriptions on the effective design of event generators and decoders. All designs and guidelines are validated by outlining their impacts on our implementations, and by consolidating various experimental results. The resulting system design for e-skin systems is scalable, efficient, flexible, and capable of handling large amounts of information without customized hardware. The system provides the feasibility of complex large-area tactile applications, for instance in robotics.

Ethical Issues Raised by the Introduction of Artificial Companions to Older Adults with Cognitive Impairment: A Call for Interdisciplinary Collaborations.

Due to the high costs of providing long-term care to older adults with cognitive impairment, artificial companions are increasingly considered as a cost-efficient way to provide support. Artificial companions can comfort, entertain, and inform, and even induce a sense of being in a close relationship. Sensors and algorithms are increasingly leading to applications that exude a life-like feel. We focus on a case study of an artificial companion for people with cognitive impairment. This companion is an avatar on an electronic tablet that is displayed as a dog or a cat. Whereas artificial intelligence guides most artificial companions, this application also relies on technicians "behind" the on-screen avatar, who via surveillance, interact with users. This case is notable because it particularly illustrates the tension between the endless opportunities offered by technology and the ethical issues stemming from limited regulations. Reviewing the case through the lens of biomedical ethics, concerns of deception, monitoring and tracking, as well as informed consent and social isolation are raised by the introduction of this technology to users with cognitive impairment. We provide a detailed description of the case, review the main ethical issues and present two theoretical frameworks, the "human-driven technology" platform and the emancipatory gerontology framework, to inform the design of future applications.

Measuring the impact of age, gender and dementia on communication-robot interventions in residential care homes.

AIM: The primary aim of this study was to examine the impact of age, gender and the stage of dementia on the results of an assistive technology intervention that make use of communication robots (com-robots). The intervention was designed to improve the social participation and interactions of nursing home residents. While our previous study showed that the overall effects of com-robot intervention were positive, it was unknown what impact age, gender and the stage of dementia of participants had on such an intervention. METHODS: This was a non-randomized, multicenter quasi-experimental intervention study conducted in residential care homes in Japan. Two types of com-robots were introduced for 8 weeks after baseline evaluation. The World Health Organization's ICF was used for evaluating any changes present after the 8-week intervention. In total, 78 residents (68 women, 10 men, 86.5 ± 7.7 years old) participated in the study. The Degree of Daily Life Independence Score for People with Dementia (DDLIS-PD) was employed for measuring the stage of dementia. RESULTS: The results showed that the older participants aged ≥80 benefited more from the intervention than the younger cohort did (P < 0.05). A greater improvement was shown among those with a more advanced stage of dementia than those at a less advanced stage (P < 0.05), when using DDLIS-PD. CONCLUSIONS: The overall findings support the use of com-robots within the context of a care team for older people with moderate dementia, and those who are aged ≥80 years. Geriatr Gerontol Int 2020; 20: 373-378.