Hand-held robotic device for laparoscopic surgery and training

Laparoscopic surgery (LS) has revolutionized traditional surgical techniques introducing minimally invasive procedures for diagnosis and local therapies. LSs have undeniable advantages, such as small patient incisions, reduced postoperative pain and faster recovery. On the other hand, restricted vision of the anatomical target, difficult handling of the surgical instruments, restricted mobility inside the human body, need of dexterity to hand-eye coordination and inadequate and non-ergonomic surgical instruments may restrict LS only to more specialized surgeons. To overcome the referred limitations, this work presents a new robotic surgical handheld system – the EndoRobot. The EndoRobot was designed to be used in clinical practice or even as a surgical simulator. It integrates an electromechanical system with 3 degrees of freedom. Each degree can be manipulated independently and combined with different levels of sensitivity allowing fast and slow movements. As other features, the EndoRobot has battery power or external power supply, enables the use of bipolar radiofrequency to prevent bleeding while cutting and allows plug-and-play of the laparoscopic forceps for rapid exchange. As a surgical simulator, the system was also instrumented to measure and transmit, in real time, its position and orientation for a training software able to monitor and assist the trainee’s surgical movements.

Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

Validation of percutaneous puncture trajectory during renal access using 4D ultrasound reconstruction

Background: An accurate percutaneous puncture is essential for disintegration and removal of renal stones. Although this procedure has proven to be safe, some organs surrounding the renal target might be accidentally perforated. This work describes a new intraoperative framework where tracked surgical tools are superimposed within 4D ultrasound imaging for security assessment of the percutaneous puncture trajectory (PPT). Methods: A PPT is first generated from the skin puncture site towards an anatomical target, using the information retrieved by electromagnetic motion tracking sensors coupled to surgical tools. Then, 2D ultrasound images acquired with a tracked probe are used to reconstruct a 4D ultrasound around the PPT under GPU processing. Volume hole-filling was performed in different processing time intervals by a tri-linear interpolation method. At spaced time intervals, the volume of the anatomical structures was segmented to ascertain if any vital structure is in between PPT and might compromise the surgical success. To enhance the volume visualization of the reconstructed structures, different render transfer functions were used. Results: Real-time US volume reconstruction and rendering with more than 25 frames/s was only possible when rendering only three orthogonal slice views. When using the whole reconstructed volume one achieved 8-15 frames/s. 3 frames/s were reached when one introduce the segmentation and detection if some structure intersected the PPT. Conclusions: The proposed framework creates a virtual and intuitive platform that can be used to identify and validate a PPT to safely and accurately perform the puncture in percutaneous nephrolithotomy.

IOPT Petri Net State Space Generation Algorithm with Maximal-Step Execution Semantics

This paper presents an algorithm to efficiently generate the state-space of systems specified using the IOPT Petri-net modeling formalism. IOPT nets are a non-autonomous Petri-net class, based on Place-Transition nets with an extended set of features designed to allow the rapid prototyping and synthesis of system controllers through an existing hardware-software co-design framework. To obtain coherent and deterministic operation, IOPT nets use a maximal-step execution semantics where, in a single execution step, all enabled transitions will fire simultaneously. This fact increases the resulting state-space complexity and can cause an arc "explosion" effect. Real-world applications, with several million states, will reach a higher order of magnitude number of arcs, leading to the need for high performance state-space generator algorithms. The proposed algorithm applies a compilation approach to read a PNML file containing one IOPT model and automatically generate an optimized C program to calculate the corresponding state-space.

Oral health in the family health strategy: a change of practices or semantics diversionism

OBJECTIVE:To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

Yellow fever in Brazil: thoughts and hypotheses on the emergence in previously free areas

This article describes and discusses factors associated to the reemergence of yellow fever and its transmission dynamics in the states of São Paulo (Southeastern Brazil) and Rio Grande do Sul (Southern) during 2008 and 2009. The following factors have played a pivotal role for the reemergence of yellow fever in these areas: large susceptible human population; high prevalence of vectors and primary hosts (non-human primates); favorable climate conditions, especially increased rainfall; emergence of a new genetic lineage; and circulation of people and/or monkeys infected by virus. There is a need for an effective surveillance program to prevent the reemergence of yellow fever in other Brazilian states.

Professions and inter-disciplinary teamwork in socially embedded bureaucracies: Synthesis and hypotheses on the impact of informal and formal organization

In order to maximize their productivity, inter-disciplinary multi-occupation teams of professionals need to maximize inter-occupational cooperation in team decision making. Cooperation, however, is challenged by status anxiety over organizational careers and identity politics among team members who differ by ethnicity-race, gender, religion, nativity, citizenship status, etc. The purpose of this paper is to develop hypotheses about how informal and formal features of bureaucracy influence the level of inter-occupation cooperation achieved by socially diverse, multi-occupation work teams of professionals in bureaucratic work organizations. The 18 hypotheses, which are developed with the heuristic empirical case of National Science Foundation-sponsored university school partnerships in math and science curriculum innovation in the United States, culminate in the argument that cooperation can be realized as a synthesis of tensions between informal and formal features of bureaucracy in the form of participatory, high performance work systems.

Shear strength of adhesively bonded polyolefins with minimal surface preparation

Interest in polyethylene and polypropylene bonding has increased in the last years. However, adhesive joints with adherends which are of low surface energy and which are chemically inert present several difficulties. Generally, their high degree of chemical resistance to solvents and dissimilar solubility parameters limit the usefulness of solvent bonding as a viable assembly technique. One successful approach to adhesive bonding of these materials involves proper selection of surface pre-treatment prior to bonding. With the correct pre-treatment it is possible to glue these materials with one or more of several adhesives required by the applications involved. A second approach is the use of adhesives without surface pre-treatment, such as hot melts, high tack pressure-sensitive adhesives, solvent-based specialty adhesives and, more recently, structural acrylic adhesives as such 3M DP-8005® and Loctite 3030®. In this paper, the shear strengths of two acrylic adhesives were evaluated using the lap shear test method ASTM D3163 and the block shear test method ASTM D4501. Two different industrial polyolefins (polyethylene and polypropylene) were used for adherends. However, the focus of this study was to measure the shear strength of polyethylene joints with acrylic adhesives. The effect of abrasion was also studied. Some test specimens were manually abraded using 180 and 320 grade abrasive paper. An additional goal of this work was to examine the effect of temperature and moisture on mechanical strength of adhesive joints.

Minimal anomaly-free chiral fermion sets and gauce coupling unification

We look for minimal chiral sets of fermions beyond the standard model that are anomaly free and, simultaneously, vectorlike particles with respect to color SU(3) and electromagnetic U(1). We then study whether the addition of such particles to the standard model particle content allows for the unification of gauge couplings at a high energy scale, above 5.0 x 10(15) GeV so as to be safely consistent with proton decay bounds. The possibility to have unification at the string scale is also considered. Inspired in grand unified theories, we also search for minimal chiral fermion sets that belong to SU(5) multiplets, restricted to representations up to dimension 50. It is shown that, in various cases, it is possible to achieve gauge unification provided that some of the extra fermions decouple at relatively high intermediate scales.

Negative non-ground queries in well founded semantics

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Computational Logic

Minimal Criteria for the Diagnosis of Avulsion of the Puborectalis Muscle by Tomographic Ultrasound

Introduction and hypothesis Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse(FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. Methods We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle. Results Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma (‘partial avulsion’) were not associated with symptoms or signs of pelvic floor dysfunction. Conclusions Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.

A score test for non-nested hypotheses with applications to discrete data models

This paper suggests that a convenient score test against non-nested alternatives can be constructed from the linear combination of the likelihood functions of the competing models. It is shown that this procedure is essentially a test for the correct specification of the conditional distribution of the variable of interest.

Repairs of databases with null values

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Revision based total semantics for extended normal logic programs

Dissertação para obtenção do Grau de Doutor em Matemática - Lógica e Fundamentos da Matemática

Efficient paraconsistent reasoning with rules and ontologies for the semantic web

Ontologies formalized by means of Description Logics (DLs) and rules in the form of Logic Programs (LPs) are two prominent formalisms in the field of Knowledge Representation and Reasoning. While DLs adhere to the OpenWorld Assumption and are suited for taxonomic reasoning, LPs implement reasoning under the Closed World Assumption, so that default knowledge can be expressed. However, for many applications it is useful to have a means that allows reasoning over an open domain and expressing rules with exceptions at the same time. Hybrid MKNF knowledge bases make such a means available by formalizing DLs and LPs in a common logic, the Logic of Minimal Knowledge and Negation as Failure (MKNF). Since rules and ontologies are used in open environments such as the Semantic Web, inconsistencies cannot always be avoided. This poses a problem due to the Principle of Explosion, which holds in classical logics. Paraconsistent Logics offer a solution to this issue by assigning meaningful models even to contradictory sets of formulas. Consequently, paraconsistent semantics for DLs and LPs have been investigated intensively. Our goal is to apply the paraconsistent approach to the combination of DLs and LPs in hybrid MKNF knowledge bases. In this thesis, a new six-valued semantics for hybrid MKNF knowledge bases is introduced, extending the three-valued approach by Knorr et al., which is based on the wellfounded semantics for logic programs. Additionally, a procedural way of computing paraconsistent well-founded models for hybrid MKNF knowledge bases by means of an alternating fixpoint construction is presented and it is proven that the algorithm is sound and complete w.r.t. the model-theoretic characterization of the semantics. Moreover, it is shown that the new semantics is faithful w.r.t. well-studied paraconsistent semantics for DLs and LPs, respectively, and maintains the efficiency of the approach it extends.