Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon

OBJECTIVE center dot To evaluate early trifecta outcomes after robotic-assisted radical prostatectomy (RARP) performed by a high-volume surgeon. PATIENTS AND METHODS center dot We evaluated prospectively 1100 consecutive patients who underwent RARP performed by one surgeon. In all, 541 men were considered potent before RARP; of these 404 underwent bilateral full nerve sparing and were included in this analysis. center dot Baseline and postoperative urinary and sexual functions were assessed using self-administered validated questionnaires. center dot Postoperative continence was defined as the use of no pads; potency was defined as the ability to achieve and maintain satisfactory erections for sexual intercourse > 50% of times, with or without the use of oral phosphodiesterase type 5 inhibitors; Biochemical recurrence (BCR) was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. center dot Results were compared between three age groups: Group 1, < 55 years, Group 2, 56-65 years and Group 3, > 65 years. RESULTS center dot The trifecta rates at 6 weeks, 3, 6, 12, and 18 months after RARP were 42.8%, 65.3%, 80.3%, 86% and 91%, respectively. center dot There were no statistically significant differences in the continence and BCR-free rates between the three age groups at all postoperative intervals analysed. center dot Nevertheless, younger men had higher potency rates and shorter time to recovery of sexual function when compared with older men at 6 weeks, 3, 6 and 12 months after RARP (P < 0.01 at all time points). center dot Similarly, younger men also had a shorter time to achieving the trifecta and had higher trifecta rates at 6 weeks, 3 and 6 months after RARP compared with older men (P < 0.01 at all time points). CONCLUSION center dot RARP offers excellent short-term trifecta outcomes when performed by an experienced surgeon. center dot Younger men had a shorter time to achieving the trifecta and higher overall trifecta rates when compared with older men at 6 weeks, 3 and 6 months after RARP.

Early Complication Rates in a Single-Surgeon Series of 2500 Robotic-Assisted Radical Prostatectomies: Report Applying a Standardized Grading System

Background: Perioperative complications following robotic-assisted radical prostatectomy (RARP) have been previously reported in recent series. Few studies, however, have used standardized systems to classify surgical complications, and that inconsistency has hampered accurate comparisons between different series or surgical approaches. Objective: To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients. Design, setting, and participants: We analyzed 2500 patients who underwent RARP for treatment of clinically localized prostate cancer (PCa) from August 2002 to February 2009. Data were prospectively collected in a customized database and retrospectively analyzed. Intervention: All patients underwent RARP performed by a single surgeon. Measurements: The data were collected prospectively in a customized database. Complications were classified using the Clavien grading system. To evaluate trends regarding complications and radiologic anastomotic leaks, we compared eight groups of 300 patients each, categorized according the surgeon`s experience (number of cases). Results and limitations: Our median operative time was 90 min (interquartile range [IQR]: 75-100 min). The median estimated blood loss was 100 ml (IQR: 100-150 ml). Our conversion rate was 0.08%, comprising two procedures converted to standard laparoscopy due to robot malfunction. One hundred and forty complications were observed in 127 patients (5.08%). The following percentages of patients presented graded complications: grade 1, 2.24%; grade 2, 1.8%; grade 3a, 0.08%; grade 3b, 0.48%; grade 4a, 0.40%. There were no cases of multiple organ dysfunction or death (grades 4b and 5). There were significant decreases in the overall complication rates (p = 0.0034) and in the number of anastomotic leaks (p < 0.001) as the surgeon`s experience increased. Conclusions: RARP is a safe option for treatment of clinically localized PCa, presenting low complication rates in experienced hands. Although the robotic system provides the surgeon with enhanced vision and dexterity, proficiency is only accomplished with consistent surgical volume; complication rates demonstrated a tendency to decrease as the surgeon`s experience increased. (C) 2010 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Robotic Surgery: History and Teaching Impact

Context: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. Summary of evidence: Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. Conclusions: Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Assessing the Use of Flexible Assessment

A course which has a large student enrolment consequently puts a heavy load on instructors both in the presentation and the assessment areas. In the School of Economics at the University of Queensland, this is the case for the quantitative analysis subjects. Assessment for many years has been through mid-semester and end of semester exams, as well as Computer Managed Learning (CML) assignments. In 2000 it was decided to incorporate a system of flexible assessment where neither the CML nor the mid-semester exam was compulsory. The outcomes are assessed and the advantages and disadvantages discussed.

A flexible method for rapid force computation in elliptical magnets

The design of open-access elliptical cross-section magnet systems has recently come under consideration. Obtaining values for the forces generated within these unusual magnets is important to progress the designs towards feasible instruments. This paper presents a novel and flexible method for the rapid computation of forces within elliptical magnets. The method is demonstrated by the analysis of a clinical magnetic resonance imaging magnet of elliptical cross-section and open design. The analysis reveals the non-symmetric nature of the generated Maxwell forces, which are an important consideration, particularly in the design of superconducting systems.

Using workflow technology to manage flexible e-learning services

Workflow technology provides a suitable platform to define and manage the coordination of business process activities. We introduce a flexible e-learning environment – called Flex-eL – that has been built upon workflow technology. The workflow functionality of Flex-eL manages the coordination of learning and assessment activities of the course process between students and teaching staff. It provides a unique environment for teachers to design and develop process-centric courses and to monitor student progress. It allows students to learn at their own pace while observing the learning guidelines and checkpoints modeled into the course process by teaching staff. We also report on the successful deployment of the concept and system for university courses and our experiences from the implementation.

Rates of electronic energy transfer in conformationally flexible bichromophoric macrocyclic complexes: a combined experimental and molecular modeling study

Electronic energy transfer (EET) rate constants between a naphthalene donor and anthracene acceptor in [ZnL4a](ClO4)(2) and [ZnL4b](ClO4)(2) were determined by time-resolved fluorescence where L-4a and L-4b are the trans and cis isomers of 6-((anthracen-9-yl-methyl)amino)-6,13-dimethyl-13-((naphthalen-1-yl-methyl)amino)-1,4,8,11-tetraazacyclotetradecane, respectively. These isomers differ in the relative disposition of the appended chromophores with respect to the macrocyclic plane. The trans isomer has an energy transfer rate constant (k(EET)) of 8.7 x 10(8) s(-1), whereas that of the cis isomer is significantly faster (2.3 x 10(9) s(-1)). Molecular modeling was used to determine the likely distribution of conformations in CH3CN solution for these complexes in an attempt to identify any distance or orientation dependency that may account for the differing rate constants observed. The calculated conformational distributions together with analysis by H-1 NMR for the [ZnL4a](2+) trans complex in the common trans-III N-based isomer gave a calculated Forster rate constant close to that observed experimentally. For the [ZnL4b](2+) cis complex, the experimentally determined rate constant may be attributed to a combination of trans-Ill and trans-I N-based isomeric forms of the complex in solution.

Conception of a flexible integrator and lean model for integrated management systems

Management systems standards (MSSs) have developed in an unprecedented manner in the last few years. These MSS cover a wide array of different disciplines, aims and activities of organisations. Also, organisations are populated with an enormous diversity of independent management systems (MSs). An integrated management system (IMS) tends to integrate some or all components of the business. Maximising their integration in one coherent and efficient MS is increasingly a strategic priority and constitutes an opportunity for businesses to be more competitive and consequently, promote its sustainable success. Those organisations that are quicker and more efficient in their integration and continuous improvement will have a competitive advantage in obtaining sustainable value in our global and competitive business world. Several scholars have proposed various theoretical approaches regarding the integration of management sub-systems, leading to the conclusion that there is no common practice for all organisations as they encompass different characteristics. One other author shows that several tangible and intangible gains for organisations, as well as to their internal and external stakeholders, are achieved with the integration of the individual standardised MSs. The purpose of this work was to conceive a model, Flexible, Integrator and Lean for IMSs, according to ISO 9001 for quality; ISO 14001 for environment and OHSAS 18001 for occupational health and safety (IMS–QES), that can be adapted and progressively assimilate other MSs, such as, SA 8000/ISO 26000 for social accountability, ISO 31000 for risk management and ISO/IEC 27001 for information security management, among others. The IMS–QES model was designed in the real environment of an industrial Portuguese small and medium enterprise, that over the years has been adopting, gradually, in whole or in part, individual MSSs. The developed model is based on a preliminary investigation conducted through a questionnaire. The strategy and research methods have taken into consideration the case study. Among the main findings of the survey we highlight: the creation of added value for the business through the elimination of several organisational wastes; the integrated management of the sustainability components; the elimination of conflicts between independent MS; dialogue with the main stakeholders and commitment to their ongoing satisfaction and increased contribution to the company’s competitiveness; and greater valorisation and motivation of employees as a result of the expansion of their skill base, actions and responsibilities, with their consequent empowerment. A set of key performance indicators (KPIs) constitute the support, in a perspective of business excellence, to the follow up of the organisation’s progress towards the vision and achievement of the defined objectives in the context of each component of the IMS model. The conceived model had many phases and the one presented in this work is the last required for the integration of quality, environment, safety and others individual standardised MSs. Globally, the investigation results, by themselves, justified and prioritised the conception of an IMS–QES model, to be implemented at the company where the investigation was conducted, but also a generic model of an IMS, which may be more flexible, integrator and lean as possible, potentiating the efficiency, added value both in the present and, fundamentally, for future.

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.

Assessment of Laparoscopic Skills Performance: 2D Versus 3D Vision and Classic Instrument Versus New Hand-Held Robotic Device for Laparoscopy

Introduction and Objectives. Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons’ performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Materials and Methods. Each participant performed 3 laparoscopic tasks—Peg transfer, Wire chaser, Knot—in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Results. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks (P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands (P < .05). Conclusion. The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures.

A flexible side information generation framework for distributed video coding

One of the most efficient approaches to generate the side information (SI) in distributed video codecs is through motion compensated frame interpolation where the current frame is estimated based on past and future reference frames. However, this approach leads to significant spatial and temporal variations in the correlation noise between the source at the encoder and the SI at the decoder. In such scenario, it would be useful to design an architecture where the SI can be more robustly generated at the block level, avoiding the creation of SI frame regions with lower correlation, largely responsible for some coding efficiency losses. In this paper, a flexible framework to generate SI at the block level in two modes is presented: while the first mode corresponds to a motion compensated interpolation (MCI) technique, the second mode corresponds to a motion compensated quality enhancement (MCQE) technique where a low quality Intra block sent by the encoder is used to generate the SI by doing motion estimation with the help of the reference frames. The novel MCQE mode can be overall advantageous from the rate-distortion point of view, even if some rate has to be invested in the low quality Intra coding blocks, for blocks where the MCI produces SI with lower correlation. The overall solution is evaluated in terms of RD performance with improvements up to 2 dB, especially for high motion video sequences and long Group of Pictures (GOP) sizes.

A Flexible Architecture for the Computation of Direct and Inverse Transforms in H.264/AVC Video Codecs

A new high throughput and scalable architecture for unified transform coding in H.264/AVC is proposed in this paper. Such flexible structure is capable of computing all the 4x4 and 2x2 transforms for Ultra High Definition Video (UHDV) applications (4320x7680@ 30fps) in real-time and with low hardware cost. These significantly high performance levels were proven with the implementation of several different configurations of the proposed structure using both FPGA and ASIC 90 nm technologies. In addition, such experimental evaluation also demonstrated the high area efficiency of theproposed architecture, which in terms of Data Throughput per Unit of Area (DTUA) is at least 1.5 times more efficient than its more prominent related designs(1).

Health and psychosocial effects of flexible working hours

OBJECTIVE: To examine whether any impairments in health and social lives can be found under different kinds of flexible working hours, and whether such effects are related to specific characteristics of these working hours. METHODS: Two studies - a company based survey (N=660) and an internet survey (N=528) - have been conducted. The first one was a questionnaire study (paper and pencil) on employees working under some 'typical' kinds of different flexible working time arrangements in different companies and different occupational fields (health care, manufacturing, retail, administration, call centres). The second study was an internet-based survey, using an adaptation of the questionnaire from the first study. RESULTS: The results of both studies consistently show that high variability of working hours is associated with increased impairments in health and well-being and this is especially true if this variability is company controlled. These effects are less pronounced if variability is self-controlled; however, autonomy does not compensate the effects of variability. CONCLUSIONS: Recommendations for an appropriate design of flexible working hours should be developed in order to minimize any impairing effects on health and psychosocial well-being; these recommendations should include - besides allowing for discretion in controlling one's (flexible) working hours - that variability in flexible working hours should be kept low (or at least moderate), even if this variability is self-controlled.

Desenvolvimento do sistema de controlo de um braço robotizado e respetiva interface com o utilizador

A robótica tem evoluído de forma significativa nos últimos anos e passa a ser indispensável em várias aplicações nas áreas da engenharia, aeronáutica, medicina, entre outras. O estado da arte do presente trabalho está dividido em duas partes, uma que aborda vários aspetos relacionados com a robótica e outra com os aspetos da fundamentação matemática por de trás da robótica, porque para controlar o robô é necessário implementar expressões matemáticas para o poder controlar. Neste trabalho é apresentado um sistema de controlo do braço robótico MENTOR e o desenvolvimento de uma interface para o utilizador. Para o controlo do braço robótico foi necessário calcular a cinemática direta e inversa, para que se possa obter os ângulos das juntas para uma dada posição ou qual é a posição final do braço robótico para um valor das juntas. O sistema é bastante flexível e foi desenvolvido para ser utilizado essencialmente para aprendizagem de robótica, podendo no entanto ser utilizado em outras aplicações.