Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

Minimally invasive surgery is a highly demanding surgical approach regarding technical requirements for the surgeon, who must be trained in order to perform a safe surgical intervention. Traditional surgical education in minimally invasive surgery is commonly based on subjective criteria to quantify and evaluate surgical abilities, which could be potentially unsafe for the patient. Authors, surgeons and associations are increasingly demanding the development of more objective assessment tools that can accredit surgeons as technically competent. This paper describes the state of the art in objective assessment methods of surgical skills. It gives an overview on assessment systems based on structured checklists and rating scales, surgical simulators, and instrument motion analysis. As a future work, an objective and automatic assessment method of surgical skills should be standardized as a means towards proficiency-based curricula for training in laparoscopic surgery and its certification.

Temporal segmentation tool for high-quality real time video editing software

The increasing use of video editing software requires faster and more efficient editing tools. As a first step, these tools perform a temporal segmentation in shots that allows a later building of indexes describing the video content. Here, we propose a novel real-time high-quality shot detection strategy, suitable for the last generation of video editing software requiring both low computational cost and high quality results. While abrupt transitions are detected through a very fast pixel-based analysis, gradual transitions are obtained from an efficient edge-based analysis. Both analyses are reinforced with a motion analysis that helps to detect and discard false detections. This motion analysis is carried out exclusively over a reduced set of candidate transitions, thus maintaining the computational requirements demanded by new applications to fulfill user needs.

Development of a human movement monitoring system based on wearable devices

It is essential to remotely and continuously monitor the movements of individuals in many social areas, for example, taking care of aging people, physical therapy, athletic training etc. Many methods have been used, such as video record, motion analysis or sensor-based methods. Due to the limitations in remote communication, power consumption, portability and so on, most of them are not able to fulfill the requirements. The development of wearable technology and cloud computing provides a new efficient way to achieve this goal. This paper presents an intelligent human movement monitoring system based on a smartwatch, an Android smartphone and a distributed data management engine. This system includes advantages of wide adaptability, remote and long-term monitoring capacity, high portability and flexibility. The structure of the system and its principle are introduced. Four experiments are designed to prove the feasibility of the system. The results of the experiments demonstrate the system is able to detect different actions of individuals with adequate accuracy.

Experimental and statistical investigation of canonical problems in sloshing

En hidrodinámica, el fenómeno de Sloshing se puede definir como el movimiento de la superficie libre de un fluido dentro de un contenedor sometido a fuerzas y perturbaciones externas. El fluido en cuestión experimenta violentos movimientos con importantes deformaciones de su superficie libre. La dinámica del fluido puede llegar a generar cargas hidrodinámicas considerables las cuales pueden afectar la integridad estructural y/o comprometer la estabilidad del vehículo que transporta dicho contenedor. El fenómeno de Sloshing ha sido extensivamente investigado matemática, numérica y experimentalmente, siendo el enfoque experimental el más usado debido a la complejidad del problema, para el cual los modelos matemáticos y de simulación son aun incapaces de predecir con suficiente rapidez y precisión las cargas debidas a dicho fenómeno. El flujo generado por el Sloshing usualmente se caracteriza por la presencia de un fluido multifase (gas-liquido) y turbulencia. Reducir al máximo posible la complejidad del fenómeno de Sloshing sin perder la esencia del problema es el principal reto de esta tesis doctoral, donde un trabajo experimental enfocado en casos canónicos de Sloshing es presentado y documentado con el objetivo de aumentar la comprensión de dicho fenómeno y por tanto intentar proveer información valiosa para validaciones de códigos numéricos. El fenómeno de Sloshing juega un papel importante en la industria del transporte marítimo de gas licuado (LNG). El mercado de LNG en los últimos años ha reportado un crecimiento hasta tres veces mayor al de los mercados de petróleo y gas convencionales. Ingenieros en laboratorios de investigación e ingenieros adscritos a la industria del LNG trabajan continuamente buscando soluciones económicas y seguras para contener, transferir y transportar grandes volúmenes de LNG. Los buques transportadores de LNG (LNGC) han pasado de ser unos pocos buques con capacidad de 75000 m3 hace unos treinta años, a una amplia flota con una capacidad de 140000 m3 actualmente. En creciente número, hoy día se construyen buques con capacidades que oscilan entre 175000 m3 y 250000 m3. Recientemente un nuevo concepto de buque LNG ha salido al mercado y se le conoce como FLNG. Un FLNG es un buque de gran valor añadido que solventa los problemas de extracción, licuefacción y almacenamiento del LNG, ya que cuenta con equipos de extracción y licuefacción a bordo, eliminando por tanto las tareas de transvase de las estaciones de licuefacción en tierra hacia los buques LNGC. EL LNG por tanto puede ser transferido directamente desde el FLNG hacia los buques LNGC en mar abierto. Niveles de llenado intermedios en combinación con oleaje durante las operaciones de trasvase inducen movimientos en los buques que generan por tanto el fenómeno de Sloshing dentro de los tanques de los FLNG y los LNGC. El trabajo de esta tesis doctoral lidia con algunos de los problemas del Sloshing desde un punto de vista experimental y estadístico, para ello una serie de tareas, descritas a continuación, se han llevado a cabo : 1. Un dispositivo experimental de Sloshing ha sido configurado. Dicho dispositivo ha permitido ensayar secciones rectangulares de tanques LNGC a escala con movimientos angulares de un grado de libertad. El dispositivo experimental ha sido instrumentado para realizar mediciones de movimiento, presiones, vibraciones y temperatura, así como la grabación de imágenes y videos. 2. Los impactos de olas generadas dentro de una sección rectangular de un LNGC sujeto a movimientos regulares forzados han sido estudiados mediante la caracterización del fenómeno desde un punto de vista estadístico enfocado en la repetitividad y la ergodicidad del problema. 3. El estudio de los impactos provocados por movimientos regulares ha sido extendido a un escenario más realístico mediante el uso de movimientos irregulares forzados. 4. El acoplamiento del Sloshing generado por el fluido en movimiento dentro del tanque LNGC y la disipación de la energía mecánica de un sistema no forzado de un grado de libertad (movimiento angular) sujeto a una excitación externa ha sido investigado. 5. En la última sección de esta tesis doctoral, la interacción entre el Sloshing generado dentro en una sección rectangular de un tanque LNGC sujeto a una excitación regular y un cuerpo elástico solidario al tanque ha sido estudiado. Dicho estudio corresponde a un problema de interacción fluido-estructura. Abstract In hydrodynamics, we refer to sloshing as the motion of liquids in containers subjected to external forces with large free-surface deformations. The liquid motion dynamics can generate loads which may affect the structural integrity of the container and the stability of the vehicle that carries such container. The prediction of these dynamic loads is a major challenge for engineers around the world working on the design of both the container and the vehicle. The sloshing phenomenon has been extensively investigated mathematically, numerically and experimentally. The latter has been the most fruitful so far, due to the complexity of the problem, for which the numerical and mathematical models are still incapable of accurately predicting the sloshing loads. The sloshing flows are usually characterised by the presence of multiphase interaction and turbulence. Reducing as much as possible the complexity of the sloshing problem without losing its essence is the main challenge of this phd thesis, where experimental work on selected canonical cases are presented and documented in order to better understand the phenomenon and to serve, in some cases, as an useful information for numerical validations. Liquid sloshing plays a key roll in the liquified natural gas (LNG) maritime transportation. The LNG market growth is more than three times the rated growth of the oil and traditional gas markets. Engineers working in research laboratories and companies are continuously looking for efficient and safe ways for containing, transferring and transporting the liquified gas. LNG carrying vessels (LNGC) have evolved from a few 75000 m3 vessels thirty years ago to a huge fleet of ships with a capacity of 140000 m3 nowadays and increasing number of 175000 m3 and 250000 m3 units. The concept of FLNG (Floating Liquified Natural Gas) has appeared recently. A FLNG unit is a high value-added vessel which can solve the problems of production, treatment, liquefaction and storage of the LNG because the vessel is equipped with a extraction and liquefaction facility. The LNG is transferred from the FLNG to the LNGC in open sea. The combination of partial fillings and wave induced motions may generate sloshing flows inside both the LNGC and the FLNG tanks. This work has dealt with sloshing problems from a experimental and statistical point of view. A series of tasks have been carried out: 1. A sloshing rig has been set up. It allows for testing tanks with one degree of freedom angular motion. The rig has been instrumented to measure motions, pressure and conduct video and image recording. 2. Regular motion impacts inside a rectangular section LNGC tank model have been studied, with forced motion tests, in order to characterise the phenomenon from a statistical point of view by assessing the repeatability and practical ergodicity of the problem. 3. The regular motion analysis has been extended to an irregular motion framework in order to reproduce more realistic scenarios. 4. The coupled motion of a single degree of freedom angular motion system excited by an external moment and affected by the fluid moment and the mechanical energy dissipation induced by sloshing inside the tank has been investigated. 5. The last task of the thesis has been to conduct an experimental investigation focused on the strong interaction between a sloshing flow in a rectangular section of a LNGC tank subjected to regular excitation and an elastic body clamped to the tank. It is thus a fluid structure interaction problem.

Elucidation of a PTS–Carbohydrate Chemotactic Signal Pathway in Escherichia coli Using a Time-resolved Behavioral Assay

Chemotaxis of Escherichia coli toward phosphotransferase systems (PTSs)–carbohydrates requires phosphoenolpyruvate-dependent PTSs as well as the chemotaxis response regulator CheY and its kinase, CheA. Responses initiated by flash photorelease of a PTS substrates d-glucose and its nonmetabolizable analog methyl α-d-glucopyranoside were measured with 33-ms time resolution using computer-assisted motion analysis. This, together with chemotactic mutants, has allowed us to map out and characterize the PTS chemotactic signal pathway. The responses were absent in mutants lacking the general PTS enzymes EI or HPr, elevated in PTS transport mutants, retarded in mutants lacking CheZ, a catalyst of CheY autodephosphorylation, and severely reduced in mutants with impaired methyl-accepting chemotaxis protein (MCP) signaling activity. Response kinetics were comparable to those triggered by MCP attractant ligands over most of the response range, the most rapid being 11.7 ± 3.1 s−1. The response threshold was <10 nM for glucose. Responses to methyl α-d-glucopyranoside had a higher threshold, commensurate with a lower PTS affinity, but were otherwise kinetically indistinguishable. These facts provide evidence for a single pathway in which the PTS chemotactic signal is relayed rapidly to MCP–CheW–CheA signaling complexes that effect subsequent amplification and slower CheY dephosphorylation. The high sensitivity indicates that this signal is generated by transport-induced dephosphorylation of the PTS rather than phosphoenolpyruvate consumption.

bioNMF: a versatile tool for non-negative matrix factorization in biology

Medical imaging has become an absolutely essential diagnostic tool for clinical practices; at present, pathologies can be detected with an earliness never before known. Its use has not only been relegated to the field of radiology but also, increasingly, to computer-based imaging processes prior to surgery. Motion analysis, in particular, plays an important role in analyzing activities or behaviors of live objects in medicine. This short paper presents several low-cost hardware implementation approaches for the new generation of tablets and/or smartphones for estimating motion compensation and segmentation in medical images. These systems have been optimized for breast cancer diagnosis using magnetic resonance imaging technology with several advantages over traditional X-ray mammography, for example, obtaining patient information during a short period. This paper also addresses the challenge of offering a medical tool that runs on widespread portable devices, both on tablets and/or smartphones to aid in patient diagnostics.

Performance Factors in Women's Team Handball: Physical and Physiological Aspects—A Review

Team handball is an Olympic sport played professionally in many European countries. Nevertheless, a scientific knowledge regarding women's elite team handball demands is limited. Thus, the purpose of this article was to review a series of studies (n = 33) on physical characteristics, physiological attributes, physical attributes, throwing velocity, and on-court performances of women's team handball players. Such empirical and practical information is essential to design and implement successful short-term and long-term training programs for women's team handball players. Our review revealed that (a) players that have a higher skill level are taller and have a higher fat-free mass; (b) players who are more aerobically resistant are at an advantage in international level women team handball; (c) strength and power exercises should be emphasized in conditioning programs, because they are associated with both sprint performance and throwing velocity; (d) speed drills should also be implemented in conditioning programs but after a decrease in physical training volume; (e) a time-motion analysis is an effective method of quantifying the demands of team handball and provides a conceptual framework for the specific physical preparation of players. According to our results, there are only few studies on on-court performance and time-motion analysis for women's team handball players, especially concerning acceleration profiles. More studies are needed to examine the effectiveness of different training programs of women's team handball players' physiological and physical attributes.

SCAPHOID AND LUNATE CARPAL MECHANICS OVER THE SPECTRUM OF HEALTHY FUNCTION

When ligaments within the wrist are damaged, the resulting loss in range of motion and grip strength can lead to reduced earning potential and restricted ability to perform important activities of daily living. Left untreated, ligament injuries ultimately lead to arthritis and chronic pain. Surgical repair can mitigate these issues but current procedures are often non-anatomic and unable to completely restore the wrist’s complex network of ligaments. An inability to quantitatively assess wrist function clinically, both before and after surgery, limits the ability to assess the response to clinical intervention. Previous work has shown that bones within the wrist move in a similar pattern across people, but these patterns remain challenging to predict and model. In an effort to quantify and further develop the understanding of normal carpal mechanics, we performed two studies using 3D in vivo carpal bone motion analysis techniques. For the first study, we measured wrist laxity and performed CT scans of the wrist to evaluate 3D carpal bone positions. We found that through mid-range radial-ulnar deviation range of motion the scaphoid and lunate primarily flexed and extended; however, there was a significant relationship between wrist laxity and row-column behaviour. We also found that there was a significant relationship between scaphoid flexion and active radial deviation range of motion. For the second study, an analysis was performed on a publicly available database. We evaluated scapholunate relative motion over a full range of wrist positions, and found that there was a significant amount of variation in the location and orientation of the rotation axis between the two bones. Together the findings from the two studies illustrate the complexity and subject specificity of normal carpal mechanics, and should provide insights that can guide the development of anatomical wrist ligament repair surgeries that restore normal function.

Caractérisation tridimensionnelle de l’amplitude articulaire de l’épaule

L’épaule est l’articulation la plus mobile et la plus instable du corps humain dû à la faible quantité de contraintes osseuses et au rôle des tissus mous qui lui confèrent au moins une dizaine de degrés de liberté. La mobilité de l’épaule est un facteur de performance dans plusieurs sports. Mais son instabilité engendre des troubles musculo-squelettiques, dont les déchirures de la coiffe des rotateurs sont fréquentes et les plus handicapantes. L’évaluation de l’amplitude articulaire est un indice commun de la fonction de l’épaule, toutefois elle est souvent limitée à quelques mesures planaires pour lesquelles les degrés de liberté varient indépendamment les uns des autres. Ces valeurs utilisées dans les modèles de simulation musculo-squelettiques peuvent amener à des solutions non physiologiques. L’objectif de cette thèse était de développer des outils pour la caractérisation de la mobilité articulaire tri-dimensionnelle de l’épaule, en passant par i) fournir une méthode et son approche expérimentale pour évaluer l’amplitude articulaire tridimensionnelle de l’épaule incluant des interactions entre les degrés de liberté ; ii) proposer une représentation permettant d’interpréter les données tri-dimensionnelles obtenues; iii) présenter des amplitudes articulaires normalisées, iv) implémenter une amplitude articulaire tridimensionnelle au sein d’un modèle de simulation numérique afin de générer des mouvements sportifs optimaux plus réalistes; v) prédire des amplitudes articulaires sécuritaires et vi) des exercices de rééducation sécuritaires pour des patients ayant subi une réparation de la coiffe des rotateurs. i) Seize sujets ont été réalisé séries de mouvements d’amplitudes maximales actifs avec des combinaisons entre les différents degrés de liberté de l’épaule. Un système d’analyse du mouvement couplé à un modèle cinématique du membre supérieur a été utilisé pour estimer les cinématiques articulaires tridimensionnelles. ii) L’ensemble des orientations définies par une séquence de trois angles a été inclus dans un polyèdre non convexe représentant l’espace de mobilité articulaire prenant en compte les interactions entre les degrés de liberté. La combinaison des séries d’élévation et de rotation est recommandée pour évaluer l’amplitude articulaire complète de l’épaule. iii) Un espace de mobilité normalisé a également été défini en englobant les positions atteintes par au moins 50% des sujets et de volume moyen. iv) Cet espace moyen, définissant la mobilité physiologiques, a été utilisé au sein d’un modèle de simulation cinématique utilisé pour optimiser la technique d’un élément acrobatique de lâcher de barres réalisée par des gymnastes. Avec l’utilisation régulière de limites articulaires planaires pour contraindre la mobilité de l’épaule, seulement 17% des solutions optimales sont physiologiques. En plus, d’assurer le réalisme des solutions, notre contrainte articulaire tridimensionnelle n’a pas affecté le coût de calculs de l’optimisation. v) et vi) Les seize participants ont également réalisé des séries d’amplitudes articulaires passives et des exercices de rééducation passifs. La contrainte dans l’ensemble des muscles de la coiffe des rotateurs au cours de ces mouvements a été estimée à l’aide d’un modèle musculo-squelettique reproduisant différents types et tailles de déchirures. Des seuils de contrainte sécuritaires ont été utilisés pour distinguer les amplitudes de mouvements risquées ou non pour l’intégrité de la réparation chirurgicale. Une taille de déchirure plus grande ainsi que les déchirures affectant plusieurs muscles ont contribué à réduire l’espace de mobilité articulaire sécuritaire. Principalement les élévations gléno-humérales inférieures à 38° et supérieures à 65°, ou réalisées avec le bras maintenu en rotation interne engendrent des contraintes excessives pour la plupart des types et des tailles de blessure lors de mouvements d’abduction, de scaption ou de flexion. Cette thèse a développé une représentation innovante de la mobilité de l’épaule, qui tient compte des interactions entre les degrés de liberté. Grâce à cette représentation, l’évaluation clinique pourra être plus exhaustive et donc élargir les possibilités de diagnostiquer les troubles de l’épaule. La simulation de mouvement peut maintenant être plus réaliste. Finalement, nous avons montré l’importance de personnaliser la rééducation des patients en termes d’amplitude articulaire, puisque des exercices passifs de rééducation précoces peuvent contribuer à une re-déchirure à cause d’une contrainte trop importante qu’ils imposent aux tendons.

In-home Assessment of Turning and Transitions using Inertial Sensors in Older Adults with Dementia and Older Caregivers

Thesis (Master's)--University of Washington, 2016-06

Myocardial blood volume and perfusion reserve responses to combined dipyridamole and exercise stress: A quantitative approach to contrast stress echocardiography

Background: Qualitative interpretation of myocardial contrast echocardiography (MCE) improves the accuracy of wall-motion analysis for assessment of coronary artery disease (CAD). We examined the feasibility and accuracy of quantitative MCE for diagnosis of CAD. Methods: Dipyridamole/exercise stress MCE (destruction-replenishment protocol with real-time imaging) was performed in 90 patients undergoing quantitative coronary angiography, 48 of whom had significant (> 50%) stenoses. MCE was repeated with exercise alone in 18 patients. Myocardial blood flow (A*beta) was obtained from blood volume (A) and time to refill (beta). Results: Quantification of flow reserve was feasible in 88%. The mean A*beta reserve in the anterior wall was significantly impaired for patients with left anterior descending coronary artery disease (n = 28) compared with those with no disease (1.6 +/- 1.2 vs; 4.0 +/- 2.5, P <=.001). This reflected impaired beta reserve, with no difference in the A reserve. Applying a receiver operating characteristic curve derived cutoff of 2.0 for A*beta reserve, quantitative MCE was 76% sensitive and 71% specific for the diagnosis of significant left anterior descending coronary artery stenosis. Posterior circulation results were similar, with 78% sensitivity and 59% specificity for detection of posterior CAD. Overall, quantitative MCE was similarly sensitive to qualitative approach for diagnosis of CAD (88% vs 93%), but with lower specificity (52% vs 65%, P =.07). In 18 patients restudied with pure exercise stress, the mean myocardial blood flow reserve was less than after combined stress (2.1 +/- 1.6 vs 3.7 +/- 1.9, P =.01). Conclusion: Quantitative MCE is feasible for the diagnosis of CAD with dipyridamole/exercise stress. Dipyridamole prolongs postexercise hyperemia, augmenting the degree of hyperemia at the time of imaging.

The effect of weightbearing exercise with low frequency, whole body vibration on lumbosacral proprioception: A pilot study on normal subjects

Patients with low back pain (LBP) often present with impaired proprioception of the lumbopelvic region. For this reason, proprioception training usually forms part of the rehabilitation protocols. New exercise equipment that produces whole body, low frequency vibration (WBV) has been developed to improve muscle function, and reportedly improves proprioception. The aim of this pilot study was to investigate whether weightbearing exercise given in conjunction with WBV would affect lumbosacral position sense in healthy individuals. For this purpose, twenty-five young individuals with no LBP were assigned randomly to an experimental or control group. The experimental group received WBV for five minutes while holding a static, semi-squat position. The control group adopted the same weightbearing position for equal time but received no vibration. A two-dimensional motion analysis system measured the repositioning accuracy of pelvic tilting in standing. The experimental (WBV) group demonstrated a significant improvement in repositioning accuracy over time (mean 0.78 degrees) representing 39% improvement. It was concluded that WBV may induce improvements in lumbosacral repositioning accuracy when combined with a weightbearing exercise. Future studies with WBV should focus on evaluating its effects with different types of exercise, the exercise time needed for optimal outcomes, and the effects on proprioception deficits in LBP patients.

Sprint patterns in rugby union players during competition

The purpose of this study was to characterize sprint patterns of rugby union players during competition. Velocity profiles (60 m) of 28 rugby players were initially established in testing from standing, walking, jogging, and striding starts. During competition, the individual sprinting patterns of 17 rugby players were determined from video by using the individual velocity profiles. Forwards commenced sprints from a standing start most frequently (41%), whereas backs sprinted from standing (29%), walking (29%),jogging (29%), and occasionally striding (13%) starts. Forwards and backs achieved speeds in excess of 90% maximal velocity (Vmax) on 5 +/- 4 and 9 +/- 4 occasions (similar to 50% of the sprints performed), respectively, during competition. The higher frequency of sprinting for the backs compared with the forwards highlights the importance of speed training for this positional group. The similar relative distribution of velocities achieved during competition for forwards and backs suggests both positional groups should train acceleration and Vmax qualities. The backs should have a higher total volume of sprint training. Sprinting efforts should be performed from a variety of starting speeds to mimic the movement patterns of competition.

Productivity: A Review For The Hospitality Manager

Hospitality managers have a number of methods available to them to enhance employee productivity. The author discusses five major concepts that can lead to successful results in the hospitality industry.

Desenvolvimento de um sistema de captura de baixo custo destinado a determinação da cinemática humana

The motion capture is a main tool for quantitative motion analyses. Since the XIX century, several motion caption systems have been developed for biomechanics study, animations, games and movies. The biomechanics and kinesiology involves and depends on knowledge from distinct fields, the engineering and health sciences. A precise human motion analysis requires knowledge from both fields. It is necessary then the use of didactics tools and methods for research and teaching for learning aid. The devices for analysis and motion capture currently that are found on the market and on educational institutes presents difficulties for didactical practice, which are the difficulty of transportation, high cost and limited freedom for the user towards the data acquisition. Therefore, the motion analysis is qualitatively performed or is quantitatively performed in highly complex laboratories. Based is these problems, this work presents the development of a motion capture system for didactic use hence a cheap, light, portable and easily used device with a free software. This design includes the selection of the device, the software development for that and tests. The developed system uses the device Kinect, from Microsoft, for its low cost, low weight, portability and easy use, and delivery tree-dimensional data with only one peripheral device. The proposed programs use the hardware to make motion captures, store them, reproduce them, process the motion data and graphically presents the data.