Mechatronic Design of a Two-Arm Concentric Tube Robot System for Rigid Neuroendoscopy.

Open surgical approaches are still often employed in neurosurgery, despite the availability of neuroendoscopic approaches that reduce invasiveness. The challenge of maneuvering instruments at the tip of the endoscope makes neuroendoscopy demanding for the physician. The only way to aim tools passed through endoscope ports is to tilt the entire endoscope; but, tilting compresses brain tissue through which the endoscope passes and can damage it. Concentric tube robots can provide necessary dexterity without endoscope tilting, while passing through existing ports in the endoscope and carrying surgical tools in their inner lumen. In this paper we describe the mechatronic design of a new concentric tube robot that can deploy two concentric tube manipulators through a standard neuroendoscope. The robot uses a compact differential drive and features embedded motor control electronics and redundant position sensors for safety. In addition to the mechatronic design of this system, this paper contributes experimental validation in the context of colloid cyst removal, comparing our new robotic system to standard manual endoscopy in a brain phantom. The robotic approach essentially eliminated endoscope tilt during the procedure (17.09° for the manual approach vs. 1.16° for the robotic system). The robotic system also enables a single surgeon to perform the procedure - typically in a manual approach one surgeon aims the endoscope and another operates the tools delivered through its ports.

Sport-Related Structural Brain Injury in High School Soccer: Epidural Hemorrhage After a "Header".

BACKGROUND: Sports-related structural brain injury (SRSBI) is a rare, but potentially catastrophic, injury. Limited data exist outlining its epidemiology, pathophysiology, and outcomes. We have presented a case of an epidural hematoma (EDH) that occurred during a high school soccer game. CASE DESCRIPTION: A 16-year-old boy had experienced a head-to-ball collision and head-to-head collision with another player. He denied loss of consciousness, endorsed retrograde amnesia, and complained of a minor headache. On the sidelines, he subsequently passed brief orientation and physical exertion tests. However, on returning to play, he experienced blurry vision, along with headache and nausea/vomiting. At the local hospital, he was found to have a 2.6-cm right frontal EDH. After transfer to our institution, increasing somnolence was noted, prompting emergent evacuation of the EDH. His postoperative course was unremarkable, and he was discharged on postoperative day 2. At the 2-week and 3-month follow-up visits, he did not express any complaints or residual deficits and was cleared for full sporting activity. CONCLUSIONS: The present case highlights one of the few SRSBIs that have occurred in soccer. Because of their rarity and severity, a concerted effort should be made to report these cases of SRSBIs regarding the mechanism, postcollision symptoms, and long-term outcomes.

A crowdsourcing model for creating preclinical medical education study tools.

During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students' use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students' exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.