Training in robotic-assisted surgery: a systematic review of training modalities and objective and subjective assessment methods.

INTRODUCTION: The variety of robotic surgery systems, training modalities, and assessment tools within robotic surgery training is extensive. This systematic review aimed to comprehensively overview different training modalities and assessment methods for teaching and assessing surgical skills in robotic surgery, with a specific focus on comparing objective and subjective assessment methods. METHODS: A systematic review was conducted following the PRISMA guidelines. The electronic databases Pubmed, EMBASE, and Cochrane were searched from inception until February 1, 2022. Included studies consisted of robotic-assisted surgery training (e.g., box training, virtual reality training, cadaver training and animal tissue training) with an assessment method (objective or subjective), such as assessment forms, virtual reality scores, peer-to-peer feedback or time recording. RESULTS: The search identified 1591 studies. After abstract screening and full-texts examination, 209 studies were identified that focused on robotic surgery training and included an assessment tool. The majority of the studies utilized the da Vinci Surgical System, with dry lab training being the most common approach, followed by the da Vinci Surgical Skills Simulator. The most frequently used assessment methods included simulator scoring system (e.g., dVSS score), and assessment forms (e.g., GEARS and OSATS). CONCLUSION: This systematic review provides an overview of training modalities and assessment methods in robotic-assisted surgery. Dry lab training on the da Vinci Surgical System and training on the da Vinci Skills Simulator are the predominant approaches. However, focused training on tissue handling, manipulation, and force interaction is lacking, despite the absence of haptic feedback. Future research should focus on developing universal objective assessment and feedback methods to address these limitations as the field continues to evolve.

Robotic hepaticojejunostomy training in novices using robotic simulation and dry-lab suturing (ROSIM): randomized controlled crossover trial.

BACKGROUND: Robotic suturing training is in increasing demand and can be done using suture-pads or robotic simulation training. Robotic simulation is less cumbersome, whereas a robotic suture-pad approach could be more effective but is more costly. A training curriculum with crossover between both approaches may be a practical solution. However, studies assessing the impact of starting with robotic simulation or suture-pads in robotic suturing training are lacking. METHODS: This was a randomized controlled crossover trial conducted with 20 robotic novices from 3 countries who underwent robotic suturing training using an Intuitive Surgical® X and Xi system with the SimNow (robotic simulation) and suture-pads (dry-lab). Participants were randomized to start with robotic simulation (intervention group, n = 10) or suture-pads (control group, n = 10). After the first and second training, all participants completed a robotic hepaticojejunostomy (HJ) in biotissue. Primary endpoint was the objective structured assessment of technical skill (OSATS) score during HJ, scored by two blinded raters. Secondary endpoints were force measurements and a qualitative analysis. After training, participants were surveyed regarding their preferences. RESULTS: Overall, 20 robotic novices completed both training sessions and performed 40 robotic HJs. After both trainings, OSATS was scored higher in the robotic simulation-first group (3.3 ± 0.9 vs 2.5 ± 0.8; p = 0.049), whereas the median maximum force (N) (5.0 [3.2-8.0] vs 3.8 [2.3-12.8]; p = 0.739) did not differ significantly between the groups. In the survey, 17/20 (85%) participants recommended to include robotic simulation training, 14/20 (70%) participants preferred to start with robotic simulation, and 20/20 (100%) to include suture-pad training. CONCLUSION: Surgical performance during robotic HJ in robotic novices was significantly better after robotic simulation-first training followed by suture-pad training. A robotic suturing curriculum including both robotic simulation and dry-lab suturing should ideally start with robotic simulation.

Prediction of laparoscopic skills: objective learning curve analysis.

INTRODUCTION: Prediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box. METHODS: Surgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency. RESULTS: A total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses. CONCLUSION: The learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.

Force-based assessment of tissue handling skills in simulation training for robot-assisted surgery.

INTRODUCTION: Although robotic-assisted surgery is increasingly performed, objective assessment of technical skills is lacking. The aim of this study is to provide validity evidence for objective assessment of technical skills for robotic-assisted surgery. METHODS: An international multicenter study was conducted with participants from the academic hospitals Heidelberg University Hospital (Germany, Heidelberg) and the Amsterdam University Medical Centers (The Netherlands, Amsterdam). Trainees with distinctly different levels of robotic surgery experience were divided into three groups (novice, intermediate, expert) and enrolled in a training curriculum. Each trainee performed six trials of a standardized suturing task using the da Vinci Surgical System. Using the ForceSense system, five force-based parameters were analyzed, for objective assessment of tissue handling skills. Mann-Whitney U test and linear regression were used to analyze performance differences and the Wilcoxon signed-rank test to analyze skills progression. RESULTS: A total of 360 trials, performed by 60 participants, were analyzed. Significant differences between the novices, intermediates and experts were observed regarding the total completion time (41 s vs 29 s vs 22 s p = 0.003), mean non zero force (29 N vs 33 N vs 19 N p = 0.032), maximum impulse (40 Ns vs 31 Ns vs 20 Ns p = 0.001) and force volume (38 N3 vs 32 N3 vs 22 N3 p = 0.018). Furthermore, the experts showed better results in mean non-zero force (22 N vs 13 N p = 0.015), maximum impulse (24 Ns vs 17 Ns p = 0.043) and force volume (25 N3 vs 16 N3 p = 0.025) compared to the intermediates (p ≤ 0.05). Lastly, learning curve improvement was observed for the total task completion time, mean non-zero force, maximum impulse and force volume (p ≤ 0.05). CONCLUSION: Construct validity for force-based assessment of tissue handling skills in robot-assisted surgery is established. It is advised to incorporate objective assessment and feedback in robot-assisted surgery training programs to determine technical proficiency and, potentially, to prevent tissue trauma.

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery.

INTRODUCTION: Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery. METHODS: An international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated. RESULTS: A total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery. CONCLUSION: The crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.

Effects of ground, steam-flaked, and super-conditioned corn grain on production performance and total-tract digestibility in dairy cows.

This study aimed to evaluate the effects of feeding ground, steam-flaked, or super-conditioned corn on production performance, rumen fermentation, nutrient digestibility, and milk fatty acid (FA) profile of lactating dairy cows. Twenty-four lactating Holstein cows (130 ± 12 d in milk) in a completely randomized block design experiment were assigned to 1 of 3 treatments that contained 31% of one of the following corn types: (1) ground corn; (2) steam-flaked corn; and (3) super-conditioned corn. Actual milk yield was greater in the super-conditioned corn diet than in the steam-flaked and ground corn diets. Dry matter intake, 3.5% fat-corrected milk and energy-corrected milk remained unaffected by treatments; however, milk fat concentration decreased in the super-conditioned corn diet compared with the ground and steam-flaked corn diets. The molar proportion of ruminal acetate decreased in the super-conditioned corn diet compared with the ground and steam-flaked corn diets, whereas the molar proportion of propionate spiked in the super-conditioned corn diet. Ruminal pH dropped in cows fed super-conditioned corn compared with the other 2 diets. A similar pattern was observed for ruminal NH3-N and acetate-to-propionate ratio. Total-tract starch digestibility increased the most in the super-conditioned corn diet followed by the steam-flaked and ground corn diets (96.8, 95.1, and 92.5%, respectively). The neutral detergent fiber digestibility declined in cows fed the super-conditioned corn diet as opposed to other diets (~3.9%). The concentrations of 16:0 and mixed-FA in milk fat dropped in the super-conditioned corn-based diet compared with the ground corn diet. Milk trans-10 18:1 FA increased, whereas trans-11 18:1 FA decreased in cows fed the super-conditioned diet. We concluded that super-conditioned corn has the potential to increase milk yield and starch digestibility in lactating dairy cows; however, reduced milk fat output caused by altering ruminal pH and ruminal FA biohydrogenation pathways may not be desirable in certain markets. Future research is warranted to investigate how super-conditioned corn affects feed efficiency.

Aspirin/antiplatelet agent use improves disease-free survival and reduces the risk of distant metastases in Stage II and III triple-negative breast cancer patients.

PURPOSE: The objective is to define the therapeutic role of antiplatelet agents in a triple-negative breast cancer (TNBC) population. METHODS: We performed retrospective analysis using the UTSW TNBC registry containing data from 222 Stage II-III TNBC patients treated between 1998 and 2016. Univariate analysis and multivariable logistic regression models were constructed to identify factors associated with disease-free survival (DFS), distant metastases rate (DMR), and overall survival outcomes. Antiplatelet drug use was determined by review of electronic medical records. RESULTS: A total of 65 patients used antiplatelet (AP) agents, and 157 patients did not use AP agents. Median follow-up for AP and non-AP groups was 41.3 and 40.9 months, respectively. There was an improvement in the AP group compared with the control group in 5-year DFS (80.4% at 5 years compared with 62.3% in the control group, p = 0.04) and 5-year DMR (8.8 vs. 31.9%, p = 0.007). In multivariate analysis, AP use was found to be significantly associated with improvements in DFS and DMR. CONCLUSIONS: We illustrate that antiplatelet agent use improves DMR and DFS among a stage II and III TNBC population despite our short follow-up evaluation. Longer follow-up evaluation will be required to determine additional outcome advantage for antiplatelet agent use. Our findings support consideration of investigation of antiplatelet therapy as an adjunctive therapy for TNBC at high risk for disease recurrence.

Genetic diversity of Iranian honey bee (Apis mellifera meda Skorikow, 1829) populations based on ISSR markers.

Honey bee is one of the most important insects considering its role in agriculture,ecology and economy as a whole. In this study, the genetic diversity of different Iranian honey bee populations was evaluated using inter simple sequence repeat (ISSR) markers. During May to September 2014, 108 young worker honey bees were collected from six different populations in 30 different geoclimatic locations from Golestan, Mazendaran, Guilan, West Azerbaijan, East Azerbaijan, Ardebil provinces of Iran. DNA was extracted from the worker honey bees. The quality and quantity of extracted DNA were measured. A set of ten primers were screened with the laboratory populations of honey bees. The number of fragments produced in the different honey bee populations varied from 3 to 10, varying within 150 to 1500 bp. The used ten ISSR primers generated 40 polymorphic fragments, and the average heterozygosity for each primer was 0.266. Maximum numbers of bands were recorded for primer A1. A dendrogram based on the Unweighted Pair Group Method with Arithmetic mean (UPGMA) method generated two sub-clusters. Honey bee populations of Golestan, Mazendaran, Guilan provinces were located in the first group. The second group included honey bee populations of Ardebil, West Azerbaijan, East Azerbaijan provinces, but this group showed a close relationship with other populations. The results showed obviously the ability of the ISSR marker technique to detect the genetic diversity among the honey bee populations.

Genetic diversity of the Dwarf honeybee (Apis florea Fabricius, 1787) populations based on microsatellite markers.

Apis florea is one of two species of small, wild honeybee. The present study was conducted to evaluate the genetic diversity of Apis florea honeybee from 48 nests (colonies) using microsatellite markers in the South of Iran. All honeybee samples were analyzed for six microsatellite loci (A88, A107, A7, B124, A113 and A35). The six loci had different numbers of alleles in the sampled colonies ranging from 7 (loci A107) to 3 (loci A7, A35). Gene diversity in Apis florea ranged from 0.491 to 0.595. This range probably reflects the spreading of nests in a large region with a varied climate. Phylogenetic tree showed two distinct clusters including a) Minab region samples and b) Bandar Abbas, Bandar Khamir and Qeshm Island regions. All of these regions are geographically rich, having varied vegetation and climate conditions. Our findings are an important contribution to the methods of studying distribution and conservation of Apis florea.

Evaluation of FGFR2 gene polymorphism in women with breast cancer.

Breast cancer (BC) is one of the most frequent cancers among women worldwide. It is a complex polygenic disorder that genetic factors play an important role in disease etiology. The highly significant association of the Fibroblast growth factor receptor 2 (FGFR2) locus with breast cancer risk has been replicated in multiple genome association study; however, it's mechanism of action remains unclear. The aim of this study was to investigate whether the single nucleotide polymorphism (SNP) C­906T within intron 2 of FGFR2 is responsible for susceptibility to breast cancer. This case-control study included 108 breast cancer cases and 108 cancer-free controls. The prevalence of genotype frequencies of the FGFR2 CC/CT/TT was 5.5%, 90.7% and 3.7%, respectively, in cancer cases. Among controls, the distribution of CC, CT and TT genotype was 48.14%, 47.66% and 10.18% respectively. Significant differences in allele and genotype distribution among controls and patients were found (OR, 18.87 95% CI, 7.55­47.16; p = 0.0001). The results from this study suggest that the FGFR2 C­906T polymorphism may be associated to breast cancer in population studied. Well­designed studies with larger sample sizes are needed to confirm the role of FGFR2 SNP in breast cancer risk.

Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery.

Surgeons performing robotic-assisted laparoscopic surgery experience physical stress and overuse of shoulder muscles due to sub-optimal arm support during surgery. The objective is to present a novel design and prototype of a dynamic arm support for robotic laparoscopic surgery to evaluate its ergonomics and performance on the AdLap-VR simulation training device. The prototype was designed using the mechanical engineering design process: Technical requirements, concept creation, concept selection, 3D-design and built of the prototype. A crossover study was performed on a marble sorting task on the AdLap-VR. The first group performed four trials without the arm support, followed by four trials with the arm support, and the other group executed the sequence vice versa. The performance parameters used were time to complete (s), path length (mm), and the number of collisions. Afterward, the participants filled out a questionnaire on the ergonomic experience regarding both situations. 20 students executed 160 performed trials on the AdLap-VR Significant decreases in the subjective comfort parameters mental demand, physical demand, effort and frustration were observed as a result of introducing the novel arm support. Significant decreases in the objective performance parameters path length and the number of collisions were also observed during the tests. The newly developed dynamic arm support was found to improve comfort and enhance performance through increased stability on the robotic surgery skills simulator AdLap-VR.

Construction 4.0 technology evaluation using fuzzy TOPSIS: comparison between sustainability and resiliency, well-being, productivity, safety, and integrity.

This study aims to compare the impact of Construction 4.0 technologies on different organizational core values, focusing on sustainability and resiliency, well-being, productivity, safety, and integrity. To achieve that aim, the study objectives are the following: (i) identify the critical Construction 4.0 technologies between core values; (ii) appraise overlapping critical Construction 4.0 technologies between core values; (iii) examine the ranking performance of Construction 4.0 technologies between core values; and (iv) analyze the interrelationships between Construction 4.0 technologies and core values. First, twelve Construction 4.0 technologies were identified from a national strategic plan. Then, the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) that incorporates subjective and objective weights was used to evaluate the impact of the Construction 4.0 technologies on the five core values. Finally, the collected data was analyzed using the following techniques: fuzzy TOPSIS, normalization, overlap analysis, agreement analysis, sensitivity analysis, ranking comparison, and Spearman correlation. The study findings reveal four critical Construction 4.0 technologies that enhance all five core values: building information modeling (BIM), Internet of Things (IoT), big data and predictive analytics, and autonomous construction. Also, there is a high agreement on the Construction 4.0 technologies that enhance well-being and productivity. Lastly, artificial intelligence (AI) has the highest number of very strong relationships among the core values. The originality of this paper lies in its comprehensive comparison of the impact of Construction 4.0 technologies on multiple organizational core values. The study findings provide valuable insights in making strategic decisions in adopting Construction 4.0 technologies.

Developing a WELL building model for office environments.

Many reported cases of occupants in modern office buildings suffer from severe health risks, negative impacts on well-being, and productivity loss. Existing building standards often prioritize energy performance and green environments over human sustainability. Moreover, office buildings have a distinct group of occupants that require extra attention. Hence, the study aims to develop a WELL building model specifically for office buildings to support occupants' well-being, health, and productivity (i.e., WELL). To achieve that objective, this study developed a list of physical indoor building features through a systematic literature review and semi-structured interviews. Then, the features were inserted into a survey and sent to office building occupants and built environment professionals. The collected data was analyzed using the analytic hierarchy process (AHP) and confirmatory factor analysis (CFA). The findings suggest twelve new features applicable for supporting WELL in office buildings: workspace privacy, sufficient space, office layout, cleanliness, efficiency in building services, individual control, building automation system, Information Technology (IT) infrastructure, Wireless Fidelity (WiFi) risk, security system, safety at parking lots, and safe design. Also, three new concepts for supporting WELL in office buildings were established: office space, building services and maintenance, and smart systems. The new concepts and features lay a foundation for designing office buildings that comprehensively target occupants' WELL. Finally, this study is unique as it accentuates the development of a WELL building model specifically for office buildings.

Objective measurement of retention of laparoscopic skills: a prospective cohort study.

INTRODUCTION: There has been an overall growth of 462% in laparoscopic procedures performed by surgical residents between 2000 and 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. METHODS: First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after, and 4 months after completing the basic laparoscopy course. Force, motion, and time were the measured variables. RESULTS: A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force ( P= 0.004), motion ( P ≤0.001), and time ( P ≤0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force ( P ≤0.001), motion ( P= 0.005), and time ( P ≤0.001).Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force ( P= 0.046), max impulse ( P= 0.12), and time ( P= 0.002). For the ZigZag loop, skill decay was observed for force ( P= 0.021), motion ( P= 0.015), and time ( P ≤0.001) parameters. CONCLUSION: Acquired laparoscopic technical skills decreased 4 months after the basic laparoscopy course. Compared to baseline performance, participants showed significant improvement, however deterioration was observed compared to postcourse measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.

Impact of corn processing and weaning age on calf performance, blood metabolites, rumen fermentation, and behavior.

This study examined the impact of two corn processing methods (steam-flaked (SFC) vs. ground) combined with two weaning ages (50 or 75 days) on calf performance, blood metabolites, rumen fermentation, nutrient digestion, and behavior. The study involved 48 three-day-old Holstein calves, with an average body weight of 41.4 ± 2.2 kg. The experimental design was a 2 × 2 factorial arrangement, resulting in four treatment groups: SFC50 (SFC and weaning at 50 days), SFC75 (SFC and weaning at 75 days), GC50 (ground corn and weaning at 50 days), and GC75 (ground corn and weaning at 75 days). Calves were given whole milk at 4 L/ day from day 3-15 and 7 L/ day from day 16 to either 43 or 68, depending on weaning age. Weaning occurred between days 44 and 50 for early-weaned calves and between days 69 and 75 for late-weaned calves. The study lasted until calves were 93 days old. The starter ration consisted of soybean meal, corn grain, 5% chopped wheat straw and premix. Results indicated that the SFC-based starter feed improved calf performance and nutrient digestion, as evidenced by increased weight gain, dry matter, crude protein, and neutral detergent fiber digestibility. Calves fed the SFC-based starter diet had lower blood albumin and urea N concentrations, while blood total protein and globulin concentrations were higher, especially in early-weaned calves. No significant changes in rumen pH and ammonia-N concentration were observed. In addition, the SFC starter feed resulted in higher volatile fatty acids concentration and longer feeding time in weaned calves compared to ground corn. Overall, these results suggest that an SFC-based starter feed may be beneficial for both early and late weaned calves.

Spinal Reirradiation-Mediated Myelopathy: A Systematic Review and Meta-Analysis.

Reirradiation of the spine is carried out in 42% of patients who do not respond to treatment or have recurrent pain. However, there are few studies and data on the effect of reirradiation of the spine and the occurrence of acute and chronic side-effects caused by reirradiation, such as myelopathy, in these patients. This meta-analysis aimed to determine the safe dose in terms of biological effective dose (BED), cumulative dose and dose interval between BED1 and BED2 to decrease or prevent myelopathy and pain control in patients undergoing radiation therapy in the spinal cord. A search was carried out using EMBASE, MEDLINE, PUBMED, Google Scholar, Cochrane Collaboration library electronic databases, Magiran, and SID from 2000 to 2022 to recognise qualified studies. In total, 17 primary studies were applied to estimate the pooled effect size. The random effects model showed that the pooled BED in the first stage, the BED in the second stage and the cumulative BED1 and BED2 were estimated at 77.63, 58.35 and 115.34 Gy, respectively. Studies reported on dose interval. The results of a random effects model showed that the pooled interval was estimated at 13.86 months. The meta-analysis revealed that using appropriate BED1 and/or BED2 in a safe interval between the first and second phases of treatment can have an influential role in preventing or reducing the effects of myelopathy and regional control pain in spinal reirradiation.

Formation of a Nanorod-Assembled TiO2 Actinomorphic-Flower-like Microsphere Film via Ta Doping Using a Facile Solution Immersion Method for Humidity Sensing.

This study fabricated tantalum (Ta)-doped titanium dioxide with a unique nanorod-assembled actinomorphic-flower-like microsphere structured film. The Ta-doped TiO2 actinomorphic-flower-like microsphere (TAFM) was fabricated via the solution immersion method in a Schott bottle with a home-made improvised clamp. The samples were characterised using FESEM, HRTEM, XRD, Raman, XPS, and Hall effect measurements for their structural and electrical properties. Compared to the undoped sample, the rutile-phased TAFM sample had finer nanorods with an average 42 nm diameter assembled to form microsphere-like structures. It also had higher oxygen vacancy sites, electron concentration, and mobility. In addition, a reversed double-beam photoacoustic spectroscopy measurement was performed for TAFM, revealing that the sample had a high electron trap density of up to 2.5 µmolg-1. The TAFM showed promising results when employed as the resistive-type sensing film for a humidity sensor, with the highest sensor response of 53,909% obtained at 3 at.% Ta doping. Adding rGO to 3 at.% TAFM further improved the sensor response to 232,152%.

Torque capabilities of self-ligating and conventional brackets under the effect of bracket width and free wire length.

OBJECTIVES: To numerically investigate the torque capacity of conventional and self-ligating brackets under the effect of varying bracket width and free wire length. MATERIAL AND METHODS: Finite element models of three kinds of orthodontic brackets in the 0.022-inch slot size were investigated: Discovery, Damon 3MX, Speed. Additionally, finite element (FE) models of Speed and Damon brackets were generated with the same width as the Discovery. From the left upper incisor to the right upper canine, four brackets each were modelled. The total wire length at the upper right incisor was kept constant at 12 mm for all brackets types. For the Discovery brackets, the wire length was increased from 12 to 16 mm in 2-mm steps. A torque of 20° was applied to the upper right incisor with 0.46 × 0.64 mm(2) (0.018″ × 0.025″) and 0.48 × 0.64 mm(2) (0.019″ × 0.025″) wires. Wires made of stainless steel, titanium molybdenum and nickel titanium were studied. Torque angle/moment characteristics were recorded. RESULTS: Wider brackets showed more torque control capability (e.g. Discovery: 10.6 Nmm, Damon: 9.2 Nmm, Speed: 4.0 Nmm for the NiTi wire). Even with the same width as the Discovery bracket, Damon and Speed brackets showed lower torque capability than the Discovery bracket. Increasing the free wire length decreased the torsional stiffness of the wire and thus decreased the torque capability. CONCLUSION: The results showed that the bracket design has less influence on the torquing moment than other parameters, such as bracket width, free wire length, wire/slot play or misalignment.

The University of NSW electronic practice based research network: disease registers, data quality and utility.

INTRODUCTION: Accurate well-maintained registers are a prerequisite to co-ordinated care of patients with chronic diseases. Their effectiveness in enabling improved management is dependent on the quality of the information captured. This paper provides an overview into the methodology and data quality of the electronic Practice Based Research Network. METHODS: Clinical records with no identifying information are routinely extracted from four general practices. The data are linked in the data warehouse. Data quality is assessed for completeness, correctness and consistency. Reports on data quality are given back to practices and semi-structured interviews provide information to interpret the results and discuss how data quality could be improved. FINDINGS: Data quality is mostly complete for sex and date of birth but indigenous status, smoking and weight were incomplete. There are generally high levels of correctness and internal consistency. Completeness of records in assisting the management of diabetes patients using the annual cycle of care was poor. GPs often use the progress notes to enter information during the consultation and coding diagnoses was considered onerous. DISCUSSION: The routine capture of electronic clinical health records from primary health care and health services can be used to monitor performance and improve the quality of clinical records. There is a need for accurate and comprehensive clinical records to ensure the safety and quality of clinical practice. Understanding the true reasons for poor data quality is complex. Having a community-based research network may assist in answering some of these questions. CONCLUSION: Electronic health records are increasingly being used for secondary research and evaluation, beyond the primary purpose of supporting clinical care. The data must be of sufficient quality to support these purposes.

Upwind responses of Anopheles stephensi to carbon dioxide and L-lactic acid: an olfactometer study.

Excretion of carbon dioxide and L-lactic acid through exhalation and perspiration provides olfactory signals to mosquitoes which allow them to find and bite humans; however, mosquito species differ in this regard. This study investigated upwind responses of Anopheles stephensi, mysorensis form, an important malaria vector in Asia, to carbon dioxide and L-lactic acid under laboratory conditions. While a minimal dose of carbon dioxide (90 ppm) activated the mosquitoes, 10 times this amount suppressed them. L-lactic acid alone did not produce a significant effect by itself, but addition of 6 microg/min of L-lactic acid to a range of 90 to 410 ppm carbon dioxide resulted in attraction. The results provide further support for the hypothesis that CO2 plays an important role in the host-seeking behaviour of zoophilic mosquitoes, and suggests that L-lactic acid might play a more critical role than CO2 in the attraction of An. stephensi.