Development and validation of a hybrid simulator for ultrasound-guided laparoscopic common bile duct exploration.

BACKGROUND: Ultrasound-guided laparoscopic common bile duct exploration (LCBDE) is the surgical management of choledocholithiasis. The procedure presents significant benefits to patients but still fails to be generalised because of the complex set of skills it requires. A simulator for ultrasound-guided LCBDE would allow trainee surgeons as well as experienced surgeons who perform this surgery seldomly to practice and gain confidence. METHODS: This article presents the development and validation of an easily reproducible hybrid simulator for ultrasound-guided LCBDE which integrates real and virtual components of the task. We first developed a physical model made of silicone. The fabrication technique is replicable and allows quick and easy production of multiple models. We then applied virtual components onto the model to create training for laparoscopic ultrasound examination. Combined with a commercially available lap-trainer and surgical equipment, the model can be used for training the fundamental steps of the surgery through the trans-cystic or trans-choledochal approaches. The simulator was evaluated through face, content, and construct validation. RESULTS: Two novices, eight middle grades, and three experts were recruited to test the simulator. The results of the face validation showed that the surgeons found the model realistic visually and felt realistic when performing the different steps of the surgery. The content validation indicated the usefulness of having a training system to practice the choledochotomy, the choledochoscopy and stone retrieval, and the suturing. The construct validation highlighted the ability of the simulator to differentiate between surgeons with various levels of expertise. CONCLUSIONS: The hybrid simulator presented is a low-cost yet realistic model which allows the surgeons to practice the technical skills required for trans-cystic and trans-choledochal ultrasound-guided LCBDE.

Fully printed and multifunctional graphene-based wearable e-textiles for personalized healthcare applications.

Wearable e-textiles have gained huge tractions due to their potential for non-invasive health monitoring. However, manufacturing of multifunctional wearable e-textiles remains challenging, due to poor performance, comfortability, scalability, and cost. Here, we report a fully printed, highly conductive, flexible, and machine-washable e-textiles platform that stores energy and monitor physiological conditions including bio-signals. The approach includes highly scalable printing of graphene-based inks on a rough and flexible textile substrate, followed by a fine encapsulation to produce highly conductive machine-washable e-textiles platform. The produced e-textiles are extremely flexible, conformal, and can detect activities of various body parts. The printed in-plane supercapacitor provides an aerial capacitance of ∼3.2 mFcm-2 (stability ∼10,000 cycles). We demonstrate such e-textiles to record brain activity (an electroencephalogram, EEG) and find comparable to conventional rigid electrodes. This could potentially lead to a multifunctional garment of graphene-based e-textiles that can act as flexible and wearable sensors powered by the energy stored in graphene-based textile supercapacitors.

Reflectance, illumination, and appearance in color constancy.

We studied color constancy using a pair of identical 3-D Color Mondrian displays. We viewed one 3-D Mondrian in nearly uniform illumination, and the other in directional, nonuniform illumination. We used the three dimensional structures to modulate the light falling on the painted surfaces. The 3-D structures in the displays were a matching set of wooden blocks. Across Mondrian displays, each corresponding facet had the same paint on its surface. We used only 6 chromatic, and 5 achromatic paints applied to 104 block facets. The 3-D blocks add shadows and multiple reflections not found in flat Mondrians. Both 3-D Mondrians were viewed simultaneously, side-by-side. We used two techniques to measure correlation of appearance with surface reflectance. First, observers made magnitude estimates of changes in the appearances of identical reflectances. Second, an author painted a watercolor of the 3-D Mondrians. The watercolor's reflectances quantified the changes in appearances. While constancy generalizations about illumination and reflectance hold for flat Mondrians, they do not for 3-D Mondrians. A constant paint does not exhibit perfect color constancy, but rather shows significant shifts in lightness, hue and chroma in response to the structure in the nonuniform illumination. Color appearance depends on the spatial information in both the illumination and the reflectances of objects. The spatial information of the quanta catch from the array of retinal receptors generates sensations that have variable correlation with surface reflectance. Models of appearance in humans need to calculate the departures from perfect constancy measured here. This article provides a dataset of measurements of color appearances for computational models of sensation.