Application of an adapted FMEA framework for robot-inclusivity of built environments.

Mobile robots are deployed in the built environment at increasing rates. However, lack of considerations for a robot-inclusive planning has led to physical spaces that would potentially pose hazards to robots, and contribute to an overall productivity decline for mobile service robots. This research proposes the use of an adapted Failure Mode and Effects Analysis (FMEA) as a structured tool to evaluate a building's level of robot-inclusivity and safety for service robot deployments. This Robot-Inclusive FMEA (RIFMEA) framework, is used to identify failures in the built environment that compromise the workflow of service robots, assess their effects and causes, and provide recommended actions to alleviate these problems. The method was supported with a case study of deploying telepresence robots in a university campus. The study concluded that common failures were related to poor furniture design, a lack of clearance and hazard indicators, and sub-optimal interior planning.

Submillimeter Diameter Poly(Vinyl Alcohol) Vascular Graft Patency in Rabbit Model.

Microvascular surgery is becoming a prevalent surgical practice. Replantation, hand reconstruction, orthopedic, and free tissue transfer procedures all rely on microvascular surgery for the repair of venous and arterial defects at the millimeter and submillimeter levels. Often, a vascular graft is required for the procedure as a means to bridge the gap between native arteries. While autologous vessels are desired for their bioactivity and non-thrombogenicity, the tedious harvest process, lack of availability, and caliber or mechanical mismatch contribute to graft failure. Thus, there is a need for an off-the-shelf artificial vascular graft that has low thrombogenic properties and mechanical properties matching those of submillimeter vessels. Poly(vinyl alcohol) hydrogel (PVA) has excellent prospects as a vascular graft due to its bioinertness, low thrombogenicity, high water content, and tunable mechanical properties. Here, we fabricated PVA grafts with submillimeter diameter and mechanical properties that closely approximated those of the rabbit femoral artery. In vitro platelet adhesion and microparticle release assay verified the low thrombogenicity of PVA. A stringent proof-of-concept in vivo test was performed by implanting PVA grafts in rabbit femoral artery with multilevel arterial occlusion. Laser Doppler measurements indicated the improved perfusion of the distal limb after implantation with PVA grafts. Moreover, ultrasound Doppler and angiography verified that the submillimeter diameter PVA vascular grafts remained patent for 2 weeks without the aid of anticoagulant or antithrombotics. Endothelial cells were observed in the luminal surface of one patent PVA graft. The advantageous non-thrombogenic and tunable mechanical properties of PVA that are retained even in the submillimeter diameter dimensions support the application of this biomaterial for vascular replacement in microvascular surgery.

Maxillary artery injury associated with subcondylar mandible fractures: a novel treatment algorithm.

Mandible fractures commonly occur in patients who have sustained blunt facial trauma, and the subcondylar region is the most frequently fractured due to its intrinsic biomechanical weakness. The maxillary artery lies in close relation to the medial cortex of the subcondyle and is vulnerable to injury by the sharp edges of the fracture fragments during the initial trauma or during operative fracture reduction. Maxillary artery injuries and subcondylar fractures may be an underdiagnosed phenomenon. Yet, this is of clinical significance as the maxillary artery caliber is usually of significant caliber and may lead to substantial hemorrhage. Surgical access to the artery for hemostasis is challenging and is further compounded by small surgical incisions usually undertaken for fracture fixation, obscuring of the artery by the overlying fracture fragments, and vessel retraction following its transection. In cases where maxillary artery injury is suspected, an open surgical approach may be favored over an endoscopic one. The authors illustrate a case in which brisk hemorrhage from the maxillary artery encountered during a preauricular approach to fixation of the mandible subcondyle was successfully controlled with temporary pressure on the external carotid artery through a neck incision and direct ligation of the lacerated maxillary artery. The authors then discuss diagnosis and treatment of such maxillary artery injuries and propose a novel diagnostic and treatment algorithm.

Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome.

BACKGROUND: Tumors arising from the esophagogastric junction (OGJ) are increasing in incidence in the west, but data from Asian populations are conflicting. Singapore has a mixed-Asian population with an international lifestyle. This study was designed to examine the changing trends in incidence of gastric cardia cancer (type III) within this population and to compare the clinicopathological characteristics and outcome of these tumors with gastric tumors. METHODS: Trends in cancer incidence were obtained from the Singapore Cancer Registry. Clinicopathological data were prospectively collected from patients undergoing surgery for gastric cancer who presented to the National University Hospital between 2000 and 2005. Patients underwent surgery with or without (neo)adjuvant therapy. Survival duration was analyzed. RESULTS: The incidence of cardia tumors has increased each decade since 1968 (1968-1982, 6.3%; 1983-1992, 7.6%; 1993-1997, 8.4%; 1998-2002, 9.1%; 2003-2007, 16.2%). Among the study population (n = 159) cardia tumors were associated with male sex (p < 0.01) and dysphagia (p < 0.01). Although R0 resection rates were similar, systemic recurrence rates were higher among patients with cardia cancer (p = 0.031) and survival was reduced compared with patients with non-cardia gastric cancer (median survival 26 vs. 69 months; p < 0.001). Cardia location of the tumor and metastatic lymph node ratio were identified as independent adverse prognostic indicators on multivariate analysis. CONCLUSIONS: Similar to western societies, the incidence of proximal gastric cancer is increasing in Singapore. Cardia tumors are associated with poorer outcomes, suggesting that cardia cancer is a distinct disease from true gastric cancer requiring different management strategies to improve the outcome for these patients.

Mydriasis during Orbital Floor Fracture Reconstruction: A Novel Diagnostic and Treatment Algorithm.

Orbital floor fractures are the most commonly encountered traumatic fractures in the facial skeleton. Mydriasis that is detected during orbital floor fracture reconstruction may cause significant distress to surgeons, as it may be associated with sinister events such as visual loss. It is not an uncommon problem; previous studies have shown the incidence of mydriasis to be 2.1%. The combination of careful preoperative evaluation and planning, as well as specific intraoperative investigations when mydriasis is encountered, can be immensely valuable in allaying surgeons' anxiety during orbital floor fracture reconstruction. In this review article, the authors discuss the common causes of mydriasis and present a novel systematic approach to its diagnostic evaluation devised by our unit that has been successfully implemented since 2008.

Distance health services under the general agreement on trade in services.

This Article discusses the state of distance health with respect to the General Agreement on Trade in Services (GATS). After examining the various aspects of telemedicine and its place in international trade, the author looks at the structure and functioning of GATS and how telemedicine is regulated under this agreement. The author argues that the potential for telemedicine under this agreement has yet to be fulfilled and suggests a number of ways to realize its potential. Ultimately, however, the author concludes that the single most important international trade objective for the United States healthcare industry should be to get its own house in order with respect to cross-border provision of health services. From an international trade perspective, the problem of non-uniform state licensure requirements within the United States makes it very difficult for the United States to negotiate market access commitments for distance health services with other countries. Therefore, it is not realistic to expect significant progress in the liberalization of distance health services until the United States has in place a reasonably uniform domestic system of licensure and regulation for telemedicine practitioners.