Christian anthropology-based contributions to the ethics of socially assistive robots in care for older adults.

Our society, in general, and health care, in particular, faces notable challenges due to the emergence of innovative digital technologies. The use of socially assistive robots in aged care is a particular digital application that provokes ethical reflection. The answers we give to the ethical questions associated with socially assistive robots are framed by ontological and anthropological considerations of what constitutes human beings and how the meaning of being human relates to how these robots are conceived. Religious beliefs and secular worldviews, each of which may participate fully in pluralist societies, have an important responsibility in this foundational debate, as anthropological theories can be inspired by religious and secular viewpoints. This article identifies seven anthropological considerations grounded in the synthesis of biblical scriptures, Roman Catholic documents, and recent research literature. We highlight the inspirational quality of these anthropological considerations when dealing with ethical issues regarding the development and use of socially assistive robots in aged care. With this contribution, we aim to foster a global and inclusive dialogue on digitalization in aged care that deeply challenges our basic understanding of what constitutes a human being and how this notion relates to machine artefacts.

Design, fabrication, and characterization of a multimodal reconfigurable bioreactor for bone tissue engineering.

In the past decades, bone tissue engineering developed and exploited many typologies of bioreactors, which, besides providing proper culture conditions, aimed at integrating those bio-physical stimulations that cells experience in vivo, to promote osteogenic differentiation. Nevertheless, the highly challenging combination and deployment of many stimulation systems into a single bioreactor led to the generation of several unimodal bioreactors, investigating one or at mostly two of the required biophysical stimuli. These systems miss the physiological mimicry of bone cells environment, and often produced contrasting results, thus making the knowledge of bone mechanotransduction fragmented and often inconsistent. To overcome this issue, in this study we developed a perfusion and electroactive-vibrational reconfigurable stimulation bioreactor to investigate the differentiation of SaOS-2 bone-derived cells, hosting a piezoelectric nanocomposite membrane as cell culture substrate. This multimodal perfusion bioreactor is designed based on a numerical (finite element) model aimed at assessing the possibility to induce membrane nano-scaled vibrations (with ~12 nm amplitude at a frequency of 939 kHz) during perfusion (featuring 1.46 dyn cm-2 wall shear stress), large enough for inducing a physiologically-relevant electric output (in the order of 10 mV on average) on the membrane surface. This study explored the effects of different stimuli individually, enabling to switch on one stimulation at a time, and then to combine them to induce a faster bone matrix deposition rate. Biological results demonstrate that the multimodal configuration is the most effective in inducing SaOS-2 cell differentiation, leading to 20-fold higher collagen deposition compared to static cultures, and to 1.6- and 1.2-fold higher deposition than the perfused- or vibrated-only cultures. These promising results can provide tissue engineering scientists with a comprehensive and biomimetic stimulation platform for a better understanding of mechanotransduction phenomena beyond cells differentiation.

A novel microwave tool for robotic liver resection in minimally invasive surgery.

INTRODUCTION: During the last two decades, many surgical procedures have evolved from open surgery to minimally invasive surgery (MIS). This limited invasiveness has motivated the development of robotic assistance platforms to obtain better surgical outcomes. Nowadays, the da Vinci robot is a commercial tele-robotic platform widely used for different surgical applications. MATERIAL AND METHODS: In this work, the da Vinci Research Kit (dVRK), namely the research version of the da Vinci, is used to manipulate a novel microwave device in a teleoperation scenario. The dVRK provides an open source platform, so that the novel microwave tool, dedicated to prevention bleeding during hepatic resection surgery, is mechanically integrated on the slave side, while the software interface is adapted in order to correctly control tool pose. Tool integration is validated through in-vitro and ex-vivo tests performed by expert surgeons, meanwhile the coagulative efficacy of the developed tool in a perfused liver model was proved in in-vivo tests. RESULTS AND CONCLUSIONS: An innovative microwave tool for liver robotic resection has been realized and integrated into a surgical robot. The tool can be easily operated through the dVRK without limiting the intuitive and friendly use, and thus easily reaching the hemostasis of vessels.

A 3D Real-Scale, Biomimetic, and Biohybrid Model of the Blood-Brain Barrier Fabricated through Two-Photon Lithography.

The investigation of the crossing of exogenous substances through the blood-brain barrier (BBB) is object of intensive research in biomedicine, and one of the main obstacles for reliable in vitro evaluations is represented by the difficulties at the base of developing realistic models of the barrier, which could resemble as most accurately as possible the in vivo environment. Here, for the first time, a 1:1 scale, biomimetic, and biohybrid BBB model is proposed. Microtubes inspired to the brain capillaries were fabricated through two-photon lithography and used as scaffolds for the co-culturing of endothelial-like bEnd.3 and U87 glioblastoma cells. The constructs show the maturation of tight junctions, good performances in terms of hindering dextran diffusion through the barrier, and a satisfactory trans-endothelial electrical resistance. Moreover, a mathematical model is developed, which assists in both the design of the 3D microfluidic chip and its characterization. Overall, these results show the effective formation of a bioinspired cellular barrier based on microtubes reproducing brain microcapillaries to scale. This system will be exploited as a realistic in vitro model for the investigation of BBB crossing of nanomaterials and drugs, envisaging therapeutic and diagnostic applications for several brain pathologies, including brain cancer.

Ultrasound-activated piezoelectric P(VDF-TrFE)/boron nitride nanotube composite films promote differentiation of human SaOS-2 osteoblast-like cells.

Piezoelectric films of poly(vinylidenedifluoride-trifluoroethylene) (P(VDF-TrFE)) and of P(VDF-TrFE)/boron nitride nanotubes (BNNTs) were prepared by cast-annealing and used for SaOS-2 osteoblast-like cell culture. Films were characterized in terms of surface and bulk features, and composite films demonstrated enhanced piezoresponse compared to plain polymeric films (d31 increased by ~80%). Osteogenic differentiation was evaluated in terms of calcium deposition, collagen I secretion, and transcriptional levels of marker genes (Alpl, Col1a1, Ibsp, and Sparc) in cells either exposed or not to ultrasounds (US); finally, a numerical model suggested that the induced voltage (~20-60 mV) is suitable for cell stimulation. Although preliminary, our results are extremely promising and encourage the use of piezoelectric P(VDF-TrFE)/BNNT films in bone tissue regeneration.

A Biohybrid Self-Dispersing Miniature Machine Using Wild Oat Fruit Awns for Reforestation and Precision Agriculture.

Advances in bioinspired and biohybrid robotics are enabling the creation of multifunctional systems able to explore complex unstructured environments. Inspired by Avena fruits, a biohybrid miniaturized autonomous machine (HybriBot) composed of a biomimetic biodegradable capsule as cargo delivery system and natural humidity-driven sister awns as biological motors is reported. Microcomputed tomography, molding via two-photon polymerization and casting of natural awns into biodegradable materials is employed to fabricate multiple HybriBots capable of exploring various soil and navigating soil irregularities, such as holes and cracks. These machines replicate the dispersal movements and biomechanical performances of natural fruits, achieving comparable capsule drag forces up to ≈0.38 N and awns torque up to ≈100 mN mm-1. They are functionalized with fertilizer and are successfully utilized to germinate selected diaspores. HybriBots function as self-dispersed systems with applications in reforestation and precision agriculture.

Remotely Controlled 3D-Engineered Scaffolds for Biomimetic In Vitro Investigations on Brain Cell Cocultures.

Most in vitro studies regarding new anticancer treatments are performed on 2D cultures, despite this approach imposes several limitations in recapitulating the real tumor behavior and in predicting the effects of therapy on both cancer and healthy tissues. Herein, advanced in vitro models based on scaffolds that support the 3D growth of glioma cells, further allowing the cocultures with healthy brain cells, are presented. These scaffolds, doped with superparamagnetic iron oxide nanoparticles and obtained through 2-photon polymerization, can be remotely manipulated thanks to an external magnet, thus obtaining biomimetic 3D organization recapitulating the brain cancer microenvironment. From a geometric point of view, the structure is functional to both cell culture on individual unit scaffolds and to tailored cocultures fostered by magnetic-driven unit assembly, also allowing for cell migration thanks to passages/fenestrations on adjacent structures. Leveraging magnetic dragging, for which a mathematical model is introduced, multiple cocultures are achieved, highlighting the high versatility and the user-friendly character of the proposed platform that can help overcome the current challenges in 3D cocultures handling, and open the way to the construction of increasingly biomimetic artificial systems.

Exact and Computationally Robust Solutions for Cylindrical Magnets Systems with Programmable Magnetization.

Magnetic systems based on permanent magnets are receiving growing attention, in particular for micro/millirobotics and biomedical applications. Their design landscape is expanded by the possibility to program magnetization, yet enabling analytical results, crucial for containing computational costs, are lacking. The dipole approximation is systematically used (and often strained), because exact and computationally robust solutions are to be unveiled even for common geometries such as cylindrical magnets, which are ubiquitously used in fundamental research and applications. In this study, exact solutions are disclosed for magnetic field and gradient of a cylindrical magnet with generic uniform magnetization, which can be robustly computed everywhere within and outside the magnet, and directly extend to magnets systems of arbitrary complexity. Based on them, exact and computationally robust solutions are unveiled for force and torque between coaxial magnets. The obtained analytical solutions overstep the dipole approximation, thus filling a long-standing gap, and offer strong computational gains versus numerical simulations (up to 106 , for the considered test-cases). Moreover, they bridge to a variety of applications, as illustrated through a compact magnets array that could be used to advance state-of-the-art biomedical tools, by creating, based on programmable magnetization patterns, circumferential and helical force traps for magnetoresponsive diagnostic/therapeutic agents.

Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices.

Cardiovascular diseases are the leading cause of death worldwide; they are mainly due to vascular obstructions which, in turn, are mainly caused by thrombi and atherosclerotic plaques. Although a variety of removal strategies has been developed for the considered obstructions, none of them is free from limitations and conclusive. The present paper analyzes the physical mechanisms underlying state-of-art removal strategies and classifies them into chemical, mechanical, laser and hybrid (namely chemo-mechanical and mechano-chemical) approaches, while also reviewing corresponding commercial/research tools/devices and procedures. Furthermore, challenges and opportunities for interventional micro/nanodevices are highlighted. In this spirit, the present review should support engineers, researchers active in the micro/nanotechnology field, as well as medical doctors in the development of innovative biomedical solutions for treating vascular obstructions. Data were collected by using the ISI Web of Knowledge portal, buyer's guides and FDA databases; devices not reported on scientific publications, as well as commercial devices no more for sale were discarded. Nearly 70% of the references were published since 2006, 55% since 2008; these percentages respectively raise to 85% and 65% as regards the section specifically reviewing state-of-art removal tools/devices and procedures.

Soft Graspers for Safe and Effective Tissue Clutching in Minimally Invasive Surgery.

OBJECTIVE: Surgical graspers must be safe, not to damage tissue, and effective, to establish a stable contact for operation. For conventional rigid graspers, these requirements are conflicting and tissue damage is often induced. We thus proposed novel soft graspers, based on morphing jaws that increase contact area with clutching force. METHODS: We introduced two soft jaw concepts: DJ and CJ. They were designed (using analytical and numerical models) and prototyped (10 mm diameter, 10 mm span). Corresponding graspers were obtained by integrating the jaws into a conventional tool used in the dVRK surgical robotics platform. Morphing performance was experimentally characterized. Jaw-tissue interaction was quantitatively assessed through damage indicators obtained from ex vivo tests and histological analysis, also comparing DJ, CJ and dVRK rigid jaws. Soft graspers were demonstrated through ex vivo tests on dVRK. Ex vivo tests and related analysis were devised/performed with medical doctors. RESULTS: Design goal was achieved for both soft jaws: by morphing, contact area exceeded by 20-30% the maximum area allowed by encumbrance specifications to rigid jaws. Experimental characterization was in good agreement with model predictions (error ≈ 4%). Damage indicators showed differences amongst DJ, CJ and dVRK jaws (ANOVA p-value  =  0.0005): damage was one order of magnitude lower for soft graspers (each pairwise comparison was statistically significant). CONCLUSION: We proposed and demonstrated soft graspers potentially less harmful to tissue than conventional graspers. SIGNIFICANCE: Beyond minimally invasive surgery, the proposed concepts and design methodology can foster the development of graspers for soft robotics.

Toward Mechanochromic Soft Material-Based Visual Feedback for Electronics-Free Surgical Effectors.

A chromogenically reversible, mechanochromic pressure sensor is integrated into a mininvasive surgical grasper compatible with the da Vinci robotic surgical system. The sensorized effector, also featuring two soft-material jaws, encompasses a mechanochromic polymeric inset doped with functionalized spiropyran (SP) molecule, designed to activate mechanochromism at a chosen pressure and providing a reversible color change. Considering such tools are systematically in the visual field of the operator during surgery, color change of the mechanochromic effector can help avoid tissue damage. No electronics is required to control the devised visual feedback. SP-doping of polydimethylsiloxane (2.5:1 prepolymer/curing agent weight ratio) permits to modulate the mechanochromic activation pressure, with lower values around 1.17 MPa for a 2% wt. SP concentration, leading to a shorter chromogenic recovery time of 150 s at room temperature (25 °C) under green light illumination. Nearly three-times shorter recovery time is observed at body temperature (37 °C). To the best of knowledge, this study provides the first demonstration of mechanochromic materials in surgery, in particular to sensorize unpowered surgical effectors, by avoiding dramatic increases in tool complexity due to additional electronics, thus fostering their application. The proposed sensing strategy can be extended to further tools and scopes.

Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study.

OBJECTIVE: Intraoperative palpation is a surgical gesture jeopardized by the lack of haptic feedback which affects robotic minimally invasive surgery. Restoring the force reflection in teleoperated systems may improve both surgeons' performance and procedures' outcome. METHODS: A force-based sensing approach was developed, based on a cable-driven parallel manipulator with anticipated seamless and low-cost integration capabilities in teleoperated robotic surgery. No force sensor on the end-effector is used, but tissue probing forces are estimated from measured cable tensions. A user study involving surgical trainees (n = 22) was conducted to experimentally evaluate the platform in two palpation-based test-cases on silicone phantoms. Two modalities were compared: visual feedback alone and both visual + haptic feedbacks available at the master site. RESULTS: Surgical trainees' preference for the modality providing both visual and haptic feedback is corroborated by both quantitative and qualitative metrics. Hard nodules detection sensitivity improves (94.35 ± 9.1% vs 76.09 ± 19.15% for visual feedback alone), while also exerting smaller forces (4.13 ± 1.02 N vs 4.82 ± 0.81 N for visual feedback alone) on the phantom tissues. At the same time, the subjective perceived workload decreases. CONCLUSION: Tissue-probe contact forces are estimated in a low cost and unique way, without the need of force sensors on the end-effector. Haptics demonstrated an improvement in the tumor detection rate, a reduction of the probing forces, and a decrease in the perceived workload for the trainees. SIGNIFICANCE: Relevant benefits are demonstrated from the usage of combined cable-driven parallel manipulators and haptics during robotic minimally invasive procedures. The translation of robotic intraoperative palpation to clinical practice could improve the detection and dissection of cancer nodules.

Light-assisted electrospinning monitoring for soft polymeric nanofibers.

A real-time tool to monitor the electrospinning process is fundamental to improve the reproducibility and quality of the resulting nanofibers. Hereby, a novel optical system integrated through coaxial needle is proposed as monitoring tool for electrospinning process. An optical fiber (OF) is inserted in the inner needle, while the external needle is used to feed the polymeric solution (PEO/water) drawn by the process. The light exiting the OF passes through the solution drop at the needle tip and gets coupled to the electrospun fiber (EF) while travelling towards the nanofibers collector. Numerical and analytical models were developed to assess the feasibility and robustness of the light coupling. Experimental tests demonstrated the influence of the process parameters on the EF waveguide properties, in terms of waveguide length (L), and on the nanofibers diameter distribution, in terms of mean [Formula: see text] and normalized standard deviation [Formula: see text]. Data analysis reveals good correlation between L and [Formula: see text] (respectively maximum correlation coefficients of [Formula: see text] = 0.88 and [Formula: see text] = 0.84), demonstrating the potential for effectively using the proposed light-assisted technology as real-time visual feedback on the process. The developed system can provide an interesting option for monitoring industrial electrospinning systems using multi- or moving needles with impact in the scaling-up of innovative nanofibers for soft systems.

Positioning and stiffening of an articulated/continuum manipulator for implant delivery in minimally invasive surgery.

BACKGROUND: Hollow, bendable manipulators can advance implant delivery in minimally invasive surgery, by circumventing the drawbacks of straight-line delivery and fostering single-port approaches. Variable stiffness manipulators are sought to be safe and effective. METHODS: We designed and experimentally assessed a cable-driven articulated/continuum manipulator, devised for cardiac valve delivery. Positioning and stiffening were teleoperated, based on cable shortening. Stiffening was parameterized by using the leading tension (LT, ie, tension of the cables driving bending). We assessed positioning (repeatability/reversibility along eight/two bending directions) and stiffening (eight bent configurations). RESULTS: We achieved good repeatability and reversibility (mean errors <1% and 1.5%, respectively, of the workspace characteristic length). Stiffening was effective (up to 9-fold increase, depending on pose). Stiffening was linearly correlated (R2 = 0.92) with LT for all the considered configurations. CONCLUSION: We accurately positioned and effectively stiffened the manipulator in several bent configurations. The proposed stiffness modulation strategy can be extended to other manipulators.

Enhanced In Vitro Magnetic Cell Targeting of Doxorubicin-Loaded Magnetic Liposomes for Localized Cancer Therapy.

The lack of efficient targeting strategies poses significant limitations on the effectiveness of chemotherapeutic treatments. This issue also affects drug-loaded nanocarriers, reducing nanoparticles cancer cell uptake. We report on the fabrication and in vitro characterization of doxorubicin-loaded magnetic liposomes for localized treatment of liver malignancies. Colloidal stability, superparamagnetic behavior and efficient drug loading of our formulation were demonstrated. The application of an external magnetic field guaranteed enhanced nanocarriers cell uptake under cell medium flow in correspondence of a specific area, as we reported through in vitro investigation. A numerical model was used to validate experimental data of magnetic targeting, proving the possibility of accurately describing the targeting strategy and predict liposomes accumulation under different environmental conditions. Finally, in vitro studies on HepG2 cancer cells confirmed the cytotoxicity of drug-loaded magnetic liposomes, with cell viability reduction of about 50% and 80% after 24 h and 72 h of incubation, respectively. Conversely, plain nanocarriers showed no anti-proliferative effects, confirming the formulation safety. Overall, these results demonstrated significant targeting efficiency and anticancer activity of our nanocarriers and superparamagnetic nanoparticles entrapment could envision the theranostic potential of the formulation. The proposed magnetic targeting study could represent a valid tool for pre-clinical investigation regarding the effectiveness of magnetic drug targeting.

A Machine-Learning-Based Approach to Solve Both Contact Location and Force in Soft Material Tactile Sensors.

This study addresses a design and calibration methodology based on numerical finite element method (FEM) modeling for the development of a soft tactile sensor able to simultaneously solve the magnitude and the application location of a normal load exerted onto its surface. The sensor entails the integration of a Bragg grating fiber optic sensor in a Dragon Skin 10 polymer brick (110 mm length, 24 mm width). The soft polymer mediates the transmission of the applied load to the buried fiber Bragg gratings (FBGs), and we also investigated the effect of sensor thickness on receptive field and sensitivity, both with the developed model and experimentally. Force-controlled indentations of the sensor (up to 2.5 N) were carried out through a cylindrical probe applied along the direction of the optical fiber (over an ∼90 mm span in length). A finite element model of the sensor was built and experimentally validated for 1 and 6 mm thicknesses of the soft polymeric encapsulation material, considering that the latter thickness resulted from numerical simulations as leading to optimal cross talk and sensitivity, given the chosen soft material. The FEM model was also used to train a neural network so as to obtain the inverse sensor function. Using four FBG transducers embedded in the 6-mm-thick soft polymer, the proposed machine learning approach managed to accurately detect both load magnitude (R = 0.97) and location (R = 0.99) over the whole experimental range. The proposed system could be used for developing tactile sensors that can be effectively used for a broad range of applications.

Polydopamine Nanoparticles as an Organic and Biodegradable Multitasking Tool for Neuroprotection and Remote Neuronal Stimulation.

Oxidative stress represents a common issue in most neurological diseases, causing severe impairments of neuronal cell physiological activity that ultimately lead to neuron loss of function and cellular death. In this work, lipid-coated polydopamine nanoparticles (L-PDNPs) are proposed both as antioxidant and neuroprotective agents, and as a photothermal conversion platform able to stimulate neuronal activity. L-PDNPs showed the ability to counteract reactive oxygen species (ROS) accumulation in differentiated SH-SY5Y, prevented mitochondrial ROS-induced dysfunctions and stimulated neurite outgrowth. Moreover, for the first time in the literature, the photothermal conversion capacity of L-PDNPs was used to increase the intracellular temperature of neuron-like cells through near-infrared (NIR) laser stimulation, and this phenomenon was thoroughly investigated using a fluorescent temperature-sensitive dye and modeled from a mathematical point of view. It was also demonstrated that the increment in temperature caused by the NIR stimulation of L-PDNPs was able to produce a Ca2+ influx in differentiated SH-SY5Y, being, to the best of our knowledge, the first example of organic nanostructures used in such an approach. This work could pave the way to new and exciting applications of polydopamine-based and of other NIR-responsive antioxidant nanomaterials in neuronal research.

A variable-stiffness tendril-like soft robot based on reversible osmotic actuation.

Soft robots hold promise for well-matched interactions with delicate objects, humans and unstructured environments owing to their intrinsic material compliance. Movement and stiffness modulation, which is challenging yet needed for an effective demonstration, can be devised by drawing inspiration from plants. Plants use a coordinated and reversible modulation of intracellular turgor (pressure) to tune their stiffness and achieve macroscopic movements. Plant-inspired osmotic actuation was recently proposed, yet reversibility is still an open issue hampering its implementation, also in soft robotics. Here we show a reversible osmotic actuation strategy based on the electrosorption of ions on flexible porous carbon electrodes driven at low input voltages (1.3 V). We demonstrate reversible stiffening (~5-fold increase) and actuation (~500 deg rotation) of a tendril-like soft robot (diameter ~1 mm). Our approach highlights the potential of plant-inspired technologies for developing soft robots based on biocompatible materials and safe voltages making them appealing for prospective applications.

Tactile Sensing and Control of Robotic Manipulator Integrating Fiber Bragg Grating Strain-Sensor.

Tactile sensing is an instrumental modality of robotic manipulation, as it provides information that is not accessible via remote sensors such as cameras or lidars. Touch is particularly crucial in unstructured environments, where the robot's internal representation of manipulated objects is uncertain. In this study we present the sensorization of an existing artificial hand, with the aim to achieve fine control of robotic limbs and perception of object's physical properties. Tactile feedback is conveyed by means of a soft sensor integrated at the fingertip of a robotic hand. The sensor consists of an optical fiber, housing Fiber Bragg Gratings (FBGs) transducers, embedded into a soft polymeric material integrated on a rigid hand. Through several tasks involving grasps of different objects in various conditions, the ability of the system to acquire information is assessed. Results show that a classifier based on the sensor outputs of the robotic hand is capable of accurately detecting both size and rigidity of the operated objects (99.36 and 100% accuracy, respectively). Furthermore, the outputs provide evidence of the ability to grab fragile objects without breakage or slippage e and to perform dynamic manipulative tasks, that involve the adaptation of fingers position based on the grasped objects' condition.

Haptic feedback in the da Vinci Research Kit (dVRK): A user study based on grasping, palpation, and incision tasks.

BACKGROUND: It was suggested that the lack of haptic feedback, formerly considered a limitation for the da Vinci robotic system, does not affect robotic surgeons because of training and compensation based on visual feedback. However, conclusive studies are still missing, and the interest in force reflection is rising again. METHODS: We integrated a seven-DoF master into the da Vinci Research Kit. We designed tissue grasping, palpation, and incision tasks with robotic surgeons, to be performed by three groups of users (expert surgeons, medical residents, and nonsurgeons, five users/group), either with or without haptic feedback. Task-specific quantitative metrics and a questionnaire were used for assessment. RESULTS: Force reflection made a statistically significant difference for both palpation (improved inclusion detection rate) and incision (decreased tissue damage). CONCLUSIONS: Haptic feedback can improve key surgical outcomes for tasks requiring a pronounced cognitive burden for the surgeon, to be possibly negotiated with longer completion times.