A resonant squid-inspired robot unlocks biological propulsive efficiency.

Elasticity has been linked to the remarkable propulsive efficiency of pulse-jet animals such as the squid and jellyfish, but reports that quantify the underlying dynamics or demonstrate its application in robotic systems are rare. This work identifies the pulse-jet propulsion mode used by these animals as a coupled mass-spring-mass oscillator, enabling the design of a flexible self-propelled robot. We use this system to experimentally demonstrate that resonance greatly benefits pulse-jet swimming speed and efficiency, and the robot's optimal cost of transport is found to match that of the most efficient biological swimmers in nature, such as the jellyfish Aurelia aurita The robot also exhibits a preferred Strouhal number for efficient swimming, thereby bridging the gap between pulse-jet propulsion and established findings in efficient fish swimming. Extensions of the current robotic framework to larger amplitude oscillations could combine resonance effects with optimal vortex formation to further increase propulsive performance and potentially outperform biological swimmers altogether.

Mobile robotic platforms for the acoustic tracking of deep-sea demersal fishery resources.

Knowing the displacement capacity and mobility patterns of industrially exploited (i.e., fished) marine resources is key to establishing effective conservation management strategies in human-impacted marine ecosystems. Acquiring accurate behavioral information of deep-sea fished ecosystems is necessary to establish the sizes of marine protected areas within the framework of large international societal programs (e.g., European Community H2020, as part of the Blue Growth economic strategy). However, such information is currently scarce, and high-frequency and prolonged data collection is rarely available. Here, we report the implementation of autonomous underwater vehicles and remotely operated vehicles as an aid for acoustic long-baseline localization systems for autonomous tracking of Norway lobster (Nephrops norvegicus), one of the key living resources exploited in European waters. In combination with seafloor moored acoustic receivers, we detected and tracked the movements of 33 tagged lobsters at 400-m depth for more than 3 months. We also identified the best procedures to localize both the acoustic receivers and the tagged lobsters, based on algorithms designed for off-the-shelf acoustic tags identification. Autonomous mobile platforms that deliver data on animal behavior beyond traditional fixed platform capabilities represent an advance for prolonged, in situ monitoring of deep-sea benthic animal behavior at meter spatial scales.

The Utilization of Robotic Pets in Dementia Care.

BACKGROUND: Behavioral problems may affect individuals with dementia, increasing the cost and burden of care. Pet therapy has been known to be emotionally beneficial for many years. Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets. Robotic pet therapy offers an alternative to traditional pet therapy. OBJECTIVE: The study rigorously assesses the effectiveness of the PARO robotic pet, an FDA approved biofeedback device, in treating dementia-related symptoms. METHODS: A randomized block design with repeated measurements guided the study. Before and after measures included reliable, valid tools such as: RAID, CSDD, GDS, pulse rate, pulse oximetry, and GSR. Participants interacted with the PARO robotic pet, and the control group received standard activity programs. Five urban secure dementia units comprised the setting. RESULTS: 61 patients, with 77% females, average 83.4 years in age, were randomized into control and treatment groups. Compared to the control group, RAID, CSDD, GSR, and pulse oximetry were increased in the treatment group, while pulse rate, pain medication, and psychoactive medication use were decreased. The changes in GSR, pulse oximetry, and pulse rate over time were plotted for both groups. The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate, while GSR had several weeks when changes were similar between groups. CONCLUSIONS: Treatment with the PARO robot decreased stress and anxiety in the treatment group and resulted in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia.

Mapping Robots to Therapy and Educational Objectives for Children with Autism Spectrum Disorder.

The aim of this study was to increase knowledge on therapy and educational objectives professionals work on with children with autism spectrum disorder (ASD) and to identify corresponding state of the art robots. Focus group sessions (n = 9) with ASD professionals (n = 53) from nine organisations were carried out to create an objectives overview, followed by a systematic literature study to identify state of the art robots matching these objectives. Professionals identified many ASD objectives (n = 74) in 9 different domains. State of the art robots addressed 24 of these objectives in 8 domains. Robots can potentially be applied to a large scope of objectives for children with ASD. This objectives overview functions as a base to guide development of robot interventions for these children.

Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: a comparison of Australian series.

INTRODUCTION: We compare the results of modern external-beam radiotherapy (EBRT), using combined androgen deprivation and dose-escalated intensity-modulated radiotherapy with MRI-CT fusion and daily image guidance with fiducial markers (DE-IG-IMRT), with recently published Australian series of brachytherapy and surgery. METHODS: Five-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) were calculated for 675 patients treated with DE-IG-IMRT and androgen deprivation therapy (ADT). Patients had intermediate-risk (IR) and high-risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. RESULTS: With a median follow-up of 59 months, our 5-year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5-year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5-year bDFS of 65.5% for HR patients. One LDR series reported 5-year bDFS of 85% for IR patients. CONCLUSIONS: Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option.

Cost-effectiveness of robotic surgery in gynecologic oncology.

PURPOSE OF REVIEW: Robotically assisted surgeries have flourished in the United States, especially in gynecological procedures. Current robotic systems have high upfront and procedure costs that have led many in the medical community to question the new technology's cost-effectiveness. RECENT FINDINGS: Recent research continues to find that robotically assisted gynecological cancer treatments have comparable outcomes to traditional laparoscopy and similar or better outcomes than that of laparotomy in the cases studied. However, robotic surgery costs remain higher than that of traditional laparoscopy. SUMMARY: Under the current reimbursement climate, practicing physicians and hospitals should collaborate on identifying cost-effective uses of robotic systems and pushing manufacturers to lower purchase and procedure costs to a level that may be accepted by all stakeholders.

Dolphins, dogs, and robot seals for the treatment of neurological disease.

A growing body of evidence suggests that animal-assisted therapies and activities involving all kinds of real and even robotic animals can have beneficial eff ects in people with neurological disease or mental illness. But what is the quality of that evidence and do these interventions really provide any health benefits? Adrian Burton investigates.

A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons.

OBJECTIVE: To compare early oncological outcomes of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporary cohort. METHODS: We reviewed patients who underwent radical prostatectomy for prostate cancer by high volume surgeons performing RALP or ORP. Biochemical recurrence (BCR) was defined as PSA ≥ 0.1 ng/mL or PSA ≥ 0.05 ng/mL with receipt of additional therapy. A Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (nomogram) based on preoperative stage, grade, volume of disease and PSA. To explore the impact of differences between surgeons, multivariable analyses were repeated using surgeon in place of approach. RESULTS: Of 1454 patients included, 961 (66%) underwent ORP and 493 (34%) RALP and there were no important differences in cancer characteristics by group. Overall, 68% of patients met National Comprehensive Cancer Network (NCCN) criteria for intermediate or high risk disease and 9% had lymph node involvement. Positive margin rates were 15% for both open and robotic groups. In a multivariate model adjusting for preoperative risk there was no significant difference in BCR rates for RALP compared with ORP (hazard ratio 0.88; 95% CI 0.56-1.39; P = 0.6). The interaction term between nomogram risk and procedure type was not statistically significant. Using NCCN risk group as the covariate in a Cox model gave similar results (hazard ratio 0.74; 95% CI 0.47-1.17; P = 0.2). The interaction term between NCCN risk and procedure type was also non-significant. Differences in BCR rates between techniques (4.1% vs 3.3% adjusted risk at 2 years) were smaller than those between surgeons (2.5% to 4.8% adjusted risk at 2 years). CONCLUSIONS: In this relatively high risk cohort of patients undergoing radical prostatectomy we found no evidence to suggest that ORP resulted in better early oncological outcomes then RALP. Oncological outcome after radical prostatectomy may be driven more by surgeon factors than surgical approach.

Trends and attitudes in surgical management of benign prostatic hyperplasia.

INTRODUCTION: Surgical management of benign prostatic hyperplasia (BPH) has changed over the past 15 years with newer techniques emerging such as laser therapy that can be used with anticoagulation, an increasing issue with modern patients. We sought to evaluate current trends in procedure utilization based on age, location, type of practice, and experience. We also hoped to determine what factors influence surgeons' decisions to choose or reject particular surgical techniques. METHODS AND MATERIALS: A 90-item on-line survey was sent via electronic mail to the American Urological Association (AUA), Veterans Administration, Society for Government Service Urologists, and Endourological Society. Data concerning utilization of 12 BPH surgical techniques were analyzed and compared to the surgeons' demographics using categorical data analysis and logistic regression. RESULTS: Of approximately 5500 urologists contacted, 600 urologists replied with 570 currently performing BPH surgery. The two procedures that continue to be utilized by urologists are open prostatectomy (OP) at 78% and monopolar transurethral resection of prostate (TURP) at 73%. When stratified by urologist age and year of residency completion, there were no differences in procedure utilization. There were no differences in types of procedures utilized between AUA sections except in the Northeastern AUA section which utilized less monopolar TURP and the New York section which utilized less photoselective vaporization (PVP). Higher volume surgeons were more likely to perform holmium laser enucleation of the prostate (HoLEP), diode laser vaporization of the prostate, holmium laser ablation of the prostate (HoLAP), and thulium laser ablation. There were no trends for low volume surgeons. There were no differences in types of procedures performed in full time academic versus non-academic settings except for robotic prostatectomy and button TURP which were utilized more often in academic settings. Urologists were more likely to accept a technique that produces good clinical outcomes, is safe in practice, and minimally invasive. Urologists reject procedures most frequently due to preference for another technique or lack of training/equipment. Interestingly, reimbursement/cost issues were never reported as primary reasons for acceptance/rejection of any approach. CONCLUSIONS: Change in technology has led urologists to change their approach to surgical treatment of BPH. OP and monopolar TURP are still the procedures utilized by most urologists, however, laser therapy is emerging as a commonly used technique. As more high-risk patients are treated, laser therapies may become a more popularized technique. Further larger scale studies evaluating surgeon attitudes might clarify how changing technology influences practice patterns.

Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke.

BACKGROUND: An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and functional electrical stimulation (FES) to reduce upper limb impairments, but current systems may not encourage maximal voluntary contribution from the participant because assistance is not responsive to performance. OBJECTIVE: This study aimed to investigate whether iterative learning control (ILC) mediated by FES is a feasible intervention in upper limb stroke rehabilitation. METHODS: Five hemiparetic participants with reduced upper limb function who were at least 6 months poststroke were recruited from the community. No participants withdrew. INTERVENTION: Participants undertook supported tracking tasks using 27 different trajectories augmented by responsive FES to their triceps brachii muscle, with their hand movement constrained in a 2-dimensional plane by a robot. Eighteen 1-hour treatment sessions were used with 2 participants receiving an additional 7 treatment sessions. OUTCOME MEASURES: The primary functional outcome measure was the Action Research Arm Test (ARAT). Impairment measures included the upper limb Fugl-Meyer Assessment (FMA), tests of motor control (tracking accuracy), and isometric force. RESULTS: Compliance was excellent and there were no adverse events. Statistically significant improvements were measured (P

Assessment of walking performance in robot-assisted gait training: a novel approach based on empirical data.

Motivation and voluntary drive of patients can be improved by applying biofeedback during robot-assisted rehabilitation trainings. Biofeedback systems were traditionally based on theoretical assumptions. In this paper, we present a novel approach to calculate biofeedback during robot-assisted gait training. Our method was based on empirical data that were obtained from healthy subjects when simulating distinctive degrees of walking performance during robot-assisted gait training. This empirical data-based biofeedback (EDBF) method was evaluated with 18 subjects without gait disorders. A higher correlation between the subjects' walking performance and biofeedback values was found for the EDBF method compared to a theory-based biofeedback approach.

Standardized patients and mechanical simulators in teaching and assessment at colleges of osteopathic medicine.

CONTEXT: A 2001 survey of 19 colleges of osteopathic medicine (COMs) revealed that standardized patient programs (SPPs) are increasingly used in osteopathic medical education. However, no new data have been published since. OBJECTIVES: To evaluate current SPP and mechanical simulator use at COMs compared with previous survey results. METHODS: In 2005, an electronic survey regarding the use of SPPs (eg, staffing, facilities) and mechanical simulators in the teaching and assessment of students' clinical skills was sent to the deans of the 23 fully accredited COMs and branch campuses. RESULTS: Responses were received from all 23 COMs for a 100% response rate. According to survey results, 19 COMs (87%) had active SPPs, 2 COMs (9%) reported that SPPs were in development, and the remaining 2 COMs (9%) used students as patients. In comparison, only 12 COMs (63%) in 2001 had active SPPs. Results indicated an increased use of standardized patients for assessment, particularly in physician-patient communication, osteopathic manipulative medicine, and osteopathic manipulative treatment. In addition, 12 COMs (52%) reported using mechanical simulators in the teaching or assessment of clinical skills. CONCLUSION: From 2001 to 2005, the use of SPPs and mechanical simulators at COMs increased substantially.