A Concurrent Framework for Constrained Inverse Kinematics of Minimally Invasive Surgical Robots.

Minimally invasive surgery has undergone significant advancements in recent years, transforming various surgical procedures by minimizing patient trauma, postoperative pain, and recovery time. However, the use of robotic systems in minimally invasive surgery introduces significant challenges related to the control of the robot's motion and the accuracy of its movements. In particular, the inverse kinematics (IK) problem is critical for robot-assisted minimally invasive surgery (RMIS), where satisfying the remote center of motion (RCM) constraint is essential to prevent tissue damage at the incision point. Several IK strategies have been proposed for RMIS, including classical inverse Jacobian IK and optimization-based approaches. However, these methods have limitations and perform differently depending on the kinematic configuration. To address these challenges, we propose a novel concurrent IK framework that combines the strengths of both approaches and explicitly incorporates RCM constraints and joint limits into the optimization process. In this paper, we present the design and implementation of concurrent inverse kinematics solvers, as well as experimental validation in both simulation and real-world scenarios. Concurrent IK solvers outperform single-method solvers, achieving a 100% solve rate and reducing the IK solving time by up to 85% for an endoscope positioning task and 37% for a tool pose control task. In particular, the combination of an iterative inverse Jacobian method with a hierarchical quadratic programming method showed the highest average solve rate and lowest computation time in real-world experiments. Our results demonstrate that concurrent IK solving provides a novel and effective solution to the constrained IK problem in RMIS applications.

Endoscope Automation Framework with Hierarchical Control and Interactive Perception for Multi-Tool Tracking in Minimally Invasive Surgery.

In the context of Minimally Invasive Surgery, surgeons mainly rely on visual feedback during medical operations. In common procedures such as tissue resection, the automation of endoscopic control is crucial yet challenging, particularly due to the interactive dynamics of multi-agent operations and the necessity for real-time adaptation. This paper introduces a novel framework that unites a Hierarchical Quadratic Programming controller with an advanced interactive perception module. This integration addresses the need for adaptive visual field control and robust tool tracking in the operating scene, ensuring that surgeons and assistants have optimal viewpoint throughout the surgical task. The proposed framework handles multiple objectives within predefined thresholds, ensuring efficient tracking even amidst changes in operating backgrounds, varying lighting conditions, and partial occlusions. Empirical validations in scenarios involving single, double, and quadruple tool tracking during tissue resection tasks have underscored the system's robustness and adaptability. The positive feedback from user studies, coupled with the low cognitive and physical strain reported by surgeons and assistants, highlight the system's potential for real-world application.

Improved Antibody-Specific Epitope Prediction Using AlphaFold and AbAdapt.

Antibodies recognize their cognate antigens with high affinity and specificity, but the prediction of binding sites on the antigen (epitope) corresponding to a specific antibody remains a challenging problem. To address this problem, we developed AbAdapt, a pipeline that integrates antibody and antigen structural modeling with rigid docking in order to derive antibody-antigen specific features for epitope prediction. In this study, we systematically assessed the impact of integrating the state-of-the-art protein modeling method AlphaFold with the AbAdapt pipeline. By incorporating more accurate antibody models, we observed improvement in docking, paratope prediction, and prediction of antibody-specific epitopes. We further applied AbAdapt-AF in an anti-receptor binding domain (RBD) antibody complex benchmark and found AbAdapt-AF outperformed three alternative docking methods. Also, AbAdapt-AF demonstrated higher epitope prediction accuracy than other tested epitope prediction tools in the anti-RBD antibody complex benchmark. We anticipate that AbAdapt-AF will facilitate prediction of antigen-antibody interactions in a wide range of applications.

The relation between emotion regulation choice and posttraumatic growth.

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.

The association between cognitive decline and incident depressive symptoms in a sample of older Puerto Rican adults with diabetes.

BACKGROUND: Older Puerto Rican adults have particularly high risk of diabetes compared to the general US population. Diabetes is associated with both higher depressive symptoms and cognitive decline, but less is known about the longitudinal relationship between cognitive decline and incident depressive symptoms in those with diabetes. This study investigated the association between cognitive decline and incident depressive symptoms in older Puerto Rican adults with diabetes over a four-year period. METHODS: Households across Puerto Rico were visited to identify a population-based sample of adults aged 60 years and over for the Puerto Rican Elderly: Health Conditions study (PREHCO); 680 participants with diabetes at baseline and no baseline cognitive impairment were included in analyses. Cognitive decline and depressive symptoms were measured using the Mini-Mental Cabán (MMC) and Geriatric Depression Scale (GDS), respectively. We examined predictors of incident depressive symptoms (GDS ≥ 5 at follow-up but not baseline) and cognitive decline using regression modeling. RESULTS: In a covariate-adjusted logistic regression model, cognitive decline, female gender, and greater diabetes-related complications were each significantly associated with increased odds of incident depressive symptoms (p < 0.05). In a multiple regression model adjusted for covariates, incident depressive symptoms and older age were associated with greater cognitive decline, and higher education was related to less cognitive decline (p < 0.05). CONCLUSIONS: Incident depressive symptoms were more common for older Puerto Ricans with diabetes who also experienced cognitive decline. Efforts are needed to optimize diabetes management and monitor for depression and cognitive decline in this population.

The two sides of adversity: the effect of distant versus recent adversity on updating emotional content in working memory.

Previous research suggests that adversity can have both adaptive and maladaptive effects, yet the emotional and working memory processes that contribute to more or less adaptive outcomes are unclear. The present study sought to investigate how updating emotional content differs in adolescents who have experienced past, recent, or no adversity. Participants who had experienced distant adversity (N = 53), no adversity (N = 58), or recent adversity only (N = 20) performed an emotion n-back task with emotional facial expressions. Results revealed that the distant adversity group exhibited significantly faster reaction times (RTs) than the no adversity and recent adversity only groups. In contrast, the recent adversity only group exhibited significantly slower RTs and more errors than the distant adversity and no adversity groups. These results suggest an emotion and executive control pathway by which both the benefits and negative effects of adversity may be conferred. Results also highlight the importance of time in assessing the impact of adversity.

Multimodal semi-supervised learning for online recognition of multi-granularity surgical workflows.

Purpose Surgical workflow recognition is a challenging task that requires understanding multiple aspects of surgery, such as gestures, phases, and steps. However, most existing methods focus on single-task or single-modal models and rely on costly annotations for training. To address these limitations, we propose a novel semi-supervised learning approach that leverages multimodal data and self-supervision to create meaningful representations for various surgical tasks. Methods Our representation learning approach conducts two processes. In the first stage, time contrastive learning is used to learn spatiotemporal visual features from video data, without any labels. In the second stage, multimodal VAE fuses the visual features with kinematic data to obtain a shared representation, which is fed into recurrent neural networks for online recognition. Results Our method is evaluated on two datasets: JIGSAWS and MISAW. We confirmed that it achieved comparable or better performance in multi-granularity workflow recognition compared to fully supervised models specialized for each task. On the JIGSAWS Suturing dataset, we achieve a gesture recognition accuracy of 83.3%. In addition, our model is more efficient in annotation usage, as it can maintain high performance with only half of the labels. On the MISAW dataset, we achieve 84.0% AD-Accuracy in phase recognition and 56.8% AD-Accuracy in step recognition. Conclusion Our multimodal representation exhibits versatility across various surgical tasks and enhances annotation efficiency. This work has significant implications for real-time decision-making systems within the operating room.

A Multi-Component Educational Intervention for Addressing Levels of Physical Activity and Sedentary Behaviors of Schoolchildren.

Physical inactivity and a sedentary lifestyle are risk factors for excess weight and obesity in childhood. It is, therefore, necessary to adopt strategies which can modify these behaviors during childhood, the age at which habits are formed. This study aimed to evaluate the impact of an educational intervention using digital media and face-to-face activities involving children, parents, and the school community on the level of physical activity and sedentary behavior among schoolchildren. This was a secondary analysis of data obtained from a community trial in which students from four primary schools in Mexico City participated. Two schools were assigned to the intervention group (IG) and two to the control group (CG). The intervention lasted 12 months and included a face-to-face component, which involved sessions and workshops for parents and children, as well as visual material for children and a distance component utilizing electronic means (web portal and text messages to mobile phones) for parents. Anthropometric measurements were taken and information was collected on moderate to vigorous physical activity performed by the children and on the time that the schoolchildren spent in front of screens at the beginning of the study and at 6 and 12 months. Information on 201 children from the IG and 167 children from the CG was included in the analysis. At 12 months, the IG showed a mean decrease of 33.4 min/d [95% CI: -53.5 to -13.3] in screen time, while the CG showed an increase of 12.5 min/d [CI 95%: -10.5 to 35.6], p = 0.003. After 12 months of follow-up, applying this educational intervention reduced the time that schoolchildren spent in front of screens. Educational intervention is a feasible and accessible strategy for promoting changes in sedentary behaviors in the school-age population.

AbAdapt: an adaptive approach to predicting antibody-antigen complex structures from sequence.

Motivation: The scoring of antibody-antigen docked poses starting from unbound homology models has not been systematically optimized for a large and diverse set of input sequences. Results: To address this need, we have developed AbAdapt, a webserver that accepts antibody and antigen sequences, models their 3D structures, predicts epitope and paratope, and then docks the modeled structures using two established docking engines (Piper and Hex). Each of the key steps has been optimized by developing and training new machine-learning models. The sequences from a diverse set of 622 antibody-antigen pairs with known structure were used as inputs for leave-one-out cross-validation. The final set of cluster representatives included at least one 'Adequate' pose for 550/622 (88.4%) of the queries. The median (interquartile range) ranks of these 'Adequate' poses were 22 (5-77). Similar results were obtained on a holdout set of 100 unrelated antibody-antigen pairs. When epitopes were repredicted using docking-derived features for specific antibodies, the median ROC AUC increased from 0.679 to 0.720 in cross-validation and from 0.694 to 0.730 in the holdout set. Availability and implementation: AbAdapt and related data are available at https://sysimm.org/abadapt/. Supplementary information: Supplementary data are available at Bioinformatics Advances online.

Orthopedic Provider Gender Preference Among Patients in an Orthopedic Surgery Residency Program of a Hispanic American Community.

Background: There are limited data regarding the gender preferences of Hispanic Americans when selecting their orthopedic surgeon. This study aimed to evaluate the gender preferences of Hispanic Americans when choosing a physician as their orthopedic provider. Materials and Methods: A cross-sectional survey was administered to all consecutive Hispanic American patients treated at the outpatient orthopedic clinics of a tertiary medical center in Puerto Rico between October 4, 2019 and March 4, 2020. Sociodemographic status and opinion of gender preference in orthopedic surgery were assessed and analyzed between female and male respondents. Results: A total of 628 surveys were completed. There were 343 (54.6%) females and 285 (45.4%) males with an average age of 51.0 ± 13.0 years. A significantly higher portion of female respondents was widowed (p = 0.01), had a higher educational level (p = 0.02), were unemployed (p = 0.01), and had a lower individual annual income salary (p = 0.04); when compared with males. Most of the respondents had no gender preference (91.1% = 572/628) for an orthopedic provider. Among those with a gender preference, 5.1% (32/628) preferred a male surgeon, and 3.8% (24/628) preferred a female surgeon. No significant difference was found between male and female respondents in the opinion of an orthopedic provider. Conclusions: This study illustrates that Hispanic Americans have no gender preference when choosing an orthopedic provider. Therefore, patient preference should not be considered a factor contributing to women's under-representation in our orthopedic surgery training program. Our findings may also assist future studies in search of other indications attributed to the under-representation of females in this field.

Quality of Education and Late-Life Cognitive Function in a Population-Based Sample From Puerto Rico.

BACKGROUND AND OBJECTIVES: We examined quality of education, literacy, and years of education in relation to late-life cognitive function and decline in older Puerto Ricans. RESEARCH DESIGN AND METHODS: Our sample consisted of 3,385 community-dwelling adults aged 60 years and older from the Puerto Rican Elderly: Health Conditions study. Quality of education was based on principal component analysis of variables gathered from Department of Education and Census reports. Literacy (yes/no) and years of education were self-reported. Cognitive function was assessed in participants' homes at baseline and 4 years later using a previously validated Spanish-language 20-point global screening measure for dementia, the minimental Cabán. Regression models were adjusted for sociodemographic and life course covariates. RESULTS: Quality of education was positively correlated with both educational attainment and cognitive performance. Independent of years of education, literacy, childhood economic hardship, and adult economic hardship, compared to participants in the lowest quartile of education quality, those in the highest quartile had significantly better baseline cognitive performance (ß = 0.09, p < .001). Quality of education did not consistently show an association with change in cognitive function over 4 years. Literacy and greater educational attainment were each independently associated with better cognitive function at baseline and less cognitive decline. DISCUSSION AND IMPLICATIONS: Quality of education, literacy, and years of education, while interrelated, also show independent associations with cognitive functioning in older Puerto Ricans. The downstream factors of literacy and years of education were more closely related to age-related cognitive decline than quality of education.

Flexible, Functional, and Familiar: Characteristics of SARS-CoV-2 Spike Protein Evolution.

The SARS-CoV-2 S protein is a major point of interaction between the virus and the human immune system. As a consequence, the S protein is not a static target but undergoes rapid molecular evolution. In order to more fully understand the selection pressure during evolution, we examined residue positions in the S protein that vary greatly across closely related viruses but are conserved in the subset of viruses that infect humans. These "evolutionarily important" residues were not distributed evenly across the S protein but were concentrated in two domains: the N-terminal domain and the receptor-binding domain, both of which play a role in host cell binding in a number of related viruses. In addition to being localized in these two domains, evolutionary importance correlated with structural flexibility and inversely correlated with distance from known or predicted host receptor-binding residues. Finally, we observed a bias in the composition of the amino acids that make up such residues toward more human-like, rather than virus-like, sequence motifs.

Methods for sequence and structural analysis of B and T cell receptor repertoires.

B cell receptors (BCRs) and T cell receptors (TCRs) make up an essential network of defense molecules that, collectively, can distinguish self from non-self and facilitate destruction of antigen-bearing cells such as pathogens or tumors. The analysis of BCR and TCR repertoires plays an important role in both basic immunology as well as in biotechnology. Because the repertoires are highly diverse, specialized software methods are needed to extract meaningful information from BCR and TCR sequence data. Here, we review recent developments in bioinformatics tools for analysis of BCR and TCR repertoires, with an emphasis on those that incorporate structural features. After describing the recent sequencing technologies for immune receptor repertoires, we survey structural modeling methods for BCR and TCRs, along with methods for clustering such models. We review downstream analyses, including BCR and TCR epitope prediction, antibody-antigen docking and TCR-peptide-MHC Modeling. We also briefly discuss molecular dynamics in this context.

Structural Modeling of Lymphocyte Receptors and Their Antigens.

Structural modeling plays a key role in protein function prediction on a genome-wide scale. For B and T lymphocyte receptors, the critical functional question is: which antigens and epitopes are targeted? With emerging B cell receptor (BCR) and T cell receptor (TCR) sequencing methods improving in both breadth and depth, there is a growing need for methods that can help answer this question. Since lymphocyte-antigen recognition depends on complementarity, structural modeling is likely to play an important role in understanding antigen specificity and affinity. In the case of BCRs, such modeling methods have a long history in the study and design of antibodies. However, for TCRs there are relatively few publicly available modeling tools, and, to our knowledge, none that incorporate interaction between TCRs and peptide-MHC (pMHC) complexes. Here, we provide a web-based tool, ImmuneScape ( https://sysimm.org/immune-scape/ ), to carry out TCR-pMHC modeling as a first step toward structure-based function prediction.

Early life exposure to poor nutrition and infectious diseases and its effects on the health of older Puerto Rican adults.

OBJECTIVES: We examined the effects of early life exposure to poor nutrition and infectious diseases on adult heart disease and diabetes using season of birth as an indicator to help disentangle the effects on health of early life exposure from effects associated with other childhood conditions. METHODS: Using data from 60- to 74-year-old Puerto Ricans who lived in rural areas during childhood (n = 1,457), we estimated the effects of seasonal exposure during late gestation on the probability of diabetes and heart disease, controlling for adult obesity and other childhood conditions (health, socioeconomic status, knee height). RESULTS: We found (a) strong associations between exposure and heart disease; (b) weaker associations between exposure and diabetes, although significant negative interaction effects between exposure and having a family member with diabetes suggest the possibility of either strong gene-environment or early adult-environment interactions; (c) virtually no attenuation of effects of self-reported childhood health with controls for exposure. DISCUSSION: Timing of birth may reveal conditions experienced perinatally that affect adult heart disease and diabetes. The results suggest that examination of the effects of season of birth on these chronic conditions among older Puerto Rican adults and among older adults from similar populations deserves deeper scrutiny.

La educación médica superior frente a la infodemia por la COVID-19 / Higher medical education facing the COVID-19 infodemia

La infodemia se ha definido como la cantidad de información, entre real y falsa, que hace imposible el acceso a fuente confiable y orientación fidedigna.1 En estos tiempos de pandemia por la enfermedad del Coronavirus 2019 (COVID-19), la situación se convierte en un verdadero problema no solo para quien desea informarse con claridad sobre esta enfermedad y sus repercusiones, sino mucho más para quienes deben tomar decisiones en el ámbito sanitario, social y político. Hasta el momento se han registrado más de 361 millones de videos en YouTube, 19 200 artículos en Google Académico y 550 millones de tuiteos sobre la COVID-19.2 Esto lleva a una reflexión: ¿cómo debe responder la educación médica superior ante esta(AU)

[Factors related with the use of screening mammogram in middle age women in Puerto Rico]. / Factores relacionados con el uso del mamograma de cernimiento en mujeres de edad mediana en Puerto Rico.

Mammography for low-income women is an important intervention issue as it is still under utilized in these sectors. Despite evidence in favor of breast cancer screening with mammograms, research indicates that mammogram compliance among low-income females and women over 50 years of age has been slow. This article revolves around the factors that affect compliance with screening mammograms among low-income women ages 40 to 64 in Puerto Rico once they receive a referral from a physician. Although the multivariate analysis demonstrated that only age, work outside of the home and performing breast self-exams significantly increased the probability for middle-aged, low-income women in Puerto Rico to comply with referrals and have mammograms, this research illustrated that certain factors such as knowledge about the disease and screening practices, a satisfactory perception of the patient-physician relationship, and the performance of a clinical breast exam by a physician influence mammogram compliance.

[Qualitative analysis on screening mammography compliance among middle-aged women in Puerto Rico]. / Análisis cualitativo sobre el cumplimiento con mamografía de cernimiento de mujeres de edad mediana en Puerto Rico.

Screening mammogram utilization is a critical issue in early detection of breast cancer. However, it is underutilized by different sectors, particularly low-income women. The objective of this study was to utilize the method known as focus group to probe into obstacles to screening mammogram among low-income women in the ages 40 to 64 in Puerto Rico once they had a physician's referral. The women in the study had knowledge of breast self-examination, clinical breast exam and mammogram as tests to detect breast cancer. Yet, they had no adequate knowledge about current screening guidelines. Attitudes toward pain or discomfort related to the mammogram and fear of a breast cancer diagnosis were the personal reasons most often cited for non-compliance in the focus group discussions. In the case of external or systemic barriers, the most prevalent reasons offered were: cost of the mammogram, transportation, and negative factors associated to the doctor-patient relationship.

[A short psychometric scale to evaluate the cognitive status of aged Spanish speakers]. / Una escala psicométrica breve para evaluar el estado cognitivo de hispanoparlantes de edad mayor.

During the last ten years there has been an interest for determining the prevalence and incidence of dementia among older adults and for cognitive tests that do to discriminate by level of education. This article revolves around the validation of a minimental exam, the Cabán minimental, to measure the cognitive capacity of Spanish-speaking adults 60 years of age and older; a test that is not affected by level of education. The factors measured in the Cabán minimental are: orientation, visual and motor coordination, learning, recent memory and abstraction. The validation process underwent two phases. During the first one, the Cabán test was subjected to construct validation and internal and predictive consistency tests. The second stage comprised a comparison between the Cabán and Folstein minimentals. The Cabán showed a statistically significant difference to discriminate for subjects with dementia. Results also suggest that the Cabán is not as much affected as the Folstein by differences in education.

Práctica profesional de los egresados del programa de Fisioterapia de la Universidad Nacional de Colombia en el marco del sistema de salud colombiano / Professional practice of Physiotherapy graduates of Universidad Nacional de Colombia in the context of the Colombian health system

Resumen Introducción. Los cambios en el saber y en la práctica han logrado consolidar a la fisioterapia como una profesión emergente de rápido crecimiento; sin embargo, las dinámicas del mercado y los sistemas de salud han transformado las características del recurso humano, las condiciones de trabajo y los avances y tendencias de la práctica profesional. Objetivo. Caracterizar el estado actual de la práctica profesional de la fisioterapia en el marco de organización del sistema de salud colombiano, cuyas transformaciones han impactado el conjunto de prácticas profesionales del sector salud. Materiales y métodos. Se realizó una encuesta electrónica a estudiantes de Fisioterapia de la Universidad Nacional de Colombia graduados durante el período 1980-2012 que evalúa campos y áreas de desempeño, condiciones de trabajo, autonomía profesional, valoración social y perfil de morbilidad. Resultados. La fisioterapia aparece como una profesión socialmente requerida, con campos y áreas de desempeño que se proyectan más allá del sector salud. Sin embargo, son preocupantes las condiciones de deterioro del trabajo, destacando las formas de contratación, los bajos salarios y las restricciones para la práctica profesional autónoma, en particular en el campo asistencial. Conclusiones. Es necesario garantizar condiciones de trabajo que promuevan una práctica profesional idónea y que garanticen la permanencia de los profesionales, en especial en la práctica asistencial.

Abstract Introduction: Changes in knowledge and practice have consolidated physiotherapy as an emerging fast-growing profession. However, the market dynamics and the configuration of health systems have transformed the characteristics of human resources, as well as the working conditions, advances and trends of professional practice. Objective: To characterize the current state of the professional practice of physiotherapy in the organizational framework of the Colombian health system, since its transformations have impacted the professional practices of the health sector. Materials and methods: An online survey was applied to physiotherapists graduated from Universidad Nacional de Colombia between 1980 and 2012. The survey evaluates the fields and areas of performance, working conditions, professional autonomy, social assessment and morbidity profile. Results: Physiotherapy is conceived as a profession required by society, with fields and areas of performance projected beyond the health sector. However, the deteriorating work conditions are worrying, particularly recruitment, low wages and restrictions for autonomous professional practice, especially those related to healthcare services. Conclusions: It is necessary to ensure working conditions that promote a suitable professional practice and the permanence of professionals, particularly in clinical practice.