Transferencia de habilidades prácticas desde el laboratorio a cirugía in vivo utilizando el sistema robótico Avatera: Estudio experimental / Transfer of acquired practical skills from dry lab into live surgery using the Avatera robotic system: an experimental study

Objetivo Evaluar la transferencia de habilidades adquiridas en el laboratorio a un entorno experimental real para realizar cirugía robótica. Material y métodos Se utilizó un modelo experimental in vivo. Seis residentes y fellows de urología; dos R2 sin exposición previa a cirugía laparoscópica (Grupo 1), dos R4 con exposición intermedia (Grupo 2) y dos fellows formados en cirugía laparoscópica (Grupo 3) realizaron reimplantes ureterales distales, pieloplastia, y nefrectomía radical en tres cerdos hembra. Previamente a realizar los procedimientos, cada participante completó entre 10 y 14 h de formación en cirugía robótica en laboratorio hasta adquirir habilidades para realizar maniobras quirúrgicas básicas (sutura, corte y paso de agujas). Las variables analizadas fueron completar o no con éxito los procedimientos, el tiempo de consola y el tiempo para realizar las maniobras solicitadas y. presencia de complicaciones. Resultados Los tres grupos completaron con éxito todos los procedimientos excepto la pieloplastia, que no la completó el Grupo 1 por sangrado de la vena renal. El Grupo 3 logró un tiempo de consola más corto para todos los procedimientos y para los pasos quirúrgicos por separado, seguido por el Grupo 2. El grupo más lento para completar los procedimientos y los pasos fue el Grupo 1. Conclusiones A pesar de que es necesaria evidencia clínica al respecto, nuestros resultados sugieren que los procedimientos urológicos con asistencia robótica y los pasos más difíciles técnicamente podrían realizarse de manera segura y efectiva después de un entrenamiento adecuado en el laboratorio bajo la supervisión de un mentor. (AU)

Objective To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methods An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 hours dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. Results All procedures were completed successfully by all groups except the pyeloplasty by Group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. Conclusions Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study. (AU)

Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study.

OBJECTIVE: To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS: An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS: All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS: Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.

Seroprevalence and risk factors of Leptospira sp. among different groups in the Jordanian population: first study.

BACKGROUND: Leptospirosis is re-emerging as a major public health problem worldwide. However, there are limited data on the disease from the Middle East, including from Jordan, despite recent outbreaks occurring in Jordan's neighbouring countries. METHODS: Sera samples from 809 participants in 11 governorates were tested for Leptospira sp. seropositivity to determine the seroprevalence and risk factors of Leptospira sp. in Jordan. RESULTS: Overall, 3.3% (95% confidence interval [CI] 2.2 to 4.8) of individuals tested were seropositive for Leptospira antibodies. Individuals who drink surface water (spring or rain water) had 5.69 (95% CI 2.57 to 12.60) higher odds of seropositivity compared with individuals who used municipal or filtered water, after controlling for age and practicing horticulture. CONCLUSIONS: This is the first seroprevalence study of Leptospira sp. in Jordan and included important data on environmental and animal exposures.

Seroprevalence, spatial distribution and risk factors of Borrelia burgdorferi sensu lato in Jordan.

Lyme borreliosis has not been studied in Jordan or in much of the Middle East. However, limited research indicates that the tick vector, Ixodes ricinus, exists in the region. This study examined the seroprevalence of B. burgdorferi s.l. in Jordan and potential demographic and zoonotic risk factors for seropositivity. Serum samples of 824 apparently healthy participants from 11 governorates in Jordan were tested for B. burgdorferi s.l. using Enzygnost Lyme link VlsE/IgG enzyme-linked immunosorbent assay. A validated questionnaire was used to collect demographic and animal exposure data. Univariate and multivariate logistic regression were used to identify factors associated with seropositivity. The results showed that 11.7 % (95 % CI, 9.3-14.0 %) of the participants were seropositive for B. burgdorferi s.l.. There was a bimodal age distribution of seroprevalence with higher seroprevalence among individuals <20 and>60 years old. After controlling for governorate of residence, females had 2.77 (95 % CI 1.53-5.00) times greater odds of seropositivity compared to males. Individuals living in the southeastern part of Jordan (Ma'an) had 2.32 (95 % CI, 1.02-5.31) greater odds of seropositivity compared to those living in Amman, the Capital of Jordan, while those living in the northeast had significantly lower odds of seropositivity. This study presents the first evidence of B. burgdorferi s.l. seropositivity in Jordan and suggests several risk factors which were reported in studies conducted elsewhere. This study suggests that Lyme borreliosis should be considered in the differential diagnosis for patients presenting with skin lesions in Jordan.

Nationwide seroprevalence, spatial distribution and risk factors of Leishmania in Jordan

Objective: To explore the seroprevalence, spatial distribution and risk factors for Leishmania seropositivity in Jordan. Methods: Blood samples from 872 apparently healthy participants were randomly selected from 11 governorates in Jordan and tested for anti-Leishmania K39 IgG. Risk factors (animal ownership and agriculture practices) and demographic data were also collected using pre-tested and validated questionnaire. Results: Overall, 2.52％ of participants were seropositive for Leishmania spp. Participants living in the Jordan Valley plateau had significantly greater odds (adjusted odds ratio = 3.70, 95％ CI 1.37-9.93) of seropositivity than those living in the Highlands after adjustment for age. Conclusions: This study supports the intermittent reports of cutaneous leishmaniasis outbreaks in the Jordan Valley. Vector control measures in the Jordan Valley should be considered, including insecticide treated bed nets, sugar baits and using flowering plants to attract and trap Phlebotomus papatasi sand flies. Active surveillance in the Jordan Valley is also recommended in light of this and other reports.

Characterization of Listeria monocytogenes from three countries and antibiotic resistance differences among countries and Listeria monocytogenes serogroups.

A total of 104 Listeria monocytogenes isolates from 330 fish samples from three countries were characterized by multiplex PCR for serogrouping and virulence markers determination and tested for antibiotics resistance. A 53·8% of the isolates belonged to serogroup 1/2a, 3a; 32% belonged to 1/2b, 3b, 7; 14·4% belonged to 4b, 4d, 4e and 1% belonged to 1/2c, 3c. All isolates exhibited resistance to at least one antibiotic but the resistance rates varied among countries. The isolates exhibited high resistance to penicillin, rifampicin, clindamycin, erythromycin and tetracycline, but low resistance to amoxicillin-clavulanic acid, streptomycin, sulfamethoxazole-trimethoprim, gentamicin, chloramphenicol and kanamycin. When comparing countries, the resistance rate for rifampicin, clindamycin, erythromycin, tetracycline, amoxicillin-clavulanic acid varied among countries. When comparing serogroup, 1/2a, 3a exhibited the highest resistance to clindamycin, erythromycin, tetracycline and vancomycin while serogroup 4b, 4d, 4e exhibited the highest resistance to amoxicillin-clavulanic acid. All isolates carried inlA, inlC, inlJ and lmo2672. Listeriolysin S was carried by 42 and 30% of 4b and 1/2b isolates respectively. Significance and impact of the study: This is one of few studies to correlate antibiotic resistance with Listeria monocytogenes serogroups. The study also compared the antibiotic resistance and serogroups of L. monocytogenes isolates from three countries in one single study. The findings of this study will be helpful in improving data on the antibiotics resistance of L. monocytogenes in developing countries and enriches the epidemiological and public health studies of L. monocytogenes.

Seroepidemiology and risk factors of Toxoplasma gondii infection in undergraduate university female students in Jordan.

This study estimated the seroprevalence and risk factors for acquiring Toxoplasma gondii infection by undergraduate female university students in Jordan. A cross-sectional study from September 2013 to July 2014 analysed 202 blood samples for IgG and IgM antibodies by enzyme-linked immunosorbent assay and a semi-constructed questionnaire was completed by participants to gather information about Toxoplasma infection risk factors. T. gondii IgG antibodies were detected in 66.5% of the females. Only one sample was positive for both IgG and IgM. Using χ2 test, six factors showed significant association with T. gondii infection (P ⩽ 0.01). The multivariate logistic regression model showed that female students living in houses, wet areas, with income >US $750/month and using spring (untreated) water were 47.42, 10.20, 5.00, 3.25 more times at risk to be seropositive for T. gondii, respectively, compared to female students living in apartments, dry areas, with income ≤ US $750/month and using treated water, respectively. This study concluded that T. gondii infection in female university students in Jordan is high and most women become infected before marriage; however, congenital toxoplasmosis is still likely to occur in Jordan. Thus, dissemination of protective measures and knowledge by healthcare professionals is essential especially for pregnant women.

Attending to women's sexual health in Bahrain: does physician's gender make a difference?

There is a rising incidence of sexually transmitted infections (STIs) in Bahrain. This study aimed to determine physician practices with regard to sexual and reproductive health in women in the primary care setting in Bahrain, and to ascertain if physician gender affected these. The study included all eligible Ministry of Health family physicians (217) in 2006 and data were collected by a self-completed questionnaire; the response rate was 90.3%. Over half (58%) of the responding physicians were female. Male physicians did not undertake gynaecological examinations nor carry out STI screening procedures for asymptomatic women, and rates for women physicians were low (28.9% and 11.4% respectively). As regards to identification of and counselling for sexual health and STI risk factors, there were no differences between male and female physicians in addressing these issues with less than 25% doing so. All physicians would benefit from continuing education in the area of sexual medicine regardless of their gender.

Attending to women's sexual health in Bahrain: does physician's gender make a difference?

There is a rising incidence of sexually transmitted infections [STIs] in Bahrain. This study aimed to determine physician practices with regard to sexual and reproductive health in women in the primary care setting in Bahrain, and to ascertain if physician gender affected these. The study included all eligible Ministry of Health family physicians [217] in 2006 and data were collected by a self-completed questionnaire; the response rate was 90.3%. Over half [58%] of the responding physicians were female. Male physicians did not undertake gynaecological examinations nor carry out STI screening procedures for asymptomatic women, and rates for women physicians were low [28.9% and 11.4% respectively]. As regards to identification of and counselling for sexual health and STI risk factors, there were no differences between male and female physicians in addressing these issues with less than 25% doing so. All physicians would benefit from continuing education in the area of sexual medicine regardless of their gender

On the use of learning automata in the control of broadcast networks: a methodology.

Due to its fixed assignment nature, the well-known time division multiple access (TDMA) protocol suffers from poor performance when the offered traffic is bursty. In this paper, an adaptive TDMA protocol, which is capable of operating efficiently under bursty traffic conditions, is introduced. According to the proposed protocol, the station which is granted permission to transmit at each time slot is selected by means of learning automata (LA). The choice probability of the selected station is updated by taking into account the network feedback information. The system which consists of the LA and the network is analyzed and it is proven that the choice probability of each station asymptotically tends to be proportional to the probability that this station is not idle. Although there is no centralized control of the stations and the traffic characteristics are unknown and time-variable, each station tends to take a fraction of the bandwidth proportional to its needs. Furthermore, extensive simulation results are presented, which indicate that the proposed protocol achieves a significantly higher performance than other well-known TDMA protocols when operating under bursty traffic conditions.

Learning automata-based bus arbitration for shared-medium ATM switches.

Although new high-bandwidth network technologies are being introduced and widely deployed, asynchronous transfer mode (ATM) is still considered one of the most important network technologies currently in use. A number of ATM switch architectures have been proposed in the literature. However, industry has shown that is better to use the well-known shared-medium technique in the design of these ATM switches. In this paper, four variations of a new distributed scheme are proposed for the arbitration of a shared bus of an ATM switch. These schemes are based on learning automata. By taking advantage of the bursty nature of ATM traffic, the new arbitration scheme demonstrates superb performance compared to the time division multiple access (TDMA) scheme.

A real-time video pattern generator for use in ophthalmology.

An automated real-time microcomputer-based video pattern generator for use in optometry and ophthalmology is presented. The system can generate various vision pattern tests including a static and dynamic random dot stereogram that can be used to test depth perception. The patterns are generated in real time, which provides the ability to generate programmable images with objects that can move at different speeds. This feature is very useful in testing depth perception among infants and non-communicative people by correlating the movement of the eye with the movement of the object. The system also can generate other patterns such as checkerboards, vertical and horizontal bars, and provide the ability to sweep the size of the checkers and bars. These patterns are also useful for testing visual acuity. The system hardware is based on the TMS34010 graphics processor and hardware circuits and is connected to a host computer through a RS-232C serial communication port. Both control and application programs are written in assembly language. The system is fast, versatile and flexible with affordable cost.

Estimating neural networks-based algorithm for adaptive cache replacement.

In this paper, we propose an adaptive cache replacement scheme based on the estimating type of neural networks (NN's). The statistical prediction property of such NN's is used in our work to develop a neural network based replacement policy which can effectively identify and eliminate inactive cache lines. This would provide larger free space for a cache to retain actively referenced lines. The proposed strategy may, therefore, yield better cache performance as compared to the conventional schemes. Simulation results for a wide spectrum of cache configurations indicate that the estimating neural network based replacement scheme provides significant performance advantage over existing policies.

Verification of computer users using keystroke dynamics.

This paper presents techniques to verify the identity of computer users using the keystroke dynamics of computer user's login string as characteristic patterns using pattern recognition and neural network techniques. This work is a continuation of our previous work where only interkey times were used as features for identifying computer users. In this work we used the key hold times for classification and then compared the performance with the former interkey time-based technique. Then we use the combined interkey and hold times for the identification process. We applied several neural network and pattern recognition algorithms for verifying computer users as they type their password phrases. It was found that hold times are more effective than interkey times and the best identification performance was achieved by using both time measurements. An identification accuracy of 100% was achieved when the combined hold and intekey time-based approach were considered as features using the fuzzy ARTMAP, radial basis function networks (RBFN), and learning vector quantization (LVQ) neural network paradigms. Other neural network and classical pattern algorithms such as backpropagation with a sigmoid transfer function (BP, Sigm), hybrid sum-of-products (HSOP), sum-of-products (SOP), potential function and Bayes' rule algorithms gave moderate performance.

Phonocardiogram signal analysis: techniques and performance comparison.

This paper presents the applications of the spectrogram, Wigner distribution and wavelet transform analysis methods to the phonocardiogram (PCG) signals. A comparison between these three methods has shown the resolution differences between them. It is found that the spectrogram short-time Fourier transform (STFT), cannot detect the four components of the first sound of the PCG signal. Also, the two components of the second sound are inaccurately detected. The Wigner distribution can provide time-frequency characteristics of the PCG signal, but with insufficient diagnostic information: the four components of the first sound, S1, are not accurately detected and the two components of the second sound, S2, seem to be one component. It is found that the wavelet transform is capable of detecting the two components, the aortic valve component A2 and pulmonary valve component P2, of the second sound S2 of a normal PCG signal. These components are not detectable using the spectrogram or the Wigner distribution. However, the standard Fourier transform can display these two components in frequency but not the time delay between them. Furthermore, the wavelet transform provides more features and characteristics of the PCG signals that will help physicians to obtain qualitative and quantitative measurements of the time-frequency characteristics.

Architecture and design of a computerised stereogram generator for vision test.

A new microcomputer-based stereogram generator was designed and implemented to generate various visual stimuli that are used for testing the binocular vision system. The system is capable of generating static and dynamic stereoscopic stereograms that can be varied in size, shape, speed and disparity. It can also be used to generate a luminous stimulus on a dark background which, except for the depth parameters, can be varied in a similar way to the stereoscopic stimulus. A 16/32-bit microprocessor has been employed for the overall control of the stereogram parameters, which provides flexibility, versatility, compactness and speed at reduced cost. We have applied this system to the measurement of eye movement and computer vision.