Low cost exoskeleton manipulator using bidirectional triboelectric sensors enhanced multiple degree of freedom sensory system.

Rapid developments of robotics and virtual reality technology are raising the requirements of more advanced human-machine interfaces for achieving efficient parallel control. Exoskeleton as an assistive wearable device, usually requires a huge cost and complex data processing to track the multi-dimensional human motions. Alternatively, we propose a triboelectric bi-directional sensor as a universal and cost-effective solution to a customized exoskeleton for monitoring all of the movable joints of the human upper limbs with low power consumption. The corresponding movements, including two DOF rotations of the shoulder, twisting of the wrist, and the bending motions, are detected and utilized for controlling the virtual character and the robotic arm in real-time. Owing to the structural consistency between the exoskeleton and the human body, further kinetic analysis offers additional physical parameters without introducing other types of sensors. This exoskeleton sensory system shows a great potential of being an economic and advanced human-machine interface for supporting the manipulation in both real and virtual worlds, including robotic automation, healthcare, and training applications.

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways are beneficial in proctocolectomy, but their impact on robotic low rectal proctectomy is not fully investigated. This study assessed the impact of an ERAS pathway on the outcomes and cost of robotic (RTME) versus laparoscopic (LTME) total mesorectal excision. METHODS: A retrospective review was performed of patients with rectal cancer in a single French tertiary centre for three yearly periods: 2011, LTME; 2015, RTME; and 2018, RTME with ERAS. Patient characteristics, operative and postoperative data, and costs were compared among the groups. RESULTS: A total of 220 consecutive proctectomies were analysed (71 LTME, 58 RTME and 91 RTME with ERAS). A prevalence of lower and locally advanced tumours was observed with RTME. The median duration of surgery increased with the introduction of RTME, but became shorter than that for LTME with greater robotic experience (226, 233 and 180 min for 2011, 2015 and 2018 respectively; P < 0·001). The median duration of hospital stay decreased significantly for RTME with ERAS (11, 10 and 8 days respectively; P = 0·011), as did the overall morbidity rate (39, 38 and 16 per cent; P = 0·002). Pathology results, conversion and defunctioning stoma rates remained stable. RTME alone increased the total cost by €2348 compared with LTME. The introduction of ERAS and improved robotic experience decreased costs by €1960, compared with RTME performed in 2015 without ERAS implementation. In patients with no co-morbidity, costs decreased by €596 for RTME with ERAS versus LTME alone. CONCLUSION: ERAS is associated with cost reductions in patients undergoing robotic proctectomy.

ANTECEDENTES: Las vías clínicas ERAS son beneficiosas en la proctocolectomía, pero su impacto en la proctectomía rectal baja robótica no se ha investigado exhaustivamente. El objetivo de este estudio fue evaluar el impacto de la vía clínica ERAS sobre los resultados y el coste de la proctectomía robótica (resección total del mesorrecto robótica, robotic total mesorectal excision, RTME) versus procedimientos laparoscópicos de resección total del mesorrecto (laparoscopic total mesorectal excision, LTME). MÉTODOS: Revisión retrospectiva de pacientes con cáncer de recto tratados en un único centro terciario francés durante un periodo de tres años: 1) 2011: resección total del mesorrecto laparoscópica (LTME); 2) 2015: TME robótica y 3) 2018: TME robótica plus ERAS. Se compararon las características de los pacientes, los datos operatorios y postoperatorios, y los costes entre subgrupos utilizando análisis estadísticos. RESULTADOS: Se analizaron 220 proctectomías consecutivas que incluían 71 LTME, 58 RTME y 91 RTME plus ERAS. Se observó un predominio de tumores inferiores y localmente avanzados en la RTME. La mediana del tiempo operatorio aumentó con la introducción de RTME, pero llegó a ser inferior que en la LTME con una mayor experiencia robótica (226, 233 y 180 minutos para los periodos 1, 2 y 3, respectivamente; P = 0,0001). La mediana de la estancia hospitalaria disminuyó significativamente con la RTME plus ERAS (11, 10 y 8 días; P = 0,01), así como la morbilidad global (40%, 38% y 16%; P = 0,002). Los resultados de la anatomía patológica, las tasas de conversión y de estomas de protección permanecieron estables. La RTME sola aumentó el coste total en €2.348 comparado con la LTME. La introducción de ERAS y una mejora en la experiencia robótica disminuyeron los costes en €1.960 versus RTME realizada en 2015 sin la implementación de ERAS. En pacientes sin comorbilidades, los costes disminuyeron en €1.196 con RTME plus ERAS versus LTME sola. CONCLUSIÓN: ERAS se asocia con reducciones de coste en la proctectomía robótica.

Bioinspired Soft Robot with Incorporated Microelectrodes.

Bioinspired soft robotic systems that mimic living organisms using engineered muscle tissue and biomaterials are revolutionizing the current biorobotics paradigm, especially in biomedical research. Recreating artificial life-like actuation dynamics is crucial for a soft-robotic system. However, the precise control and tuning of actuation behavior still represents one of the main challenges of modern soft robotic systems. This method describes a low-cost, highly scalable, and easy-to-use procedure to fabricate an electrically controllable soft robot with life-like movements that is activated and controlled by the contraction of cardiac muscle tissue on a micropatterned sting ray-like hydrogel scaffold. The use of soft photolithography methods makes it possible to successfully integrate multiple components in the soft robotic system, including micropatterned hydrogel-based scaffolds with carbon nanotubes (CNTs) embedded gelatin methacryloyl (CNT-GelMA), poly(ethylene glycol) diacrylate (PEGDA), flexible gold (Au) microelectrodes, and cardiac muscle tissue. In particular, the hydrogels alignment and micropattern are designed to mimic the muscle and cartilage structure of the sting ray. The electrically conductive CNT-GelMA hydrogel acts as a cell scaffold that improves the maturation and contraction behavior of cardiomyocytes, while the mechanically robust PEGDA hydrogel provides structural cartilage-like support to the whole soft robot. To overcome the hard and brittle nature of metal-based microelectrodes, we designed a serpentine pattern that has high flexibility and can avoid hampering the beating dynamics of cardiomyocytes. The incorporated flexible Au microelectrodes provide electrical stimulation across the soft robot, making it easier to control the contraction behavior of cardiac tissue.

Inexpensive robotic system for standard and fluorescent imaging of protein crystals.

Protein-crystallization imaging and classification is a labor-intensive process typically performed either by humans or by instruments that currently cost well over $100 000. This cost puts the use of crystallization-trial imaging outside the reach of most academic laboratories, and also start-up biotechnology firms, where resources are scarce. An imaging system has been designed and prototyped which automatically captures images from multi-well protein-crystallization experiments using both standard and fluorescent imaging techniques at a cost 28 times lower than current market rates. The machine uses a Panowin F1 3D printer as a base and controls it using G-code commands sent from a Python script running on a desktop computer. A graphical user interface (GUI) was developed to enable users to control the machine and facilitate image capture, classification and editing. A 488 nm laser diode and a 525 nm filter were incorporated to allow in situ fluorescent imaging of proteins trace-labeled with a fluorophore, Alexa Fluor 488. The instrument was primarily designed using a 3D printer and augmented using commercially available parts, and this publication aims to serve as a guide for comparable in-laboratory robotics projects.

Proof of Concept of an Assistive Robotic Arm Control Using Artificial Stereovision and Eye-Tracking.

Assistive robotic arms have become popular to help users with upper limb disabilities achieve autonomy in their daily tasks, such as drinking and grasping objects in general. Usually, these robotic arms are controlled with an adapted joystick. Joysticks are user-friendly when it comes to a general approach to an object. However, they are not as intuitive when having to accurately approach an object, especially when obstacles are present. Alternatively, the combined use of artificial stereovision and eye-tracking seems to be a promising solution, as the user's vision is usually dissociated from their upper limb disability. Hence, the objective of this study was to develop a proof of concept for the control of an assistive robotic arm using a low-cost combination of stereovision and eye-tracking. Using the developed control system, a typically developed person was able to control the robotic arm successfully reaching and grasping an object for 92% of the trials without obstacles with an average time of 13.8 seconds. Then, another set of trials with one obstacle had a success rate of 91% with an average time of 17.3 seconds. Finally, the last set of trials with two obstacles had a success rate of 98% with an average time of 18.4 seconds. Furthermore, the cost of an eye-tracker and stereovision remains below 400$.

The benefits of and barriers to using a social robot PARO in care settings: a scoping review.

BACKGROUND: Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how. METHODS: Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO. RESULTS: A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users' needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation. CONCLUSIONS: Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Cost of ownership assessment for a da Vinci robot based on US real-world data.

BACKGROUND: Despite growth of robotic surgery, published literature lacks assessment of the cost of ownership (CoO) of a da Vinci robot by surgical service line and the associated benefit such data provides. METHODS: Based on real-world data (RWD) from 14 US hospitals and ≈6000 da Vinci robotic cases, CoO was assessed using all relevant fixed and variable cost components, calculated by surgical service line. RESULTS: At a representative hospital with an efficient robotic program (n = 424 cases), the weighted average fixed cost per case was $984. Weighted average variable cost per case was $8025 (range: $3325 for Cholecystectomy-multiport, to $16 986 for Rectal Resection). Assessing weighted average by case, main variable cost drivers were non-da Vinci supplies (49.5%), staff costs (28.6%), and da Vinci supplies (21.9%). CONCLUSIONS: Case mix, annual robotic case volumes, and cut-to-close/patient-in-room time by surgical service line represent core variables influencing robotic program CoO, which help drive profitable program management.

Regulating Child Sex Robots: Restriction or Experimentation?

In July 2014, the roboticist Ronald Arkin suggested that child sex robots could be used to treat those with paedophilic predilections in the same way that methadone is used to treat heroin addicts. Taking this onboard, it would seem that there is reason to experiment with the regulation of this technology. But most people seem to disagree with this idea, with legal authorities in both the UK and US taking steps to outlaw such devices. In this article, I subject these different regulatory attitudes to critical scrutiny. In doing so, I make three main contributions to the debate. First, I present a framework for thinking about the regulatory options that we confront when dealing with child sex robots. Secondly, I argue that there is a prima facie case for restrictive regulation, but that this is contingent on whether Arkin's hypothesis has a reasonable prospect of being successfully tested. Thirdly, I argue that Arkin's hypothesis probably does not have a reasonable prospect of being successfully tested. Consequently, we should proceed with utmost caution when it comes to this technology.

The economic cost of robotic rehabilitation for adult stroke patients: a systematic review.

OBJECTIVE: The objective of this review was to examine the economic cost of robotic therapy compared to conventional therapy for adult stroke patients, from the perspective of hospitals. INTRODUCTION: It is important to identify appropriate treatment methods that not only reduce the disability experienced by stroke survivors but also do so cost effectively. While robotic devices enable a high-intensity training regime for patients, robotic training equipment involves a significant capital outlay for healthcare providers. Hence, the decision to introduce robotic devices into clinical settings and offer robotic stroke rehabilitation to patients has an important cost consideration for hospitals. INCLUSION CRITERIA: This review included rehabilitation trials of adult stroke patients (18 years and older) involving robotic devices and comparing the economic outcomes to control groups that used conventional physiotherapy. METHODS: We searched major databases such as PubMed, Embase and CINAHL for trial studies conducted from year 2000 and published in English. Included studies were critically appraised, and data were extracted and synthesized using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). RESULTS: Five studies with 213 patients were included in this review. Four studies examined upper limb interventions, and one study evaluated both upper limb and lower limb interventions. Of the five studies, two included acute/sub-acute patients and three included chronic patients. The overall methodological quality of the studies was of a moderate level. The included studies compared the cost of providing robotic intervention against the cost of providing conventional therapy in dose-matched therapy sessions and computed the cost measures in terms of cost per patient session or cost per patient. We performed a cost comparison of the various studies and reviewed the data based on two approaches: the dominance ranking framework and the dominance ranking score. By comparing the cost outcome of each study, four of the five studies showed better cost benefits for the robotic intervention group. Under the dominance ranking framework and the dominance ranking score, the overall dominance levels for most sub-groups favored robotic intervention. CONCLUSIONS: Our review indicated that robotic therapy had a better economic outcome than conventional therapy. For patients with severe disability from significant stroke, a moderate dominance favoring robotic therapy for health benefit was found, and a strong dominance for robotic therapy for cost benefit was found. However, the limited number of studies in the review required us to view the results with caution. Key sensitivity factors affecting robotic therapy were the number of patients who could be treated per robotic session and the time therapists spent with patients during a robotic session. Robotic therapy could be prescribed primarily for patients with severe impairment after stroke. To maximize the cost economics, hospital providers may wish to organize their robotic therapy programs based on cost-sensitivity factors. For further research, we suggest better collaboration in methods within this field to enable a more comparable cost computation across studies.

A centralized automated-dispensing system in a French teaching hospital: return on investment and quality improvement.

OBJECTIVES: To evaluate the return on investment (ROI) and quality improvement after implementation of a centralized automated-dispensing system after 8 years of use. DESIGN: Prospective evaluation of ROI; before and after study to evaluate dispensing errors; user satisfaction questionnaire after 8 years of use. SETTING: The study was conducted at a French teaching hospital in the pharmacy department, which is equipped with decentralized automated medication cabinets in the wards. PARTICIPANTS: Pharmacy staff (technicians and residents). INTERVENTION(S): Implementation of a centralized automated-dispensing robot. MAIN OUTCOME MEASURE(S): The true ROI was prospectively and annually compared to estimated returns calculated after implementation and upgrade of the robot; dispensing errors determined by observation of global deliveries and the satisfaction of users based on a validated questionnaire were evaluated. RESULTS: Following the upgrade, we found little difference for the ROI (+1.86%). The payback period increased by almost 3 years. There was a significant reduction of dispensing errors, from 2.9% to 1.7% (P < 0.001). User satisfaction of the robot by the pharmacy staff was reported (score of 5.52 ± 1.20 out of 7). CONCLUSIONS: These systems are worthwhile investments and largely contribute to improving the quality and safety of the medication process.

Robot milking and relationship with culling rate in dairy cows.

Cow routines and behavioral responses are altered substantially following the installation of robot milking. The present study was designed to analyze the effect that switching from milking parlor to automatic milking system (AMS) had on the culling rate (due to various causes) of dairy cattle. For this purpose, culling records and causes for culling were tracked in 23 dairy farms in the Galicia region (NW Spain). The animals in these farms were monitored for 5 years. For the present study, that length of time was divided into three different stages, as follows: 2 years before switching from a milking parlor to AMS (stage 1), the 1st year following the implementation of AMS (stage 2) and the 2nd and 3rd years succeeding the implementation of AMS (stage 3). Cox models for survival analysis were used to estimate the time to culling due to different reasons during stage 1 in relation to stages 2 and 3. The data indicated that the risk of loss due to death or emergency slaughter decreased significantly following the installation of AMS. In contrast, the risk of culling due to low production, udder problems, infertility or lameness increased significantly. Low-production cows (such as cows in advanced lactation due to infertility) or sick cows (such as mastitic or lame cows) allegedly have a noticeable effect both on the performance and the amortization of the cost of AMS, which in turn would lead to a higher probability of elimination than in conventional systems.

Operational and Financial Considerations of Using Drones for Medical Support of Mass Events in Poland.

OBJECTIVE: The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system. METHODS: The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well. RESULTS: This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world. CONCLUSIONS: The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532).

Economic benefits of microprocessor controlled prosthetic knees: a modeling study.

BACKGROUND: Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. To answer this question, the differential clinical outcomes and cost of microprocessor-controlled knees (MPK) compared to non-microprocessor controlled knees (NMPK) were assessed. METHODS: We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a 10-year time period for unilateral transfemoral Medicare amputees with a Medicare Functional Classification Level of 3 and 4 using estimates from the published literature and expert input. The results are summarized as an incremental cost effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPK compared to NMPK for each quality-adjusted life-year gained. All costs were adjusted to 2016 U.S. dollars and discounted using a 3% rate to the present time. RESULTS: The results demonstrated that compared to NMPK over a 10-year time period: for every 100 persons, MPK results in 82 fewer major injurious falls, 62 fewer minor injurious falls, 16 fewer incidences of osteoarthritis, and 11 lives saved; on a per person per year basis, MPK reduces direct healthcare cost by $3676 and indirect cost by $909, but increases device acquisition and repair cost by $6287 and total cost by $1702; on a per person basis, MPK is associated with an incremental total cost of $10,604 and increases the number of life years by 0.11 and quality adjusted life years by 0.91. MPK has an ICER ratio of $11,606 per quality adjusted life year, and the economic benefits of MPK are robust in various sensitivity analyses. CONCLUSIONS: Advanced prosthetics for transfemoral amputees, specifically MPKs, are associated with improved clinical benefits compared to non-MPKs. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S. payers.

The economic cost of robotic rehabilitation for adult stroke patients: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the best available evidence on the economic cost of robotic rehabilitation for adult stroke patients to improve their motor movement abilities. More specifically, the objective is to identify the evidence on the economic cost of robotic training compared to conventional physiotherapy for adult stroke patients, from the perspective of hospitals.

Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art.

Robots were introduced in rehabilitation in the 90s to meet different needs, that is, reducing the physical effort of therapists. This work consists of a meta-analysis of robot-mediated lower limbs rehabilitation for stroke-affected patients; it aims at evaluating the effectiveness of the robotic approach through the use of wearable robots or operational machines with respect to the conventional approach (i.e., manual rehabilitation therapy). The primary assessed outcome is the patient's ability to recover walking independence, whereas the secondary outcome is the average walking speed. The therapy acceptability and the treatment costs are also assessed. The assessment shows that the robot-mediated therapy is more effective than the conventional one in reaching the primary outcome. As for the secondary outcome, there is no significant difference between the robotic (wearable robots or operational machines) and the conventional approach. Rehabilitation using wearable robots has a greater acceptability than the conventional one. This does not apply to operational machines. The cost of robotic treatment with wearable robots ranges from double to triple the cost of the conventional approach. On the contrary, rehabilitation using operational machines costs the same as the conventional treatment. Robotic rehabilitation based on operational machines is the most cost-effective approach.