Flexible Instruments Research Articles

Evolving the Scope of Cardiac Point-of-Care Ultrasound in the Current Era.

Point-of-care ultrasound (POCUS) has become a flexible and multifaceted diagnostic instrument in the realm of cardiac care, transforming the landscape of cardiovascular assessment. This review aims to explore the extensive scope of POCUS applications in cardiac care, highlighting its diverse utility across various medical specialties. POCUS, conducted at the patient's bedside, offers real-time insights into cardiac anatomy and function, providing a valuable adjunct to traditional diagnostic methods. In critically ill patients, POCUS has demonstrated its effectiveness in the rapid evaluation of the left and right ventricular function, identification of pericardial effusion and tamponade, assessment of volume status, and detection of valvular lesions. Its role as an adjunct to the physical examination has been particularly impactful, leading to early diagnoses and significantly influencing medical management decisions. The review also discusses the current limitations of POCUS technology. As the utilization of POCUS continues to expand across diverse medical disciplines, its ability to offer timely and accurate diagnostic information is poised to reshape the standard of care in cardiac medicine. This comprehensive review provides insights into the evolving role of POCUS in cardiac care and underscores its potential to enhance patient outcomes through rapid and informed decision-making at the point of care.

Arduino-Based Experiments: Leveraging Engineering Design and Scientific Inquiry in STEM Lessons

Organizing STEM activities based on scientific inquiry and engineering design processes is recommended for competency-based education in many countries, including Vietnam, to develop vital 21st-century practices. However, one of the challenges in the scientific inquiry process is the lack of equipment for conducting experiments. Therefore, there is a need for cost-effective and flexible instrument initiatives that students and teachers can design, create, and operate on their own. Additionally, real-world contexts like designing experiments for studying are also essential to engage students in engineering design processes. With its open-source platform, user-friendly interface, and limitless creative potential, Arduino is a valuable tool for STEM education. Hence, this study aims to develop Arduino-based experiments and suitable lesson plans to facilitate the implementation of STEM lessons following scientific inquiry and engineering design processes. In this study, we have proposed three Arduino-based experiments, followed by instruction plans, that students can build through engineering design processes to study several Physics concepts. The results show that microcontroller systems combined with common sensors are a low-cost yet effective approach with acceptable accuracy, allowing students to quantitatively and professionally investigate the relationship between physical quantities. In addition, 21st-century practices such as STEM literacy and design thinking are also concentrated in the context of working with the solutions for STEM problems.

A novel flexible catheter with integrated magnetic variable stiffness and actuation

Flexible instruments offer significant advantages over traditional rigid instruments in ophthalmic surgery, because they can achieve larger working space and minimize the risk of damage caused by contact with eye tissues. However, it also needs to be rigid to achieve sufficient surgical operation force and stability. In this study, we propose a novel flexible catheter with integrated magnetic variable stiffness and actuation, based on electromagnetic induction heating and phase change alloy. The experimental results show that the catheter can switch from rigid to flexible modes in 11 s, and it takes 10 s to switch from flexible to rigid modes in room temperature. The bending stiffness of the catheter is 930.23°N mm2 in rigid mode and 74.42°N mm2 in flexible mode. In addition, the catheter can limit the axial force below 0.08°N in flexible mode, while withstand a force greater than 1.08°N in rigid mode. The catheter is equipped with a magnetic tip that can safely navigate in flexible mode with maximum bending angle of 106 degrees. The phantom experimental results demonstrated the potential clinical value of the proposed catheter.

Multibody dynamic modeling of the behavior of flexible instruments used in cervical cancer brachytherapy.

The steep radiation dose gradients in cervical cancer brachytherapy (BT) necessitate a thorough understanding of the behavior of afterloader source cables or needles in the curved channels of (patient-tailored) applicators. The purpose of this study is to develop and validate computer models to simulate: (1) BT source positions, and (2) insertion forces of needles in curved applicator channels. The methodology presented can be used to improve the knowledge of instrument behavior in current applicators and aid the development of novel (3D-printed) BT applicators. For the computer models, BT instruments were discretized in finite elements. Simulations were performed in SPACAR by formulating nodal contact force and motion input models and specifying the instruments' kinematic and dynamic properties. To evaluate the source cable model, simulated source paths in ring applicators were compared with manufacturer-measured source paths. The impact of discrepancies on the dosimetry was estimated for standard plans. To validate needle models, simulated needle insertion forces in curved channels with varying curvature, torsion, and clearance, were compared with force measurements in dedicated 3D-printed templates. Comparison of simulated with manufacturer-measured source positions showed 0.5-1.2mm median and<2.0mm maximum differences, in all but one applicator geometry. The resulting maximum relative dose differences at the lateral surface and at 5mm depth were 5.5% and 4.7%, respectively. Simulated insertion forces for BT needles in curved channels accurately resembled the forces experimentally obtained by including experimental uncertainties in the simulation. The models developed can accurately predict source positions and insertion forces in BT applicators. Insights from these models can aid novel applicator design with improved motion and force transmission of BT instruments, and contribute to the estimation of overall treatment precision. The methodology presented can be extended to study other applicator geometries, flexible instruments, and afterloading systems.

A novel miniature flexible robotic system for endoscopic mucosal dissection: an animal experimental study.

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastrointestinal cancer due to its higher rate of en-bloc resection and lower recurrence rate. However, the technical challenges lead to long learning curve and high risks of adverse events. A gastrointestinal flexible robotic-tool system (GIFTS) was proposed to reduce the difficulty and shorten the learning curve of novices. This is an animal study to evaluate the feasibility of GIFTS in ESD. The GIFTS provides a total of 13 degrees of freedom within 10 mm in diameter and variable stiffness function to achieve endoscopic intervention and submucosal dissection with the cooperation of two flexible robotic instruments. One esophageal and four colorectal ESDs in five porcine models were performed. In all five ESD procedures, the GIFTS was successfully intubated and submucosal dissection was completed without perforation or significant bleeding, and there was no system fault. The mean operative time was 99min, and the mean size of the specimen was 151 mm2. The fifth experiment showed significantly better results than the first one. In vivo animal experiments confirmed the feasibility of GIFTS in performing ESD. The control of GIFTS is friendly to inexperienced beginners, which will help reduce the technical challenges of ESD and shorten the learning curve of endoscopists.

Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study.

Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals. An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured. On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy. Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments.

Investors’ Perception towards the Share Market Awareness, Challenges and Satisfaction – A Study from Indian Context

Individual investors' participation has gradually increased in the financial market. It also offers the possibility of making money through returns from the invested capital alone with flexible market instruments, liquidity and diversity with risk. Reviewing the relevant articles, many authors found that a lack of awareness in the share market is the cause of every investor's loss. The study wants to investigate the importance of share market awareness and its impact on investors' challenges while investing. Also, this paper seeks to address the influence of investor awareness on investor satisfaction in the share market. Using the Snowball technique, a sample size of n=79 data was taken for the study. Through gaps in the existing literature, a self-administered questionnaire was constructed and used for data collection to explore the impact of awareness on challenges and satisfaction of investors in the share market. Structural Equation Modelling (SEM) was performed to test the hypothesis framed for this study after checking the validity and reliability of the questions as indicators. Based on the results, it is revealed that investor awareness has positively influenced investors to overcome challenges while investing in shares and satisfying them with the share market norms and returns.

Dynamic References To International Soft Law Agreements: Flexibility With Limits

The European Union relies increasingly on non-binding international agreements as a blueprint for its legislation on direct taxation. This implies converting a flexible soft law instrument into hard law that is subsequently difficult to amend due to the unanimity principle. A nascent trend to ensure that such Union legislation nevertheless stays in sync with future developments of the underlying soft law agreement are dynamic references to the latter. However, the scope for this approach is limited by the requirements of sufficient democratic legitimacy and legality of taxation, and respect for the institutional balance of the Union. Dynamic references to international soft law standards should therefore primarily be used as a source of interpretation or illustration for the concretization of already executable rules in the relevant EU legal act. They do not normally allow to incorporate also amendments and supplements of the original soft law agreement, unless additional safeguards exist that ensure compliance with the aforementioned Union law principles – at the expense of the desired flexibility, however. In this regard, the better approach would be the conferral of delegated powers upon the Commission to ensure a timely yet controlled alignment of the relevant Union tax legislation with new soft law standards. soft law, dynamic reference, democratic legitimacy, legality of taxation, institutional balance

A Novel Miniature Flexible Instrument With Unfolding and Decoupling Design for Endoscopic Surgery

A Novel Miniature Flexible Instrument With Unfolding and Decoupling Design for Endoscopic Surgery

Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases.

During the last decades, the advent of flexible ureteroscopic lithotripsy has revolutionized the management of upper urinary tract stones. We designed a patented tip-bendable ureteral access sheath to facilitate stone clearance. Our current study reported our initial experience of 224 cases. The study is a descriptive, retrospective analysis. The initial 224 cases, operated consecutively by one surgeon during 16 months, were reviewed. The novel tip-bendable ureteral access sheath was applied in the procedure. Demographics, laboratory tests, and peri- and postoperative findings (operation duration, stone-free rate (SFR), utilization of flexible instruments and complications) were analyzed. The median age of the patients was 56 years and the mean stones size was 2.3 ± 1.3cm. There were 63 cases of upper ureteral stone, 93cases of renal stone and 68 cases of ureteral-renal stones. The mean operative time was 69.2 ± 65.2min. The immediate stone-free rate was 76.8% and the 1 month post-operative stone-free rate was 97.3%. Most cases(95.5%)were success in single session. Two patient experienced post-operative fever. There was no unplanned readmission. The frequency of post-operative complications was estimated at 0.89% (Clavien I). Flexible ureteroscopic lithotripsy with tip-bendable ureteral access sheath is a safe and effective procedure, which can achieve excellent stone clearance.

Mechanically Induced Anisotropic Fragments in Sn-Doped In2O3 Nanoparticle Films for Flexible Strain Sensing Based on Surface Plasmons.

Recently, mechanical strain sensors have been extensively developed to quantify large mechanical deformations for stretchable and wearable applications. In this study, we propose a plasmonic strain sensor based on the mechanical control of optical properties using an assembled film comprising In2O3: Sn nanoparticles (ITO NP film). The resonant reflectance in the infrared range could effectively be tuned by applying strain to the ITO NP film deposited on an elastomeric polydimethylsiloxane (PDMS) sheet. The change in reflectance was caused by the mechanical deformation of the PDMS sheet. The operating mechanism of the proposed plasmonic strain sensor was related to anisotropic fragments induced by cracks formed perpendicular to the direction of the applied strain. These anisotropic fragments were functionalized as optical modulators to change the reflectance depending on the applied strain. The sensing performance of the proposed plasmonic strain sensor was evaluated by using a PDMS sheet with a circular hole that produced nonuniform stress distributions. Finally, to evaluate the flexible and wearable performance of the proposed sensor, the optical detection of human motion was performed by detecting joint-related movements. The optical detection of human motion could be achieved because a change in motion (e.g., bending and stretching of the index finger) was reversibly associated with reflectance changes. Therefore, this study provides new insights into plasmon-based strain sensing for various applications in flexible instruments and human motion detection.

Readiness for Online Learning, Social Media Assignment, and Its Effects on Learning Motivation of Islamic Education (PAI )Students

This study examines the extent to which online learning preparation has been implemented despite the pandemic's termination. Even said, some campuses still offer face-to-face instruction with the remaining 30% of instruction taking place online. Based on this, the researcher seeks to ascertain the viability of social media-based online assignments and learning, as well as their impact on student motivation. To determine the link between variable constructions, this study employs the SmartPls path data analysis technique. All PAI students at the Islamic University of Jakarta made up the sample, which included 56 respondents, of which 20 were men and 36 were women. The study's findings showed a 37.8% boost in learning motivation for those who were prepared for online learning. Additionally, there is a 53% boost in learning motivation for tasks while using social media. It is clear that technology and education will always go hand in hand, and that it will always be a flexible instrument for learning.

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05). For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

IP Law and Policy for the Data Economy in the EU

Abstract The current policy vision for Europe’s digital future centres around facilitating the availability of data by means of data access, sharing, and portability rights. In the existing legal framework, such rights are already foreseen in different legal instruments. In actual practice, however, (horizontal) data sharing is governed in the first place by contracts. Currently, well-established business practices and non-mandatory model contract terms are lacking. To reduce transaction costs and chilling effects in the sector, the main task would therefore be to provide a set of non-mandatory default rules or soft-law model contracts. The database maker’s sui generis right or trade secrets protection, mainstays of this area, have the potential to aggravate access problems and hamper efficient access and portability regimes. While the Trade Secrets Directive as a very modern and necessarily flexible instrument, on principle, is rather well-equipped for achieving balanced results, the Database Directive is in imminent need of reform, in particular as even the Data Act Proposal leaves many issues of the database sui generis right unsolved.

End-to-end digitalization factors: Challenges for Russian manufacturers

Despite clear progress in digitalization, Russia significantly lags behind global leaders in the use of digital technologies, including robots, artificial intelligence and 3D printing. In this study, we use the organizational characteristics of Russian industrial companies and the role of innovation diffusion channels to explain the digitalization factors of Russian industrial enterprises. The database is grounded on the results of a sample survey of 1.7 thousand companies; empirical estimates include the construction of logit regressions. The results of the study are mixed: digitized companies are focused on the domestic market, but are receptive to technology transfer from foreign investors, examples of other Russian and foreign companies in the industry, developments of research centers in the field of robotics and artificial intelligence. The study of the relationship between digitalization and firms’ use of innovation channels has shown the importance of market incentives and flexible public innovation policy instruments. Direct government involvement as an owner in stimulating digitalization affects innovative companies using robots and 3D printing, while indirect government support measures are significant for innovative companies using artificial intelligence. This suggests that Russian companies overcome the barriers of resource constraints and organizational rigidity in different ways, and are also selectively susceptible to external incentives, which should be taken into account by the government in its policies

Flexible instrument with contact-aided structure and force feedback for endoscopic surgery.

Robot-assisted surgery can effectively reduce the difficulty and improve the success rate of the surgeries. However, currently available flexible instruments have several limitations, such as large size, few degrees of freedom, and lack of contact force perception. This study proposes a master-slave flexible instrument capable of force feedback. The instrument has a maximum outer diameter of 3mm and an overall length of 1200mm. With the internal working channel unoccupied, a three-dimensional force sensing unit is designed based on the neural network. The corresponding master-slave control method with proportional force feedback was also designed to effectively control the instrument. To verify the effectiveness of the system, in vitro and in vivo experiments were conducted. The corresponding tasks were successfully completed. The animal trial conducted in the digestive tract of a live swine proved that the system has the potential for clinical use.

Flexible endoscopic instrument for diagnosis and treatment of early gastric cancer.

Gastric cancer is a common cancer endangering human life and health worldwide. Early detection and diagnosis of gastric cancer that is normally performed by flexible endoscope can significantly improve the survival rate of patients. However, current endoscopic instruments have some problems, such as limitation of degrees of freedom (DOFs) and lack of surgical triangulation. Meanwhile, the lack of an intraoperative technique for the real-time evaluation of early gastric cancer is also a serious problem. To solve these problems, we have developed a dual-bending flexible endoscopic instrument for the diagnosis and treatment of early gastric cancer. This instrument has a compact structure with a maximum outer diameter of 3mm and an insertion length of 1220mm. It has 5 DOFs with a dual-bending function, which can form a surgical operation triangulation to easily perform the endoscopic procedure. Apart from the surgical forceps, the end of the instrument can be equipped with different endoscopic devices to meet the needs of diagnosis and treatment, such as endomicroscopic probes, electrosurgical knives, and laser ablation optical fibers. It is verified that the instrument can carry these devices to complete corresponding tasks, demonstrating the great potential of this instrument in clinical applications.

A Robust Graph-Based Framework for 3-D Shape Reconstruction of Flexible Medical Instruments Using Multi-Core FBGs

This paper proposes a novel graph-based framework for 3-D shape sensing of flexible medical instruments using multi-core fiber Bragg grating (FBG) sensors. Due to noisy signals, deformability of instruments, and environmental disturbances, conventional shape sensing methods using direct FBG measurements are far from accurate and stable, especially for long devices. The localization errors will substantially accumulate with the increase of sensing lengths. To tackle this challenge, we propose a generic 3-D shape graph to optimize the entire shape of flexible instruments globally and account for the accumulative errors in both spatial and temporal domains. By leveraging the geometry configurations of FBG cores as the measurement model, a robust dynamic filtering approach is introduced for iterative curvature and twist estimation, which guarantees edge constraints of the graph-based shape optimization. Dedicated experiments are processed to validate our sensing approach in both structured and unstructured environments, where a robotic-assisted colonoscope system embedded with a multi-core FBG fiber is manipulated for the evaluations of bending as well as paths following in 3-D space. The results demonstrate the superiority of our framework as a promising solution for 3-D shape reconstruction of flexible instruments and continuum robots in terms of accuracy, robustness, and fast response compared to state-of-the-art works.

Leveraging land-value capture in contexts of urban austerity: evidence from the Grand Paris Express (France)

ABSTRACT Austerity urbanism has emerged as a powerful concept to explore the political and socio-spatial consequences of cuts in public spending, but interrogations remain regarding public actors’ shifting role in urban production in times of increased budgetary constraints. This article focuses on Land Value Capture (LVC), a financing mechanism that has been gaining traction amongst scholars and practitioners alike. While LVC can be framed as a valuable tool to finance infrastructure provision in times of austerity, we argue that the existing literature has neglected its use by other public actors, for the funding of other urban projects. Indeed, we analysed how different public actors (public landowners, land developers, and local governments) sought to take advantage of the anticipated rise in land value around future stations of the new urban railway system surrounding Paris, the Grand Paris Express. Through an exploration of four case studies, we show that LVC can be a flexible instrument that allows actors to either play into, or mitigate austerity-driven urban policies in French cities.

Shape-sensing by self-sensing of shape memory alloy instruments for minimal invasive surgery

Abstract Shape memory alloy-based flexible instruments have potential for enhancing the safety in minimally invasive surgery compared to passive rigid devices. We developed a data-driven polynomial model to estimate deflection of a 2D bending actuator using electrical resistance. The model accurately predicts deflections (mean error &lt;3.6 mm), but force sensing augmentation is required for unknown load cases. The model is specific to the tested actuator geometry, and future research should investigate multiple actuators and explore nonlinear modeling approaches.