Force Guidance Research Articles

Challenging the American College of Obstetricians and Gynecologists' Clinical Practice Update on Screening for Pre-existing Diabetes and Early Gestational Diabetes.

A recent American College of Obstetricians and Gynecologists Clinical Practice Update continues to recommend targeted (as opposed to universal) screening for pregestational diabetes, no longer recommends screening for early gestational diabetes mellitus (GDM), and provides updated guidelines for immediate postpartum testing for diabetes in patients with GDM. Here, we present data that the targeted screening paradigm, which has repeatedly been shown to fail in practice because of its complexity, no longer makes sense in the context of the high and rising prevalence of diabetes and diabetic risk factors, and we argue that the time has come for universal early pregnancy screening for pregestational diabetes. Furthermore, the recommendation against early screening for GDM is based on 2021 U.S. Preventive Services Task Force guidance, which in turn is based almost entirely on a single underpowered study that excluded individuals at highest risk and does not account for more recent research showing benefits of early diagnosis and treatment. Universal early pregnancy screening for pregestational diabetes may also help to identify patients at risk who will benefit from early GDM diagnosis and treatment and may provide rationale for prioritizing postpartum diabetes testing.

Real-Time Trajectory Smoothing and Obstacle Avoidance: A Method Based on Virtual Force Guidance.

In dynamic environments, real-time trajectory planners are required to generate smooth trajectories. However, trajectory planners based on real-time sampling often produce jerky trajectories that necessitate post-processing steps for smoothing. Existing local smoothing methods may result in trajectories that collide with obstacles due to the lack of a direct connection between the smoothing process and trajectory optimization. To address this limitation, this paper proposes a novel trajectory-smoothing method that considers obstacle constraints in real time. By introducing virtual attractive forces from original trajectory points and virtual repulsive forces from obstacles, the resultant force guides the generation of smooth trajectories. This approach enables parallel execution with the trajectory-planning process and requires low computational overhead. Experimental validation in different scenarios demonstrates that the proposed method not only achieves real-time trajectory smoothing but also effectively avoids obstacles.

ChatGPT4 Outperforms Endoscopists for Determination of Postcolonoscopy Rescreening and Surveillance Recommendations

Large language models including Chat Generative Pretrained Transformers version 4 (ChatGPT4) improve access to artificial intelligence, but their impact on the clinical practice of gastroenterology is undefined. This study compared the accuracy, concordance, and reliability of ChatGPT4 colonoscopy recommendations for colorectal cancer rescreening and surveillance with contemporary guidelines and real-world gastroenterology practice. History of present illness, colonoscopy data, and pathology reports from patients undergoing procedures at 2 large academic centers were entered into ChatGPT4 and it was queried for the next recommended colonoscopy follow-up interval. Using the McNemar test and inter-rater reliability, we compared the recommendations made by ChatGPT4 with the actual surveillance interval provided in the endoscopist's procedure report (gastroenterology practice) and the appropriate US Multisociety Task Force (USMSTF) guidance. The latter was generated for each case by an expert panel using the clinical information and guideline documents as reference. Text input of de-identified data into ChatGPT4 from 505 consecutive patients undergoing colonoscopy between January 1 and April 30, 2023, elicited a successful follow-up recommendation in 99.2% of the queries. ChatGPT4 recommendations were in closer agreement with the USMSTF Panel (85.7%) than gastroenterology practice recommendations with the USMSTF Panel (75.4%) (P < .001). Of the 14.3% discordant recommendations between ChatGPT4 and the USMSTF Panel, recommendations were for later screening in 26 (5.1%) and for earlier screening in 44 (8.7%) cases. The inter-rater reliability was good for ChatGPT4 vs USMSTF Panel (Fleiss κ, 0.786; 95% CI, 0.734-0.838; P < .001). Initial real-world results suggest that ChatGPT4 can define routine colonoscopy screening intervals accurately based on verbatim input of clinical data. Large language models have potential for clinical applications, but further training is needed for broad use.

Overcoming the cognition-reality gap in robot-to-human handovers with anisotropic variable force guidance

Object handover is a fundamental task for collaborative robots, particularly service robots. In in-home assistance scenarios, individuals often face constraints due to their posture and declining physical functions, necessitating high demands on robots for flexible real-time control and intuitive interactions. During robot-to-human handovers, individuals are limited to making perceptual judgements based on the appearance of the object and the consistent behaviour of the robot. This hinders their comprehensive perception and may lead to unexpected dangerous behaviour. Various handover trajectories pose challenges to predictive robot control and motion coordination. Many studies have shown that force guidance can provide adequate information to the receivers. However, force modulation with intention judgements based on velocity, acceleration, or jerk may impede the intended motion and require additional effort. In this paper, starting from a human-to-human handover study, an anisotropic variable force-guided robot-to-human handover control method is proposed to overcome the cognition-reality gap. The retraction motion was decoupled based on a fitted motion plane and a task-related linear trajectory, which served as a reference for overshoot suppression and impedance force modulation. The experimental results and user surveys show that the anisotropic variable impedance force suppresses overshooting without impeding the intended motions, giving the receiver sufficient time for behavioural adjustments and assisting them in completing a safe and efficient handover in a preferred manner.

Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach.

A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.

DS05 Future guidelines should consider time needed to treat in clinics

Abstract The British Association of Dermatologists (BAD) published comprehensive guidelines on the management of cutaneous squamous cell carcinomas (cSCC) in 2021, outlining 46 recommendations over 32 pages. These recommendations include a full skin check or total body skin exam (TBSE) for the detection of new malignancies in this at-risk group. We present our experience in implementing this new guidance and the importance of considering the estimated clinician time needed to improve the outcome for one person in the target population (i.e. TNTNNT) when formulating new guidelines (Johansson M, Guyatt G, Montori V. Guidelines should consider clinicians’ time needed to treat. BMJ 2023; 380:e072953). A prospective audit of a skin cancer clinic found that the average consultation time for a patient with a newly diagnosed cSCC was 31 min (range 22–60 min). Follow-up appointments are routinely scheduled at 15 min; therefore, on average, a further 16 min is required to implement the new guidelines for each patient correctly. Recent evidence shows that one new SCC can be diagnosed per 57 TBSEs performed (Harding T, Seyffert J, Maner B et al. Exploring the clinical efficacy of the TBSE. J Clin Oncol 2020. DOI: 10.1200/JCO.2020.38.15_suppl.10078). Therefore, the approximate TNTNNT is 912 min (16 min × 57) or 15.2 h of clinical examination to detect one extra cSCC. This equates to nearly four consultant clinics (one clinic represents 4 h of activity) to detect an additional SCC in a patient group that is already attending for frequent review. There is a paucity of evidence to support the hypothesis that screening and removal of these lesions leads to reduced morbidity and mortality as compared with routine presentation and subsequent management. This lack of evidence is reflected in the US Preventive Services Task Force guidance on TBSE for skin cancer screening, where they provide ‘no recommendation’. Implementing the BAD guidelines has an effect on clinic times and generates an increased surgical caseload. We recommend that future guideline committees should indicate how much extra time in clinic would be required per patient to implement their advice adequately. The TNTNNT is one method to consider the clinical impact of such guidance.

National Psoriasis Foundation Telemedicine Task Force guidance for management of psoriatic disease via telemedicine

Telemedicine emerged as an alternative care delivery system used to offer effective long-term management to patients with chronic, inflammatory conditions such as psoriatic disease. Teledermatology can provide reliable clinical information through thorough history-taking and virtual evaluations that include patient-provided images and disease activity assessment tools that may help accurately diagnose and manage patients with psoriasis. The integration of validated screening tools for psoriatic arthritis and effective teledermatology practices may improve access to specialists, thus avoiding preventable delays in the diagnosis and treatment of patients with psoriatic arthritis. Although the provision of telehealthcare should not completely replace high quality, in-person dermatologic or rheumatologic visits, the convenience and collaborative nature of teledermatology may lead to expanded access and expedited care in the appropriate setting, whether it be in a virtual or in-person visit.

A vision-based virtual fixture with robot learning for teleoperation

Teleoperation plays a key role for semi-automated tasks with high complexity in remote working environment. By integrating the interaction information and control strategy, the control performance can be guaranteed by the skilled operator manipulation in terms of stability and precision. However, due to a lack of prolonged specialized training, the manipulation characteristics, such as operation habits and tremor for green hands, the control performance of teleoperation cannot be guaranteed, especially for complicated and refined tasks. To this end, a vision-based virtual fixture with robot learning approach is proposed for teleoperation. In the proposed method, a dynamic movement primitives method is utilized to learn the human tutor or skilled operator manipulation skill and then generates the expert trajectories for training of green hands. Additionally, considering the instantaneity of manipulation, a vision-based virtual fixture is utilized to generate a force selector based on position error and provides a force guidance to the green hands in order to enhance the precision of control with expert level and reduce the operation pressure. Comparative experimental results demonstrated the performance of the developed approach for teleoperation.

Radiofrequency Ablation in Chronic Pain Syndromes

Chronic pain is a frequent, intricate, and adverse condition that has a considerable influence on individuals and society at large. In India, its prevalence is around 20%. Although a spectrum of conservative treatment modalities is available, a significant proportion of patients with chronic pain syndromes remain refractory and require surgical intervention. In these groups of patients, radiofrequency ablation (RFA) techniques are safe minimally invasive treatments and provide significant and durable pain relief. Thus, we aimed to formulate the Indian Society for the Study of Pain (ISSP) guidelines for the management of chronic pain syndromes with various RFA techniques. An in-depth literature review by experts in Pain Medicine practising in India, was used to produce 16 statements across 4 common chronic pain syndromes, including knee pain, headache and facial pain, lumbar facet joint pain, and sacroiliac joint pain. The quality of evidence was assessed with the Third US Preventive Service Task Force guidance document and the strength of the recommendation was determined by the Delphi consensus process. The level of evidence for most of the statements was I. Moreover, for most statements, the level of agreement between the experts was good (≥80% of the experts). The ISSP guidelines for the management of chronic pain syndromes are developed by experts in pain medicine. For most of the statements, the highest level of evidence was available and inter-expert agreement was good. However, further high-quality research is required to formulate more inclusive guidelines in this evolving pain medicine speciality.

An Adaptive Force Guidance System for Computer-Guided Laparoscopy Training.

We present an adaptive force guidance system for laparoscopic surgery skills training. This system consists of self-adjusting fuzzy sliding-mode controllers and switching mode controllers to provide proper force feedback. Using virtual fixtures, the proposed system restricts motions or guides a trainee to navigate a surgical instrument in a 3-D space in a manner that mimics a human instructor who would teach the trainees by holding their hands. The self-adjusting controllers incorporate human factors, such as different force sensitivity and proficiency levels. The proposed system was implemented and evaluated using the computer-assisted surgical trainer (CAST). The effects of the force guidance system are presented based on the experimental test results.

Examining the Efficacy of Pre-Service Training for Enlisted Professional Military Education Instructors During the COVID-19 Pandemic

U.S. Air Force enlisted professional military education shifted traditionally in-person leadership interventions online due to the COVID-19 pandemic. Air Force guidance stated that pre-service faculty training focused on in-person instruction was sufficient for teaching online and that instructors did not require training that included online teaching strategies. This study was conducted to examine the efficacy of pre-service training for military leadership instructors teaching online. Utilizing a conceptual framework of teacher self-efficacy, locus of control theory, and social-cognitive theory, this research examined the experiences of four instructors who graduated pre-service training focused on in-person instruction and taught online directly thereafter. Analyzing data from interviews, observations, and student surveys, results indicated the pre-service training, coupled with the participants' military supervisory background, adequately prepared participants to teach online. Future studies should examine a larger sample size of instructors to identify trends and patterns within the professional military education instructor community.

Importance of public-private partnerships for nutrition support research: An ASPEN Position Paper.

Parenteral and enteral nutrition support are key components of care for various medical and physiological conditions in infants, children, and adults. Nutrition support practices have advanced over time, driven by the goals of safe and sufficient delivery of needed nutrients and improved patient outcomes. These advances have been, and continue to be, dependent on research and development studies. Such studies address aspects of enteral and parenteral nutrition support: formulations, delivery devices, health outcomes, cost-effectiveness, and related metabolism. The studies are supported by public funding from the government and by private funding from foundations and from the nutrition support industry. To build public trust in nutrition support research findings, it is important to underscore ethical research conduct and reporting of results for all studies, including those with industry sponsors. In 2019, American Society for Parenteral and Enteral Nutrition's (ASPEN's) Board of Directors established a task force to ensure integrity in nutrition support research that is done as collaborative partnerships between the public (government and individuals) and private groups (foundations, academia, and industry). In this ASPEN Position Paper, the Task Force presents principles of ethical research to guide administrators,researchers, and funders. The Task Force identifies ways to curtail bias and to minimize actual or perceived conflict of interests, as related to funding sources and research conduct. Notably, this paper includes a Position Statement to describe the Task Force's guidance on Public-Private Partnerships for research and funding. This paper has been approved by the ASPEN Board of Directors.

Behavioral Therapy and Pharmacotherapy for Relapse Prevention in Abstinent Smokers: Korea Preventive Services Task Force Guidance

Behavioral Therapy and Pharmacotherapy for Relapse Prevention in Abstinent Smokers: Korea Preventive Services Task Force Guidance

Behavioral Interventions for Smoking Cessation in Adolescents: Korea Preventive Services Task Force Guidance

Behavioral Interventions for Smoking Cessation in Adolescents: Korea Preventive Services Task Force Guidance

Fluid Reconstruction and Editing from a Monocular Video based on the SPH Model with External Force Guidance

AbstractWe specifically present a general method for monocular fluid videos to reconstruct and edit 3D fluid volume. Although researchers have developed many monocular video‐based methods, the reconstructed results are merely one layer of geometry surface, lack of accurate physical attributes of fluids, and challenging to edit fluid. We obtain a high‐quality 3D fluid volume by extending the smoothed particle hydrodynamics (SPH) model with external force guidance. For reconstructing fluid, we design target particles that are recovered from the shape from shading (SFS) method and initialize fluid particles that are spatially consistent with target particles. For editing fluid, we translate the deformation of target particles into the 3D fluid volume by merging user‐specified features of interest. Separating the low‐ and high‐frequency height field allows us to efficiently solve the motion equations for a liquid while retaining enough details to obtain realistic‐looking behaviours. Our experimental results compare favourably to the state‐of‐the‐art in terms of global fluid volume motion features and fluid surface details and demonstrate our model can achieve desirable and pleasing effects.

National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2—Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments

ObjectiveTo update guidance regarding the management of psoriatic disease during the COVID-19 pandemic.Study DesignThe task force (TF) includes 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation staff. Clinical questions relevant to the psoriatic disease community were informed by inquiries received by the National Psoriasis Foundation. A Delphi process was conducted.ResultsThe TF updated evidence for the original 22 statements and added 5 new recommendations. The average of the votes was within the category of agreement for all statements, 13 with high consensus and 14 with moderate consensus.LimitationsThe evidence behind many guidance statements is variable in quality and/or quantity.ConclusionsThese statements provide guidance for the treatment of patients with psoriatic disease on topics including how the disease and its treatments affect COVID-19 risk, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 (including novel vaccination), and what they should do if they develop COVID-19. The guidance is a living document that is continuously updated by the TF as data emerge.

Preliminary Assessment of a Postural Synergy-Based Exoskeleton for Post-Stroke Upper Limb Rehabilitation.

Upper limb exoskeletons have drawn significant attention in neurorehabilitation because of the anthropomorphic mechanical structure analogous to human anatomy. Whereas, the training movements are typically unorganized because most exoskeletons ignore the natural movement characteristic of human upper limbs, particularly inter-joint postural synergy. This paper introduces a newly developed exoskeleton (Armule) for upper limb rehabilitation with a postural synergy design concept, which can reproduce activities of daily living (ADL) motion with the characteristics of human natural movements. The semitransparent active control strategy with the interactive force guidance and visual feedback ensured the active participation of users. Eight participants with hemiplegia due to a first-ever, unilateral stroke were recruited and included. They participated in exoskeleton therapy sessions for 4 weeks, with passive/active training under trajectories and postures with the characteristics of human natural movements. The primary outcome was the Fugl-Meyer Assessment for Upper Extremities (FMA-UE). The secondary outcomes were the Action Research Arm Test(ARAT), modified Barthel Index (mBI), and metric measured with the exoskeleton After the 4-weeks intervention, all subjects showed significant improvements in the following clinical measures: the FMA-UE (difference, 11.50 points, p = 0.002), the ARAT (difference, 7.75 points ), and the mBI (difference, 17.50 points, p = 0.003 ) score. Besides, all subjects showed significant improvements in kinematic and interaction force metrics measured with the exoskeleton. These preliminary results demonstrate that the Armule exoskeleton could improve individuals' motor control and ADL function after stroke, which might be associated with kinematic and interaction force optimization and postural synergy modification during functional tasks.

National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1

ObjectiveTo provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic.Study designA task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted.ResultsThe TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus.LimitationsThe evidence behind many guidance statements is limited in quality.ConclusionThese statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.

Using Anti-Money Laundering Measures to Curb Pension Fraud in Nigeria

PURPOSE – This paper proposes a new approach to curbing pension fraud in Nigeria. The approach involves the use of anti-money laundering tools, procedures and expertise to advance the fight against pension fraud in Nigeria. The guidance is non-binding and does not override the purview of the National Pension Commission. The intention is to build on the revised procedures on the processing of Death Benefits and to complement existing circulars and guidelines issued by the National Pension Commission, including in particular the guidelines for Compliance Officers. DESIGN/METHODOLOGY/APPROACH – The analysis took the form of a desk study, which analyzed various documents and reports such as the Financial Action Task Force (2012-2018), International Standards on Combating Money Laundering and the Financing of Terrorism & Proliferation (the FATF Recommendations); the Financial Action Task Force Guidance on the Risk-Based Approach to Combating Money Laundering and Terrorist Financing: High Level Principles and Procedures; National Pension Commission Regulations for Compliance Officers; the Joint Money Laundering Steering Group Guidance for the United Kingdom Financial Sector Part I, June 2017 [Amended December 2017] and the Federal Financial Institutions Examination Council (FFIEC) Bank Secrecy Act/Anti-Money Laundering Examination Manual 2014. FINDINGS – This paper determined that a strong due diligence process where the owner of the pension account and the Next-of-Kin/legal beneficiary are duly identified before the establishment of a business relationship is capable of reducing the risks associated with pension fraud to the barest minimum. This paper also determined that anti-money laundering measures like record keeping, suspicious transactions reporting, training for anti-fraud/money laundering compliance and an independent audit of systems and controls can help curb pension fraud. RESEARCH LIMITATIONS – Pension fraud involves the use of deceit or misrepresentation in connection with a pension claim. There are many different kinds of pension fraud, but the type where the Fraud is aimed at stealing a person’s pension funds is what this paper is concerned with. ORIGINALITY/VALUE – While most publications on pension fraud are focused on anti-fraud measures, this paper focuses on the anti-money laundering measures which can be used by Pension Fund Administrators to curb pension fraud.

Variable Admittance Control of Robot Manipulators Based on Human Intention

This paper presents a variable admittance control method to achieve intuitive human–robot interactions that consider human intentions. Human intention is classified into two categories—direct and indirect. With respect to direct intention, the concept of standard force is introduced to adjust the interacting force. The proposed variable admittance control method improves intuitiveness when velocity is used as an estimate of direct intention. In the estimation of indirect intention, a force guidance method is suggested to make a robot follow and guide a human. The proposed control methodology is adapted to a six-DOF manipulator based on a one-dimensional analysis. The experiments are conducted with a manipulator (Universal Robots, UR10) and a force/torque sensor (Robotus, RFT60-HA) to evaluate the performance. The experiments validate that variable admittance control enhances the execution time, accuracy, and comfort of the operator.