Studies In Human Subjects Research Articles

Kinematic coordinations capture learning during human–exoskeleton interaction

Human–exoskeleton interactions have the potential to bring about changes in human behavior for physical rehabilitation or skill augmentation. Despite significant advances in the design and control of these robots, their application to human training remains limited. The key obstacles to the design of such training paradigms are the prediction of human–exoskeleton interaction effects and the selection of interaction control to affect human behavior. In this article, we present a method to elucidate behavioral changes in the human–exoskeleton system and identify expert behaviors correlated with a task goal. Specifically, we observe the joint coordinations of the robot, also referred to as kinematic coordination behaviors, that emerge from human–exoskeleton interaction during learning. We demonstrate the use of kinematic coordination behaviors with two task domains through a set of three human-subject studies. We find that participants (1) learn novel tasks within the exoskeleton environment, (2) demonstrate similarity of coordination during successful movements within participants, (3) learn to leverage these coordination behaviors to maximize success within participants, and (4) tend to converge to similar coordinations for a given task strategy across participants. At a high level, we identify task-specific joint coordinations that are used by different experts for a given task goal. These coordinations can be quantified by observing experts and the similarity to these coordinations can act as a measure of learning over the course of training for novices. The observed expert coordinations may further be used in the design of adaptive robot interactions aimed at teaching a participant the expert behaviors.

Use of a Fitbit-like device in rats: Sex differences, relation to EEG sleep, and use to measure the long-term effects of adolescent ethanol exposure.

Sleep difficulties and rhythm disturbances are some of the problems associated with adolescent binge drinking. Recently, animal models of alcohol-induced insomnia have been developed. However, studies in human subjects have recently focused not only on nighttime EEG findings but also on daytime sleepiness and disrupted activity levels as typically measured by activity tracking devices such as the "Fitbit." We sought to develop and test a Fitbit-like device (the "FitBite") in rats and use it to track rest-activity cycles following adolescent alcohol exposure. The effects of 5 weeks of adolescent ethanol vapor or control conditions were evaluated in 48 male and female Wistar rats using FitBite activity while intoxicated, and during acute (24 h post-vapor exposure) and chronic withdrawal (4 weeks post-vapor exposure). Data were analyzed using activity count and cosinor analyses. Fourteen rats were subsequently implanted with cortical electrodes, and data from the FitBite were compared with EEG data to determine how well the FitBite could identify sleep and activity cycles. Female rats were generally more active than males, with higher circadian rhythm amplitudes and mesors (rhythm-adjusted means) across a 24-h period. There were significant correlations between EEG-estimated sleep and activity counts using the FitBite. When the rats were tested during intoxication after 4 weeks of ethanol vapor exposure, they had significantly less overall activity. Disruptions in circadian rhythm were also found with significant decreases in the circadian amplitude, mesor, and a later shift in the acrophase. At 24 h of ethanol withdrawal, rats had more episodes of activity with shorter durations during the daytime, when rats are expected to spend more of their time sleeping. This effect remained at 4 weeks following withdrawal, but circadian rhythm disruptions were no longer present. A Fitbit-like device can be successfully used in rats to assess rest-activity cycles. Adolescent alcohol exposure produced circadian rhythm disturbances that were not observed after withdrawal. Fragmentation of ultradian rest-activity cycles during the light period was found at 24 h and 4 weeks after withdrawal and support data demonstrating the presence of sleep disturbance long after alcohol withdrawal.

Effect of Oral Administration of Syzygium cumini Seed Powder on the Hepatic Function-related Enzymes of the Alcoholic Transport Laborers

Background: Syzygium cumini (locally known as Kalo Jam) seed powder is being used as folk medicine in various diseases since unknown times in Bangladesh. However, data on the systematic studies in human subjects are rare. Objective: To determine the effect of Syzygium cumini seed powder on the hepatic function-related enzymes of the alcoholic transport laborers. Methods: Here, we investigated the effects of oral administration of Syzygium cumini seed powder on hepaticfunction markers that included activities of Gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and renal-function markers such as creatinine and urea along with lipid profile, blood pressure and body mass index (BMI) upon chronic alcoholic human volunteers. Results: The levels of serum ALT, AST and GGT levels decreased, respectively, by 15.0, 8.5 and 23.0% after oral administration of the S. cumini powder in the alcoholic subjects. However, the levels of creatinine and urea were not altered significantly. In contrast, the effects of administration of S. cumini on the hepatic ALT, AST and GGT enzymes in the non-alcoholic control subjects were less prominent than those found in the alcoholic subjects. Blood pressure decreased only by 5-4 mmHg, while BMI was not altered in either the alcoholic or the non-alcoholic groups. Furthermore, there were significant reduction in the levels of TC (by 10%) and LDL-C (by >20%) and elevation of HDL-C (by 11%) in the S. cumini-prescribed alcoholic subjects. TC and LDL-C levels also decreased in the non-alcoholic subjects, but the rate was not statistically significant. Conclusions: Our results suggest that S. cumini seed extract ameliorated GGT, ALT and the atherosclerotic lipid parameters TC and LDL-C without having a significant side effect on the kidney functions, as indicated by the unaltered levels of serum creatinine levels in the alcoholic human subjects without any effect on BP and BMI of the same subjects. Thus, alcohol drinkers can be advised to intake S. cumini seed powder to protect against the oxidative hepatic damage. Bangladesh Medical Res Counc Bull 2022; 48: 97-104

Non-Surgical Carpal Arch Space Augmentation for Median Nerve Decompression.

The carpal tunnel is a tightly bounded space, making the median nerve prone to compression and eventually leading to carpal tunnel syndrome. Carpal tunnel release surgery transects the transverse carpal ligament to expand the tunnel arch space, decompress the median nerve, and relieve the associated symptoms. However, the surgical procedure unavoidably disrupts essential anatomical, biomechanical and physiological functions of the wrist, potentially causing reduced grip strength, pillar pain, carpal bone instability, scar tissue formation, and perineural fibrosis. It is desirable to decompress the median nerve without surgically transecting the transverse carpal ligament. This paper is to review several approaches we have developed for nonsurgical carpal arch space augmentation (CASA), namely, radio ulnar wrist compression, muscle-ligament interaction, palmar pulling, and collagenolysis of the transverse carpal ligament. Briefly summarized is the research work on the CASA topic about theoretical considerations, in vitro and in situ experiment, computational modeling, and human subject studies with asymptomatic and carpal tunnel syndrome hands.

High-fat-sugar diet is associated with impaired hippocampus-dependent memory in humans

Overconsumption of high-fat and high-sugar (HFS) diet may affect the hippocampus, and consequently, memory functions. Yet, converging evidence is needed to demonstrate that the type of memory affected by HFS diet consumption is indeed hippocampus dependent. Moreover, the extent to which HFS diet can also affect executive functioning, and indirectly affect memory requires further examination. In this online study, we asked 349 young adults to report their HFS diet consumption and complete a word memory task, the Everyday Memory Questionnaire, and importantly two memory tasks that have been shown to robustly engage the hippocampus, i.e., the Pattern Separation and Associative Memory Tasks. Participants also completed two executive functioning tasks, the Trail Making Task (TMT) and the Stroop Task. These measures assess attention/cognitive flexibility and the ability to inhibit cognitive interference, respectively. After controlling for confounding variables, we found that participants who reported higher level consumption of a HFS diet performed worse on the Pattern Separation Task and that higher HFS intake was significantly associated with poorer TMT task performance and longer Stroop average reaction time (RT). TMT and Stroop RT scores indicative of reduced executive function also partially mediated the relationship between HFS diet and memory performance on the pattern separation task. Taken together, our results provide converging evidence that HFS diet may impair hippocampus-dependent memory. HFS diet may also affect executive functioning and indirectly impair memory function. The findings are consistent with human subject and animal studies and call for further investigations on the psychological and neural mechanisms underlying the dietary effects on cognitive processes.

Role of untargeted omics biomarkers of exposure and effect for tobacco research

Tobacco research remains a clear priority to improve individual and population health, and has recently become more complex with emerging combustible and noncombustible tobacco products. The use of omics methods in prevention and cessation studies are intended to identify new biomarkers for risk, compared risks related to other products and never use, and compliance for cessation and reinitation. to assess the relative effects of tobacco products to each other. They are important for the prediction of reinitiation of tobacco use and relapse prevention. In the research setting, both technical and clinical validation is required, which presents a number of complexities in the omics methodologies from biospecimen collection and sample preparation to data collection and analysis. When the results identify differences in omics features, networks or pathways, it is unclear if the results are toxic effects, a healthy response to a toxic exposure or neither. The use of surrogate biospecimens (e.g., urine, blood, sputum or nasal) may or may not reflect target organs such as the lung or bladder. This review describes the approaches for the use of omics in tobacco research and provides examples of prior studies, along with the strengths and limitations of the various methods. To date, there is little consistency in results, likely due to small number of studies, limitations in study size, the variability in the analytic platforms and bioinformatic pipelines, differences in biospecimen collection and/or human subject study design. Given the demonstrated value for the use of omics in clinical medicine, it is anticipated that the use in tobacco research will be similarly productive.

Analysis of injury mechanism and thoracic response of elderly, small female PMHS in near-side impact scenarios

Objective In 2020, 17% of all crash fatalities were individuals aged 65 years or older. Crash data also revealed that for older occupants, thoracic related injuries are among the leading causes of fatality. Historically, the majority of near-side impact postmortem human subjects (PMHS) studies used a generic load wall to capture external loads that were applied to PMHS. While these data were helpful in documenting biofidelity, they did not represent a realistic response an occupant would undergo in a near-side crash. The objective of this research was to test small, elderly female PMHS in a repeatable, realistic near-side impact crash scenario to investigate current injury criteria as they relate to this vulnerable population. Method Ten small, elderly PMHS were subjected to a realistic near-side impact loading condition. The PMHS were targeted to be elderly females age 60+, approximately 5th percentile in height and weight, with osteopenic areal bone mineral density. Each subject was seated on a mass-production seat, equipped with a side airbag and standard three-point restraint with a pretensioner. Other boundary conditions included an intruding driver’s side door. PMHS instrumentation included strain gages on ribs 3-10 bilaterally to identify fracture timing. Two chestbands were used to measure chest deflection, one at the level of the axilla and one at the level of the xiphoid process. Results Injuries observed included rib fractures, particularly on the struck side, and in multiple cases a flail chest was observed. Eight of ten subjects resulted in AIS3+ thoracic injuries, despite previously tested ATDs predicting less than a 10% chance of AIS3+ injury. Subjects crossed the threshold for AIS3 injury in the range of only 1% − 9% chest compression. Additionally, mechanisms of injury varied, as some injuries were incurred by door interactions while others came during airbag interactions. Conclusions This research points to two areas of concern that likely require further analysis: (1) the appropriateness of potentially oversimplified PMHS testing to establish injury thresholds and define injury criteria for complicated crash scenarios; (2) the importance of identifying the precise timing of injuries to better understand the effect of current passive restraint systems.

Abstract 2450: Transforming intestinal stem cells into metastatic cancer Stem cells by aberrantly activated cytokine-STAT5A signaling

Abstract Background: Lgr5 intestinal stem cells (ISC) are augmented by colorectal (CRC), but it is not clear if the aberrant Lgr5 ISCs result in the metastatic phenotypes of CRC, suggesting that epistasis-involved mutations in CRC suppressor genes or oncogene control Lgr5 ISC transformation into cancer stem cells (CSC). Somatic mutations in STAT5A or B are highly associated with CRC. Cytokine-STAT5 action is essential for Lgr5 ISC stemness, and enhanced STAT5 phosphorylation can induce Lgr5 ISC differentiation into secretory niche cells. Using human and mouse tumoroids, and organoid xerograph models, we aim to determine the effects of STAT5 oncogenic activation on Lgr5 ISC malignant and metastatic phenotypes. Methods: Colorectal surgical specimen from CRC and hepatic metastatic CRC patients were collected to perform RNAseq or single cell RNAseq (scRNAseq) analysis. Compound-mutant mice with STAT5 loss or gain of function in Apcmin+/- mice, were generated by crossing Apcmin+/- mice with Lgr5CreER and Rs26CreER, and Stat5f/f (loss of function of Stat5) or icS5f/f (gain of function of STAT5A) mice. CRISPR/Cas9 gene editing was applied to engineer APC mutations in human epithelial cell lines or Apc mutations in Lgr5 ISCs. Apc-mutant Lgr5 ISCs or tumoroids from Apcmin+/- mice combined with STAT5 loss or gain of function were differentiated, then were under intra-abdominal xenotransplantation. APC-mutant intestinal epithelial cell lines were used to determined CSC migration in the presence of STAT5 activation. STAT5 inhibitors were used to treat Apcmin+/- mice or tumoroids. Results: Human subject studies revealed that hepatic metastatic CRC patients exhibited the robustly increased STAT5A and/or Lgr5 colonic cancer cells. Murine studies showed that constitutively STAT5A activation (Ca-pYSTAT5) in colonic Apcmin+/- CSCs promoted CSC migration, invasion and metastasis. In vivo migration assay showed that transient STAT5A activation in the APC-mutant intestinal epithelia accelerated the migration of APC-mutant epithelia. Ex Vivo tumoroid xenotransplantation showed that Ca-pYSTAT5 resulted in tumoroid invasion into liver. Lineage tracing analysis showed that Ca-pYSTAT5 expanded Lgr5 CSCs in tumoroids and drove Lgr5 CSCs to hepatic metastasis. Importantly, Stat5 deletion in Lgr5 ISCs abolishes colon cancer orgnoids invasion. Pharmacological inhibition of STAT5 dimerization leads to Lgr5 cancer organoid degeneration and partially annihilated intestinal adenoma in Apcmin+/-. CHIP-seq analysis showed that Ca-pYSTAT5 increased an aberrant high level of Bcl6 expression by inducing super-enhancer activation in the Bcl-6 locus. Conclusion: Aberrantly activated Cytokine-STAT5A signaling is required for ISC malignancy and CSC hepatic metastasis. STAT5 blockade could be important to impair CRC metastasis. Citation Format: Haifeng Li, Wen Gao, Ruixue Liu, Xiaonan Han. Transforming intestinal stem cells into metastatic cancer Stem cells by aberrantly activated cytokine-STAT5A signaling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2450.

MP68-14 INTRAVENOUS ACETATE IS RENOPROTECTIVE FOLLOWING KIDNEY ISCHEMIA IN A PIG MODEL

You have accessJournal of UrologyCME1 Apr 2023MP68-14 INTRAVENOUS ACETATE IS RENOPROTECTIVE FOLLOWING KIDNEY ISCHEMIA IN A PIG MODEL Hal Kominsky, Jessica Dai, Tara Morgan, Alaina Garbens, Ryan Steinberg, Brett Johnson, and Jeffrey Cadeddu Hal KominskyHal Kominsky More articles by this author , Jessica DaiJessica Dai More articles by this author , Tara MorganTara Morgan More articles by this author , Alaina GarbensAlaina Garbens More articles by this author , Ryan SteinbergRyan Steinberg More articles by this author , Brett JohnsonBrett Johnson More articles by this author , and Jeffrey CadedduJeffrey Cadeddu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of medication to avoid ischemia related kidney injury following hilar occlusion has been previously investigated. Renoprotection appears to be conferred by HIF-2A activation which can be stimulated by exogenous acetate administration. The goal of this project was to assess whether administration of acetate in a pig model can negate kidney injury related to ischemia-reperfusion following renal vessel occlusion. METHODS: For this study we selected a porcine single-kidney model. First, a laparoscopic radical nephrectomy was performed, and the pigs were recovered. After seven days, the pigs underwent laparoscopic hilar dissection with 90 minutes of cross clamping on the contralateral kidney to simulate renal vessel occlusion during a partial nephrectomy. We employed block randomization of four experimental groups. Pigs in Group 1 received 150 mEq of sodium acetate intravenously during cross clamping. Group 2 received 0.75 g/kg of oral sodium acetate for three days leading up to the day of cross clamping. Group 3 received no acetate and underwent hilar dissection without any cross clamping. Group 4 also received no acetate and underwent hilar dissection with 90-minute cross clamping. Basic metabolic and complete blood panels were drawn after nephrectomy, immediately before and after cross clamping, at 24 and 72 hours and then 7 days after cross clamping. Serum creatinine was used to evaluate renal function. RESULTS: We performed a total of 16 procedures allocating 4 pigs for each experimental group. All pigs were 6-month-old females with median mass of 34.6 kg. One pig from Group 1 had to be excluded due to renal failure. Figure 1 demonstrates the mean serum creatinine for the experimental groups at each time point following hilar cross clamping. A significant difference in serum creatinine was observed at 90 minutes (p=0.038), 24 hours (p<0.001) and 72 hours (p=0.002) after crossing clamping for the pigs receiving intravenous acetate. The same effect was not observed for the pigs receiving oral acetate. CONCLUSIONS: We observed that the administration of intravenous acetate did confer a significant renoprotective benefit in our ischemia-reperfusion porcine single kidney model. This work is hypothesis generating and could lead to performing a similar study in human subjects undergoing renal hilar occlusion during partial nephrectomy. Source of Funding: Institutional © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e958 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hal Kominsky More articles by this author Jessica Dai More articles by this author Tara Morgan More articles by this author Alaina Garbens More articles by this author Ryan Steinberg More articles by this author Brett Johnson More articles by this author Jeffrey Cadeddu More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-10 USENSE: A LABEL-FREE, RAPID, NON-CULTURE BASED BIOSENSING PLATFORM FOR URINARY TRACT INFECTION DIAGNOSIS AND MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023LBA01-10 USENSE: A LABEL-FREE, RAPID, NON-CULTURE BASED BIOSENSING PLATFORM FOR URINARY TRACT INFECTION DIAGNOSIS AND MANAGEMENT Antra Ganguly, Ujjaini Basu, Philippe Zimmern, Nicole De Nisco, and Shalini Prasad Antra GangulyAntra Ganguly More articles by this author , Ujjaini BasuUjjaini Basu More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , Nicole De NiscoNicole De Nisco More articles by this author , and Shalini PrasadShalini Prasad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this work, we have developed a novel label-free and non-culture based, rapid point-of-care testing device for reliable UTI and recurrent UTI diagnosis and management, by combinatorially evaluating critical inflammatory biomarkers i.e., bacterial lipopolysaccharide (LPS), Prostaglandin E2 (PGE2) and Interleukin-8 (IL-8), within 5 minutes, using a drop (<0.2mL) of neat, unprocessed human urine requiring little to no sample preparation at the user end. Our POC diagnostic device can detect pathogen (e.g., bacterial lipopolysaccharide (LPS) and local inflammation (PGE2 and IL-8) and can thus diagnose UTI with high accuracy and precision. This technology is also able to assess risk of rUTI relapse. METHODS: The device platform is label-free and is made of gold-based electrodes immobilized with highly specific capture probes for highly selective detection. A wide dynamic range of 500-5,000pg/mL for PGE2, 1-1000 pg/mL for IL-8 and 1-1500 pg/mL for LPS was achieved using non-faradaic electrochemical impedance spectroscopy. Further, spike-in and recovery studies were performed to test for the accuracy of biomarker quantification. Cross-reactivity studies using potential intereferents were performed to gauge sensor specificity. The sensor performance and the ability to diagnose UTI was validated using human subject studies. RESULTS: USENSE platform is novel because it can detect UTI relevant biomarkers within a single sensor. This technology addressed the gap in the current urine dipsticks which are semi quantitative or give out a yes/no result. The measurement of two inflammatory markers (IL-8 and PGE2) and one bacterial marker (LPS) allows for a culture-free method with a rapid turnaround time for diagnosis, suitable for routine home-based screening. In addition, the USENSE framework will produce risk scores to help clinicians differentiate between UTI and asymptomatic bacteriuria. Further, USENSE uses PGE2 concentration to predict UTI recurrence and relapse. CONCLUSIONS: This work introduces a novel rapid POC testing device for reliable UTI diagnosis, by combinatorially evaluating critical inflammatory biomarkers using a drop of urine. The device is highly sensitive and specific and shows wide dynamic range, high accuracy, and reliability comparable to established lab standard technique. USENSE can be used as a vital clinical resource to make informed clinical decisions in <5 minutes. This will enable timely and appropriate prescription of antibiotics by allowing early UTI treatment. Source of Funding: Welch Foundation (Grant AT-2030-20200401) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antra Ganguly More articles by this author Ujjaini Basu More articles by this author Philippe Zimmern More articles by this author Nicole De Nisco More articles by this author Shalini Prasad More articles by this author Expand All Advertisement PDF downloadLoading ...

Local thermal comfort chart for non-uniform building environments: Comparison with vehicle environments and its application

There have been many laboratory studies of human subjects exposed to non-uniform thermal environments such as radiant temperature asymmetry from different directions, vertical air temperature differences, and draught. However, there are no final conclusions on the unified quantitative index for general non-uniform environments, which will be stressed in this study. The equivalent temperature (teq) that integrates air temperature, radiant temperature and air velocity at different body parts and well relates with thermal perceptions is adopted as an integral evaluation index. Published data from laboratory measurements of office environments with subjects exposed to different types of radiant asymmetry and measurements with a thermal manikin were analysed. A new comfort chart of teq was developed to evaluate non-uniform building environments and it was compared with the existing comfort chart (in ISO 14505) applied in vehicle. The results indicated that overall sensible heat loss of the human body remained constant, but local thermal discomfort and sensation changed with the non-uniform environments. The new comfort chart identified the source of discomfort and predicted the observed subjective evaluations. Significant discrepancy of the comfort chart between buildings and vehicles was found, indicating the necessity of developing a comfort chart that applied in the building environment. The study provides new insights into the causes of local thermal discomfort and can provide information on the sensitivity of different body parts to heat loss that can be used to optimise the thermal design of indoor environments.

Automating Surgical Peg Transfer: Calibration With Deep Learning Can Exceed Speed, Accuracy, and Consistency of Humans

Peg transfer is a well-known surgical training task in the Fundamentals of Laparoscopic Surgery (FLS). While human surgeons teleoperate robots such as the da Vinci to perform this task with high speed and accuracy, it is challenging to automate. This paper presents a novel system and control method using a da Vinci Research Kit (dVRK) surgical robot and a Zivid depth sensor, and a human subjects study comparing performance on three variants of the peg-transfer task: unilateral, bilateral without handovers, and bilateral with handovers. The system combines 3D printing, depth sensing, and deep learning for calibration with a new analytic inverse kinematics model and time-minimized motion controller. In a controlled study of 3384 peg transfer trials performed by the system, an expert surgical resident, and 9 volunteers, results suggest that the system achieves accuracy on par with the experienced surgical resident and is significantly faster and more consistent than the surgical resident and volunteers. The system also exhibits the highest consistency and lowest collision rate. To our knowledge, this is the first autonomous system to achieve “superhuman” performance on a standardized surgical task. All data is available at <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://sites.google.com/view/surgicalpegtransfer</uri> Note to Practitioners—This paper presents a new approach to calibrating cable-driven robots based on a combination of 3D printing, depth sensing, inverse kinematics, convex optimization, and deep learning. The approach is applied to calibrating the da Vinci, commercial surgical-assist robot, to automate a standard “pick and place” task. Experiments suggest that the resulting system matches human surgical expert performance in speed and accuracy and significantly outperforms humans in terms of consistency. All details on the system including CAD models, code, and user study data are available online.

Web-Based Patient Recommender Systems for Preventive Care: Protocol for Empirical Research Propositions

Preventive care helps patients identify and address medical issues early when they are easy to treat. The internet offers vast information about preventive measures, but the sheer volume of data can be overwhelming for individuals to process. To help individuals navigate this information, recommender systems filter and recommend relevant information to specific users. Despite their popularity in other fields, such as e-commerce, recommender systems have yet to be extensively studied as tools to support the implementation of prevention strategies in health care. This underexplored area presents an opportunity for recommender systems to serve as a complementary tool for medical professionals to enhance patient-centered decision-making and for patients to access health information. Thus, these systems can potentially improve the delivery of preventive care. This study proposes practical, evidence-based propositions. It aims to identify the key factors influencing patients' use of recommender systems and outlines a study design, methods for creating a survey, and techniques for conducting an analysis. This study proposes a 6-stage approach to examine user perceptions of the factors that may influence the use of recommender systems for preventive care. First, we formulate 6 research propositions that can be developed later into hypotheses for empirical testing. Second, we will create a survey instrument by collecting items from extant literature and then verify their relevance using expert analysis. This stage will continue with content and face validity testing to ensure the robustness of the selected items. Using Qualtrics (Qualtrics), the survey can be customized and prepared for deployment on Amazon Mechanical Turk. Third, we will obtain institutional review board approval because this is a human subject study. In the fourth stage, we propose using the survey to collect data from approximately 600 participants on Amazon Mechanical Turk and then using R to analyze the research model. This platform will serve as a recruitment tool and the method of obtaining informed consent. In our fifth stage, we will perform principal component analysis, Harman Single Factor test, exploratory factor analysis, and correlational analysis; examine the reliability and convergent validity of individual items; test if multicollinearity exists; and complete a confirmatory factor analysis. Data collection and analysis will begin after institutional review board approval is obtained. In pursuit of better health outcomes, low costs, and improved patient and provider experiences, the integration of recommender systems with health care services can extend the reach and scale of preventive care. Examining recommender systems for preventive care can be vital in achieving the quadruple aims by advancing the steps toward precision medicine and applying best practices. PRR1-10.2196/43316.

Is mandible derived mesenchymal stromal cells superior in proliferation and regeneration to long bone-derived mesenchymal stromal cells?

Mesenchymal stromal cells (MSCs) are cells with the characteristic ability of self-renewal along with the ability to exhibit multilineage differentiation. Bone marrow (BM) is the first tissue in which MSCs were identified and BM-MSCs are most commonly used among various MSCs in clinical settings. MSCs can stimulate and promote osseous regeneration. Due to the difference in the development of long bones and craniofacial bones, the mandibular-derived MSCs (M-MSCs) have distinct differentiation characteristics as compared to that of long bones. Both mandibular and long bone-derived MSCs are positive for MSC-associated markers such as CD-73, -105, and -106, stage-specific embryonic antigen 4 and Octamer-4, and negative for hematopoietic markers such as CD-14, -34, and -45. As the M-MSCs are derived from neural crest cells, they have embryogenic cells which promote bone repair and high osteogenic potential. In vitro and in vivo animal-based studies demonstrate a higher rate of proliferation and high osteogenic potential for M-MSCs as compared to long-bones MSCs, but in vivo studies in human subjects are lacking. The BM-MSCs have their advantages and limitations. M-MSCs may be utilized as an alternative source of MSCs which can be utilized for tissue engineering and promoting the regeneration of bone. M-MSCs may have potential advantages in the repair of craniofacial or orofacial defects. Considering the utility of M-MSCs in the field of orthopaedics, we have discussed various unresolved questions, which need to be explored for their better utility in clinical practice.

Aging in nucleus accumbens and its impact on alcohol use disorders.

Ethanol is one of the most widely consumed drugs in the world and prolonged excessive ethanol intake might lead to alcohol use disorders (AUDs), which are characterized by neuroadaptations in different brain regions, such as in the reward circuitry. In addition, the global population is aging, and it appears that they are increasing their ethanol consumption. Although research involving the effects of alcohol in aging subjects is limited, differential effects have been described. For example, studies in human subjects show that older adults perform worse in tests assessing working memory, attention, and cognition as compared to younger adults. Interestingly, in the field of the neurobiological basis of ethanol actions, there is a significant dichotomy between what we know about the effects of ethanol on neurochemical targets in young animals and how it might affect them in the aging brain. To be able to understand the distinct effects of ethanol in the aging brain, the following questions need to be answered: (1) How does physiological aging impact the function of an ethanol-relevant region (e.g., the nucleus accumbens)? and (2) How does ethanol affect these neurobiological systems in the aged brain? This review discusses the available data to try to understand how aging affects the nucleus accumbens (nAc) and its neurochemical response to alcohol. The data show that there is little information on the effects of ethanol in aged mice and rats, and that many studies had considered 2-3-month-old mice as adults, which needs to be reconsidered since more recent literature defines 6 months as young adults and >18 months as an older mouse. Considering the actual relevance of an aged worldwide population and that this segment is drinking more frequently, it appears at least reasonable to explore how ethanol affects the brain in adult and aged models.

An observational study demonstrating the measurement, characterization and validation of expression of calprotectin in human sweat through a sweat wearable

Inflammatory bowel diseases (IBD) comprising Crohn's disease (CD) and ulcerative colitis (UC) are typically characterized by chronic episodes of inflammation within and through the gastrointestinal (GI) tract. Calprotectin (CP) is a biomarker employed by clinicians effectively guide diagnostic and therapeutic decisions. However, there exists several challenges in sample collection and fecal CP testing for patient-use and patient enablement. Hence, there is a current unmet need to access CP in a completely non-invasive manner. This work is the first demonstration of CP in sweat using a wearable sweat sensor device. The sweat sensor device demonstrated a wide dynamic range of 0.1–10 μg/mL with a limit of detection of 0.1 μg/mL. The sensor was also specific to CP and demonstrated negligible to no response for non-specific inflammatory markers such as C-reactive protein, interleukin-6. Excellent correlation was achieved between ELISA and the sweat sensor device with Pearson's r > 0.95. Human subject studies demonstrated that elevated basal levels in IBD subject (500 ng/mL) as compared to healthy cohort (∼350 ng/mL). Further, 3 times increase in CP levels was observed due to flare-up in the IBD subject with a mean concentration ∼1300 ng/mL as compared to the basal levels. The pre-clinical results of elevated CP levels will be of significant interest to clinicians as it provides a non-invasive and non-intrusive tracking flare-ups in IBD patients and can aid in better management of the disease.

AN OBSERVATIONAL STUDY DEMONSTARTING THE MEASUREMENT, CHARACTERIZATION AND VALIDATION OF EXPRESSIONS OF CALPROTECTIN IN HUMAN SWEAT THROUGH A SWEAT WEARABLE

Abstract BACKGROUND Inflammatory bowel diseases (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) are typically characterized by chronic episodes of inflammation within and through the gastrointestinal (GI) tract. In many inflammatory conditions including IBD, Calprotectin (CP) is well-studied (systemic and fecal) and employed by clinicians due to assay stability and low cost to effectively guide diagnostic and therapeutic decisions. While, accessing fecal CP is non-invasive, there is significant resistance to continuous fecal CP testing from patient-use and patient enablement aspects due to the challenges is sample collection, hence there is a current unmet need to access CP in a completely non-invasive manner. METHODS The sweat sensor device and reference ELISA was used to investigate and quantify CP levels in sweat. The immunoassay on the sweat sensor was developed by immobilizing specific capture probe antibody to capture CP in sweat. The sensor response was measured using impedance spectroscopy. Sweat samples from seven healthy and one IBD subject were collected and correlation analysis between the sweat sensor device and ELISA was performed to evaluate CP levels in sweat. RESULTS The sweat sensor device demonstrated a wide dynamic range of 0.1- 10 μg/mL with a limit of detection of 0.1 μg/mL. The sensor was also specific to CP and demonstrated negligible to no response for non-specific inflammatory markers such as C-reactive protein, interleukin-6. Excellent correlation was achieved between ELISA and the sweat sensor device with Pearson’s r&amp;gt;0.95. Human subject studies demonstrated that elevated basal levels in IBD subject (500 ng/mL) as compared to healthy cohort (~ 350 ng/mL). Further, 3 times increase in CP levels was observed due to flare-up in the IBD subject with a mean concentration ~1300 ng/mL as compared to the basal levels. CONCLUSION This work is the first demonstration of CP in sweat. The pre-clinical results of elevated CP levels will be of significant interest to clinicians as it provides a non-invasive and non-intrusive tracking flare-ups in IBD patients and can aid in better management of the disease.

Artificial Intelligence Impersonating a Human: The Impact of Design Facilitator Identity on Human Designers

Abstract Advances in artificial intelligence (AI) offer new opportunities for human–AI cooperation in engineering design. Human trust in AI is a crucial factor in ensuring an effective human–AI cooperation, and several approaches to enhance human trust in AI have been explored in prior studies. However, it remains an open question in engineering design whether human designers have more trust in an AI and achieve better joint performance when they are deceived into thinking they are working with another human designer. This research assesses the impact of design facilitator identity (“human” versus AI) on human designers through a human subjects study, where participants work with the same AI design facilitator and they can adopt their AI facilitator’s design anytime during the study. Half of the participants are told that they work with an AI, and the other half of the participants are told that they work with another human participant but in fact they work with the AI design facilitator. The results demonstrate that, for this study, human designers adopt their facilitator’s design less often on average when they are deceived about the identity of the AI design facilitator as another human designer. However, design facilitator identity does not have a significant impact on human designers’ average performance, perceived workload, and perceived competency and helpfulness of their design facilitator in the study. These results caution against deceiving human designers about the identity of an AI design facilitator in engineering design.

Free Choice Navigation in the Real World: Giving Back Freedom to Wayfinders

In recent years, there has been collected evidence suggesting that increased usage of navigation assistance systems has a harmful effect on spatial cognition, including spatial knowledge acquisition. Previously, we proposed a potential remedy called Free Choice Navigation (simulation study). This novel navigation approach aims to provide the user with more freedom while navigating, and simultaneously give fewer navigation instructions. This approach also aims at increasing engagement with the environment and fostering spatial knowledge acquisition. We conducted a human-subject study with 48 participants comparing Free Choice Navigation with the widespread Turn-by-Turn approach on the outskirts of Vienna, Austria. The study showed the viability of our navigation system in real urban environments, providing fewer navigation instructions compared to the Turn-by-Turn approach (relative to the number of traversed junctions). Fewer instructions and forced engagement with the environment, however, did not result in differences concerning spatial knowledge acquisition, but interestingly, Free Choice Navigation users (without a map) could extract spatial configuration information similarly well as Turn-by-Turn users having a map. Moreover, we provide evidence that people are interested in learning more about their environments and are willing to walk longer routes to achieve it.

IEMS: An IoT-Empowered Wearable Multimodal Monitoring System in Neurocritical Care

IoT-empowered wearable multimodal monitoring system (IEMS), an IEMS for neurocritical care is developed to perform simultaneous monitoring of 8-channel electroencephalogram (EEG), 2-channel regional cerebral oxygen saturation (rSO2) based on near-infrared spectrum (NIRS), body surface temperature, electrocardiogram (ECG), photoplethysmography (PPG), and bioimpedance (Bio-Z). The IoT platform and wireless devices enable the patients’ signals available for remote diagnosis. Besides, analysis functions and artificial intelligence (AI) algorithms could be embedded in both the bedside platform and the cloud server to support physicians with clinical decisions. In the multimodal neural monitoring device, the following designs are adopted to face the neurological intensive care unit (NICU) application. Active electrodes and preamplifying free topology provide better signal quality and a larger dynamic range (DR). Dedicated low-power designs ensure the device lasts 10 h of operation. A nonwoven headset improves long-term wearability, which is also quick and easy to install. In the cardiovascular patch, the disposable electrode patch based on elastic materials ensures tight and comfortable contact with skin. Besides, the reusable wireless sensing module is tiny (20 mm <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\times16$ </tex-math></inline-formula> mm <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\times9$ </tex-math></inline-formula> mm) but could measure ECG, PPG, and Bio-Z simultaneously. Electrical tests and human subject (healthy volunteers and NICU patients) studies were conducted to examine the performance. The EEG channels show 130.75-dB DR and 0.84- <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\mu {}\text{V}_{\mathrm{ RMS}}$ </tex-math></inline-formula> input-referred noise, which also yields signals with high quality during human EEG monitoring. The NIRS channels exhibit good linearity and are able to operate under severe ambient interference. The temperature sensors show ±0.2 °C accuracy. Moreover, the system complies with mandatory standards for medical equipment. Overall, an IEMS can meet the requirements for NICU applications and could provide better comfort during long-term wearing.