Instrument Counts Research Articles

A Comparative Analysis of Performance Simulation for PUI Detectors Based on Traditional Probability Model and the Vasyliunas and Siscoe Model.

In recent years, the enthusiasm for deep space missions has remained unabated, resulting in continuous advancements in the research field of space environment and particles. Many instruments carried on these missions have conducted detection of pickup ions (PUIs) in the solar system. For those instruments, simulation is an effective means and a crucial step for their performance optimization and future operation in-orbit. It holds great significance for the instrument's in-orbit performance assessment, science operation optimization, and detection efficiency enhancement. In this paper, the traditional probability model and the Vasyliunas and Siscoe (V-S) model are used to generate the PUIs, which are the input for the simulation of the PUI detector. For further analysis, the numerical results of the simulation are processed to calculate the instrument's geometric factor, mass resolution, and count rates. Then, two sets of experiments are carried out for the comparison of the traditional probability model and the V-S model. The results show that, for the simulation of the instrument in the design stage, the simulation results of the traditional probability model and the V-S model are not much different. However, for the simulation of the instrument performance in-orbit, the PUI data generated based on the V-S model gave a better result than those of the traditional probability model. This conclusion is of great significance for evaluating the detection ability of the PUI detector in future deep space explorations.

Surgical instrument counting: Current practice and staff perspectives on technological support

BackgroundSurgical instrument counting is a manual, attention-intensive task of the operating room (OR) nurse. Many labour-saving technologies have been proposed, but implementation remains challenging. Knowledge of current counting methods and staff preferences could guide future developments towards effective application. ApproachWe observed OR nurses counting materials and instruments in 50 surgical procedures performed by various surgical specialties in a regional teaching hospital in Delft, The Netherlands. Additionally, we surveyed them on their preferences concerning the methods of counting. Key findingsVariations in approaches of surgical counting were observed, with OR nurses using multiple strategies and counting techniques to manage disruptions and limit workload. Interest in using supportive technology is limited to the preoperative and postoperative phase. RelevanceThis research relates observational data to staff preferences. Our findings may guide future developments of labour-saving innovations regarding surgical counting towards developing more effective applications and to ensure successful implementation.

Evaluation of on-site calibration procedures for SKYNET Prede POM sun–sky photometers

Abstract. To retrieve columnar intensive aerosol properties from sun–sky photometers, both irradiance and radiance calibration factors are needed. For the irradiance the solar calibration constant, V0, which denotes the instrument counts for a direct normal solar flux extrapolated to the top of the atmosphere, must be determined. The solid view angle, SVA, is a measure of the field of view of the instrument, and it is important for obtaining the radiance from sky diffuse irradiance measurements. Each of the three sun-photometer networks considered in the present study (SKYNET, AERONET, WMO GAW) adopts different protocols of calibration, and we evaluate the performance of the on-site calibration procedures, applicable to every kind of sun–sky photometer but tested in this analysis only on SKYNET Prede POM01 instruments, during intercomparison campaigns and laboratory calibrations held in the framework of the Metrology for Aerosol Optical Properties (MAPP) European Metrology Programme for Innovation and Research (EMPIR) project. The on-site calibration, performed as frequently as possible (ideally monthly) to monitor changes in the device conditions, allows operators to track and evaluate the calibration status on a continuous basis, considerably reducing the data gaps incurred by the periodic shipments for performing centralized calibrations. The performance of the on-site calibration procedures for V0 was very good at sites with low turbidity, showing agreement with a reference calibration between 0.5 % and 1.5 % depending on wavelengths. In the urban area, the agreement decreases between 1.7 % and 2.5 %. For the SVA the difference varied from a minimum of 0.03 % to a maximum of 3.46 %.

Comparison between a new device for the semen quality analysis and the manual microscopic evaluation in a not specialistic clinical laboratory

Abstract Objectives Semen analysis investigates different parameters of human semen with a high relevance in fertility workup, confirmation of sterility by post vasectomy, in pathologies follow-up such as varicocele and in all cases where sperm preservation is required. Manually seminal fluid examination is characterized by poor reproducibility. Aim of this study was to evaluate the performance of an automatic device in semen analysis by comparing its results with those obtained with the manual microscopy. Materials Fifty samples (age 18–59 years) were analyzed simultaneously by the manual and automated method. Manual analysis was performed by at least two experienced operators. Concentration and motility were determined by means of standard manual analysis and by the automated LensHooke™ analyzer following the last WHO guidelines. Results We compared the concentration (million/mL) of spermatozoa obtained from manual and instrumental count and different classifications obtained: normal, oligospermic, cryptospermic and azoospermic samples. The Wilcoxon test does not show a statistically significant difference. The Bland-Altman plot showed a slightly higher value for the manual count. Second, we compared the morphology and the samples classification in morphological normal and abnormal. Third, spermatozoa motility obtained from the manual and instrumental count was compared with a different classification in normal total motility and asthenozoospermia. Statistical tests showed respectively for morphology and motility a moderate and a very good agreement. Conclusions Our study demonstrates that the LensHooke™ shows an acceptable agreement with the manual microscopic seminal fluid evaluation. The use of this simple device could help to standardize reports in non specialistic laboratories.

Artificial intelligence model for automated surgical instrument detection and counting: an experimental proof-of-concept study

BackgroundRetained surgical items (RSI) are preventable events that pose a significant risk to patient safety. Current strategies for preventing RSIs rely heavily on manual instrument counting methods, which are prone to human error. This study evaluates the feasibility and performance of a deep learning-based computer vision model for automated surgical tool detection and counting.MethodsA novel dataset of 1,004 images containing 13,213 surgical tools across 11 categories was developed. The dataset was split into training, validation, and test sets at a 60:20:20 ratio. An artificial intelligence (AI) model was trained on the dataset, and the model’s performance was evaluated using standard object detection metrics, including precision and recall. To simulate a real-world surgical setting, model performance was also evaluated in a dynamic surgical video of instruments being moved in real-time.ResultsThe model demonstrated high precision (98.5%) and recall (99.9%) in distinguishing surgical tools from the background. It also exhibited excellent performance in differentiating between various surgical tools, with precision ranging from 94.0 to 100% and recall ranging from 97.1 to 100% across 11 tool categories. The model maintained strong performance on a subset of test images containing overlapping tools (precision range: 89.6–100%, and recall range 97.2–98.2%). In a real-time surgical video analysis, the model maintained a correct surgical tool count in all non-transition frames, with a median inference speed of 40.4 frames per second (interquartile range: 4.9).ConclusionThis study demonstrates that using a deep learning-based computer vision model for automated surgical tool detection and counting is feasible. The model’s high precision and real-time inference capabilities highlight its potential to serve as an AI safeguard to potentially improve patient safety and reduce manual burden on surgical staff. Further validation in clinical settings is warranted.

The SRG/eROSITA All-Sky Survey

Aims. Characterising galaxy cluster populations from a catalogue of sources selected in astronomical surveys requires knowledge of sample incompleteness, known as the selection function. The first All-Sky Survey (eRASS1) by eROSITA on board Spectrum Roentgen Gamma (SRG) has enabled the collection of large samples of galaxy clusters detected in the soft X-ray band over the western Galactic hemisphere. The driving goal consists in constraining cosmological parameters, which puts stringent requirements on the accuracy and flexibility of explainable selection function models. Methods. We used a large set of mock observations of the eRASS1 survey and we processed simulated data identically to the real eRASS1 events. We matched detected sources to simulated clusters and we associated detections to intrinsic cluster properties. We trained a series of models to build selection functions depending only on observable surface brightness data. We developed a second series of models relying on global cluster characteristics such as X-ray luminosity, flux, and the expected instrumental count rate as well as on morphological properties. We validated our models using our simulations and we ranked them according to selected performance metrics. We validated the models with datasets of clusters detected in X-rays and via the Sunyaev–Zeldovich effect. We present the complete Bayesian population modelling framework developed for this purpose. Results. Our results reveal the surface brightness characteristics most relevant to cluster selection in the eRASS1 sample, in particular the ambiguous role of central surface brightness at the scale of the instrument resolution. We have produced a series of user-friendly selection function models and demonstrated their validity and their limitations. Our selection function for bright sources reproduces the catalogue matches with external datasets well. We discuss potential inconsistencies in the selection models at a low signal-to-noise revealed by comparison with a deep X-ray sample acquired by eROSITA during its performance verification phase. Conclusions. Detailed modelling of the eRASS1 galaxy cluster selection function is made possible by reformulating selection into a classification problem. Our models are used in the first eRASS1 cosmological analysis and in sample studies of eRASS1 cluster and groups. These models are crucial for science with eROSITA cluster samples and our new methods pave the way for further investigation of faint cluster selection effects.

Investigation of the perceptions of operating theatre nurses and central sterile supply department technicians regarding the barriers and facilitators of surgical instrument counts and tray management in the operating theatre

BackgroundProper surgical equipment management is essential for ensuring patient safety in the operating theater (OT). Despite existing protocols, errors persist, leading to severe complications and emotional distress. This study aimed to investigate the perceptions of OT nurses and Central Sterile Supply Department (CSSD) technicians regarding barriers and facilitators of instrument counts and tray management. MethodsA multicenter cross-sectional, descriptive study was carried out using a SurveyMonkey conducted with a purposive sample of 52 participants of OT Nurses and CSSD technician from three hospitals in Saudi Arabia and the United Arab Emirates (UAE). The data were analyzed using frequencies and percentages, and to explore the relationship between the demographic variables and participants' overall perception scores, a chi-square test was employed. ResultsData analysis revealed that participant perceptions varied by years in the profession (p = 0.31) and gender (p = 0.003). About 52 % agreed that current policies are clear, while 36.5 % were uncertain. The majority (40.4 %) believed the current tray couldn't reduce OT costs. Participants disagreed with the lack of training (42.3 %) and communication issues during handover (38.5 %). Confidence in the current protocol was low (40.4 %), and 46.2 % agreed that a new protocol would impact OT operations. Alarmingly, 84.6 % of participants had a negative overall perception, indicating widespread concerns. ConclusionThese findings lay the groundwork for implementing a revised protocol for surgical tray management. Understanding healthcare professionals' perspectives will aid in identifying strategies to overcome barriers, enhancing instrument management practices, improving patient safety, and optimizing OT efficiency.

Automated hematological cell count using sysmex XN-1000V in Testudo hermanni: Agreement with manual count

Mediterranean area represents the main habitat of Testudo hermanni. Clinical signs of disease of these tortoises are non-specific, making the hematology results crucial in revealing underlying pathological conditions. However, accurate automated identification of blood cell populations is hampered by the presence of nucleated erythrocytes (NRBC) and thrombocytes (Thr), necessitating manual methods such as counting chambers. The aim of the study was to assess the performance of the novel automated hematology analyzer Sysmex XN-1000 V, which includes a a specific channel (WNR) for counting NRBC, in accurately identify and quantify the different blood cell populations of Testudo hermanni. Additionally, its agreement with manual counts was evaluated. Fifty heparinized blood samples were initially counted using the Neubauer improved chamber and then analysed twice with Sysmex XN-1000 V. Thirteen out of 50 samples were instrumentally counted again after 48 h to assess the inter-assay precision. All WNR scattergrams were re-analysed using an ad hoc gate panel to differentiate two populations: NRBCs (weak fluorescence signal) and WBC + Thr (high fluorescence signal). Sysmex XN-1000 V demonstrated optimal intra- and inter-assay precision for NRBCs (CV 0.98% ± 1.96; 1.31% ± 2.98) and moderate precision for WBC + Thr (CV 9.24% ± 16.61; 12.69% ± 10.35). No proportional nor constant errors were observed between the methods for both the populations. The instrumental NRBC counts were consistently slightly lower, while WBC + Thr counts were slightly higher compared to manual counts. These findings suggest that Sysmex XN-1000 V can be used for analyzing cell populations in heparinized blood of Testudo hermanni. However, specific instrumental reference intervals are suggested.

Clinical Issues - February 2024.

Retaining count sheets in the patient's medical record Key words: count sheet, medical record, procedural risk factor, retained surgical item, surgical count. Counting instruments during cavity closure Key words: uterine cavity, abdominal cavity, fetal procedure, cesarean delivery, instrument count. Surgical wound classification of procedures involving cancer removal Key words: cancer, contamination, infection, surgical wound classification, decision making. Placing an electrosurgical unit dispersive electrode over a tattoo Key words: dispersive electrode placement, metallic pigment, burn, tattoo, electrosurgical unit (ESU).

Assessment of manual operation note documentation practice: a cross-sectional study.

Operation note documentation captures the key findings and subtle elements of a surgical strategy and is crucial for patient safety. Poor operation note documentation can negatively influence postoperative patient care. This study aimed to assess manual operation note documentation practice. An institutional-based, cross-sectional study was conducted from 30 March to 30 April 2022, on 240 operation notes of patient data. Data were entered and analyzed by SPSS version 20. According to the RCSE, the Royal College of Surgeons of England, the practice of operation note documentation was rated excellent for each variable when it met 100%, good if it met more than 50%, and poor if it met less than 50% of the operation notes of patient data. All operation notes (n=240) were handwritten. The practice of manual operation note documentation was deemed excellent in two (7.69%), good in 18 (69.2%), and poor in six (23.1%). Residents wrote 84.2% of the operation notes and surgeons and assistants were identified in greater than 94% of the notes, while anesthesia team members were identified in 90.8%. Estimated blood loss was documented in 4.2% of the notes, and the closure technique was described in 64.2%. The operation note templates did not include antibiotic prophylaxis, runner nurse name, or gauze and instrument counts. The urgency of the surgery and time of documentation had a negative relationship, and the seniority of the operation note writer had a positive relationship with manual operative note documentation practice. Compared to the standard, all operation note documentation was incomplete and below the standard. We recommend that this comprehensive and specialized hospital administrator implement a new format for operation notes that incorporates RCSE requirements.

Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Implementation of the refined Clean Cut program. The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.

Calibrating SPI-ACS/INTEGRAL for gamma-ray bursts and re-estimating energetics of GRB/GW 190425 in gamma-ray range

ABSTRACT SPI-ACS/INTEGRAL is one of the most sensitive orbital gamma-ray detectors in energy range above 80 keV. Since 2002 it registered several thousands of gamma-ray bursts (GRBs), including the bursts associated with LIGO-Virgo gravitational wave events GW 170817 and GW 190425. No dedicated in-flight calibrations were performed for SPI-ACS/INTEGRAL, complicating estimation of spectral and energetic characteristics of an event. Using data of GBM/Fermi we perform cross-calibration of SPI-ACS/INTEGRAL, based on 1032 bright GRBs registered by both experiments. We find the conversion factor between instrumental counts from SPI-ACS and energy units from GBM to be dependent on hardness of GRB spectrum (defined as the characteristic energy value, Ep) and on location of a source in spacecraft-based coordinate system. We determine the corresponding analytical model to calculate the conversion factor and estimate its accuracy empirically. Sensitivity of SPI-ACS/INTEGRAL to detect gamma-ray transients is also investigated. Using the calibration we re-estimate energetics of GRB/GW 190425, detected by SPI-ACS/INTEGRAL alone. We constrain possible range of the characteristic energy Ep and isotropic equivalent of total energy, emitted in gamma-rays Eiso for GRB 190425, using the Ep, i–Eiso (Amati) correlation. The calibration model could be applied to any transients with energy spectrum, analogous to GRBs.

A new working fluid for condensation particle counters for use in sensitive working environments

Abstract. The working fluid of a condensation particle counter (CPC) is one of its essential characteristics. Butanol is commonly used as the working fluid in alcohol-based CPCs due to its proven performance for various applications and for a wide range of working conditions over the past almost 5 decades. At the same time, butanol has several disadvantages, including its strong and unpleasant odour, negative effects when inhaled over prolonged periods and flammability, making it troublesome to use in places with strict safety regulations. In this work, we propose addressing these negative issues by replacing butanol with dimethyl sulfoxide (DMSO), a substance that has not been used as a CPC working fluid to date. DMSO is an odourless, non-flammable and non-toxic substance that is easily accessible and inexpensive. During thorough experiments, this new substitute working fluid has proven to be stable with respect to its performance for CPCs and storage. We show that DMSO behaves in an equivalent manner to butanol when used to operate a CPC in terms of the instrument's counting efficiency, D50 cut-off diameter (the diameter at which 50 % of the particles are counted with respect to a reference) and concentration linearity. In addition, we have demonstrated this for operating pressures ranging from ambient pressure down to 200 hPa without the need for any safety precautions. Our new working fluid was tested on three CPC units representing two different models, almost always in side-by-side measurements. So far, we have achieved the best results with operating temperatures of 40 ∘C for the CPC's saturator and 5 ∘C for its condenser. To address a less desirable property of DMSO, it could be mixed with a slight amount of water to decrease its freezing point significantly. When mixed accordingly, the substance remains a liquid, even in work environments with temperatures ≤ −10 ∘C, without any impact on the CPC's counting efficiency performance.

Surgical Instrument Detection Algorithm Based on Improved YOLOv7x.

The counting of surgical instruments is an important task to ensure surgical safety and patient health. However, due to the uncertainty of manual operations, there is a risk of missing or miscounting instruments. Applying computer vision technology to the instrument counting process can not only improve efficiency, but also reduce medical disputes and promote the development of medical informatization. However, during the counting process, surgical instruments may be densely arranged or obstruct each other, and they may be affected by different lighting environments, all of which can affect the accuracy of instrument recognition. In addition, similar instruments may have only minor differences in appearance and shape, which increases the difficulty of identification. To address these issues, this paper improves the YOLOv7x object detection algorithm and applies it to the surgical instrument detection task. First, the RepLK Block module is introduced into the YOLOv7x backbone network, which can increase the effective receptive field and guide the network to learn more shape features. Second, the ODConv structure is introduced into the neck module of the network, which can significantly enhance the feature extraction ability of the basic convolution operation of the CNN and capture more rich contextual information. At the same time, we created the OSI26 data set, which contains 452 images and 26 surgical instruments, for model training and evaluation. The experimental results show that our improved algorithm exhibits higher accuracy and robustness in surgical instrument detection tasks, with F1, AP, AP50, and AP75 reaching 94.7%, 91.5%, 99.1%, and 98.2%, respectively, which are 4.6%, 3.1%, 3.6%, and 3.9% higher than the baseline. Compared to other mainstream object detection algorithms, our method has significant advantages. These results demonstrate that our method can more accurately identify surgical instruments, thereby improving surgical safety and patient health.

Genetic susceptibility for autoimmune diseases and white blood cell count

Some autoimmune (AI) conditions affect white blood cell (WBC) counts. Whether a genetic predisposition to AI disease associates with WBC counts in populations expected to have low numbers of AI cases is not known. We developed genetic instruments for 7 AI diseases using genome-wide association study summary statistics. Two-sample inverse variance weighted regression (IVWR) was used to determine associations between each instrument and WBC counts. Effect size represents change in transformed WBC counts per change in log odds-ratio of the disease. For AI diseases with significant associations by IVWR, polygenic risk scores (PRS) were used to test for associations with measured WBC counts in individuals of European ancestry in a community-based (ARIC, n = 8926), and a medical-center derived cohort (BioVU, n = 40,461). The IVWR analyses revealed significant associations between 3 AI diseases and WBC counts: systemic lupus erythematous (Beta = − 0.05 [95% CI, − 0.06, − 0.03]), multiple sclerosis (Beta = − 0.06 [− 0.10, − 0.03]), and rheumatoid arthritis (Beta = 0.02 [0.01, 0.03]). PRS for these diseases showed associations with measured WBC counts in ARIC and BioVU. Effect sizes tended to be larger among females, consistent with the known higher prevalence of these diseases among this group. This study shows that genetic predisposition to systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis was associated with WBC counts, even in populations expected to have very low numbers of disease cases.

Internationalization under attack: the external threat of short sellers

PurposeThe purpose of this paper is to examine the role of short sellers in foreign direct investment (FDI) decisions. Drawing on threat rigidity theory, the authors argue that short sellers pose a threat to chief executive officers (CEOs) by exerting downward pressure to target firms’ stock prices. That threat will evoke rigid managerial responses that hinder new FDI activities. The authors also posit that CEOs will be less reactive to short sellers’ threats when they are generalist CEOs who have extensive general work experience or when they serve as the board chair.Design/methodology/approachThe authors collect data from S&P 1,500 firms, and the final sample consists of 717 firms and 6,930 firm-year observations from 1998 to 2016. The authors use an Arellano and Bond generalized method of moments static linear probability panel data model and an instrumental panel count data model to test the hypotheses.FindingsThe findings support the hypotheses and suggest that CEOs who are under more pressure from short sellers engage in fewer new FDI activities. The negative impact of short sellers on FDI decisions is less salient when CEOs have general work experience or are the chairperson of the board.Originality/valueThis study contributes to the international business research by stressing the need to consider the role of short sellers in firm internationalization decisions.

Laparoscopic Appendectomy and Cholecystectomy Timing Predicts Hand-Offs but Not Miscounts

IntroductionIntraoperative hand-offs are poorly coordinated and associated with risk of surgical miscount. We evaluated hand-off patterns for nursing staff during two common operations hypothesizing that hand-off patterns would be associated with increased surgical miscounts and vary during operations performed standard versus nonstandard operating hours. MethodsWe retrospectively analyzed laparoscopic cholecystectomy (N = 3888) and appendectomy (N = 1768) from 2012 to 2021 at a single institution using electronic medical records. We evaluated intraoperative hand-off patterns and the presence of miscounts for operations performed during standard versus nonstandard hours. Standard operating hours were defined as M-F 7:30 am to 5:00 pm. ResultsAcross 5656 operations, 10 cases had surgical miscounts and were significantly longer than those without (156.5 versus 101 min P = 0.0178). More than half (51.3%) of cases had no identified hand-offs, and 42.9% of cases occurred during nonstandard hours. Cases during standard versus nonstandard hours were more likely to have hand-offs (56.0% versus 38.9%), P < 0.0001 and had shorter interval between hand-offs (64 versus 75 min), P < 0.0001. The period between patient entry to the room and intubation, which includes initial counts, had a disproportionately high percentage of hand-offs (P < 0.0001). ConclusionsVariability in hand-off occurrence and frequency in operations performed during standard and nonstandard hours suggest that hand-offs are influenced by staffing patterns. Few surgical miscounts occurred but were associated with longer cases. Hand-offs disproportionately occurred between patient entry and intubation, with a potential for disruption of initial instrument counts. Future work optimizing hand-off coordination is an opportunity to mitigate risk to patients.

Design and preparation of a biomedical titanium alloy with low elastic modulus and high antibacterial property based on Ti-Mo-Ag system

Titanium and titanium alloys have been widely used as biomedical materials as a result of low density, high specific strength, good biological propertise, good mechanical compatibility and easy processing. However, problems such as stress shielding and bacterial infection often occur in the clinical application. In this paper, Ti-15Mo-xAg (x = 10, 12) alloys were designed and prepared to obtain low elastic modulus and excellent antibacterial ability. We studied the microstructure, mechanical properties, antibacterial properties and cytocompatibility by scanning electron microscopy, differential scanning calorimeter, X-ray diffraction, micro-hardness instrument and plate counting method. The calculated results indicated that Ti-15Mo alloys with different Ag contents could be β-type or near β-type alloy with potential of a low elastic modulus. Microstructure results demonstrated that the increasing Ag content from 10 wt% to 12 wt% increased the phase transformation temperature and resisted the formation of ω phase in Ti-Mo-Ag system. Both the elastic modulus and the antibacterial ability were significantly influenced by the ageing treatment and Ag content due to the phase constitution, and high Ag content and the precipitation of Ti 2 Ag were beneficial to the antibacterial performance but increased the elastic modulus. Cell assessment showed that Ti-Mo-Ag alloys did not have cytotoxicity to MC3T3. Ti-15Mo-10Ag alloy exhibited strong antibacterial rate of 99.5%, good cellular compatibility and low elastic modulus of 85 GPa, which suggests that this alloy might be a highly competitive medical material. • The effects of Ag content and heat treatment process on elastic modulus and antibacterial properties were studied. • Ti-15Mo-10Ag and Ti-15Mo-12Ag alloy had no cytotoxicity to MC3T3 cell. • Ti-15Mo-10Ag exhibited low elastic modulus and good antibacterial ability after the ageing treatment of 650 ℃.

Adverse Events Associated With Robotic-Assisted Joint Arthroplasty: An Analysis of the US Food and Drug Administration MAUDE Database

BackgroundThe use of robotic assistance in arthroplasty is increasing; however, the spectrum of adverse events potentially associated with this technology is unclear. Improved understanding of the causes of adverse events in robotic-assisted arthroplasty can prevent future incidents and enhance patient outcomes. MethodsAdverse event reports to the US Food and Drug Administration Manufacturer and User Facility Device Experience database involving robotic-assisted total hip arthroplasty (THA), total knee arthroplasty (TKA), and partial knee arthroplasty were reviewed to determine causes of malfunction and related patient impact. ResultsOverall, 263 adverse event reports were included. The most frequently reported adverse events were unexpected robotic arm movement for TKA (59/204, 28.9%) and retained registration checkpoint for THA (19/44, 43.2%). There were 99 reports of surgical delay with an average delay of 20 minutes (range 1-120). Thirty-one cases reported conversion to manual surgery. In total, 68 patient injuries were reported, 7 of which required surgical reintervention. Femoral notching (12/36, 33.3%) was the most common for TKA and retained registration checkpoint (19/28, 67.9%) was the most common for THA. Although rare, additional reported injuries included femoral, tibial, and acetabular fractures, MCL laceration, additional retained foreign bodies, and an electrical burn. ConclusionDespite the increasing utilization of robotic-assisted arthroplasty in the United States, numerous adverse events are possible and technical difficulties experienced intraoperatively can result in prolonged surgical delays. The events reported herein seem to indicate that robotic-assisted arthroplasty is generally safe with only a few reported instances of serious complications, the nature of which seems more related to suboptimal surgical technique than technology. Based on our data, the practice of adding registration checkpoints and bone pins to the instrument count of all robotic-assisted TJA cases should be widely implemented to avoid unintended retained foreign objects.

Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics.

Objective: To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments. Methods & Results: Five surgeons performed thirteen simulated surgical cases on three human cadavers. Procedures included (i) two abdominal aortic aneurysm (AAA) repairs, (ii) three carotid endarterectomies (CE), (iii) two femoropopliteal (fem-pop) bypasses, (iv) thoracic aortic aneurysm repair, (v) coronary artery bypass graft, (vi) aortic valve replacement, (vii) ascending aortic aneurysm repair, (viii) heart transplants, and (ix) mitral valve replacement. For each case an average of 139 surgical instruments were RFID-tagged and tracked intraoperatively. Data was captured and analyzed retrospectively. Of the 139 instruments tracked across each of the 13 cases, 55 instruments (39.5%) were actually used, demonstrating a high level of redundancy. For repeat cases (i.e. CE/AAA/fem-pop): (i) average instrument usage was 41 ± 3.6 (8.8% variation) for CE (n=3); (ii) average instrument usage was 69 ± 4.0 (5.8% variation) for AAA (n=2); and (iii) average instrument usage was 48 ± 2.5 (5.3% variation) for fem- pop (n=2). Results also showed a reduction in end-of-procedure instrument counting times of 58-87%. Conclusions: We report on a method for collecting intraoperative data analytics regarding instrument usage via RFID technology. This system will help refine instrument selection, quantitate instrument utilization and prevent inadvertent retention in a patient. This should help increase efficiency in packaging and sterilization and let surgeons make objective decisions in the composition of surgical trays. Clinical and Translational Impact Statement—Intraoperative analytics of surgical tools and associated equipment may ultimately lead to safer more efficient surgeries that increase patient outcomes while decreasing the cost of care.