Navigation Tools Research Articles

Digital platforms to facilitate physical activities for people with physical or sensory disabilities: A scoping review

BackgroundPeople with disabilities (PWD) commonly experience difficulties in accessing their environments, which can lead to restricted participation in outdoor leisure-time physical activity. Participating in outdoor leisure-time physical activity (OLTPA) provides health and social benefits to PWD and benefits to the communities in which they live. ObjectiveThe aim of the study was to identify features existing in digital platforms that facilitate access to OLTPA for PWD. MethodsA scoping review was conducted in four library databases and in Google advance search to identify relevant scientific and grey literature, and websites. Each step of the review was independently conducted by two co-authors who confirmed consensus of results. Descriptive data analyses were performed. ResultsSeven scientific studies and ten websites were included in the scoping review. Seven presented mobile apps, nine presented a website and one presented an online database. Sources reported five main obstacles to using digital platforms that support access to physical activities (e.g., lack of digital literacy, technical issues, unintuitive design), and 10 facilitators (e.g., possibility to personalize your online space, accessibility features of the navigation). Among these sources, a trend emerged in the most important factors and features to consider for the visuals and navigation of the platforms. ConclusionThe features of digital platforms that facilitate access to OLTPA include intuitive design compliant with accessibility guidelines and supported by navigation tools, personalization of the online space, and features for social interactions.

472 Complications of 3D-Navigated Spinal Procedures: A Systematic Review

INTRODUCTION: 3D surgical navigation has revolutionized spinal surgery. However, information on the overall usability of these tools is limited and inconsistent, especially with regard to operative time and radiation exposure. Complication rates across institutions and platforms have not been systematically examined, leading to a lack of quantitative understanding on surgical success rates. METHODS: This study used PRISMA guidelines and a PROSPERO-registered protocol to identify studies on FDA-approved 3D navigation systems in spinal procedures from Ovid MEDLINE(R), Embase, and Cochrane CENTRAL. Results were assessed by two independent reviewers using inclusion/exclusion criteria and risk of bias tools. RESULTS: 70 studies, totaling 3500 patients, were included. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.18% and 93.74%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r = 0.49, p = 0.40). 23 studies, totaling 1723 patients, compared the performance of 3D navigation to 2D fluoroscopy or freehand navigation. There was a significant difference of 6.47% between surgical success rates of the interventional and control groups (p = 0.01). However, there was no significant difference in radiation exposure or operative time between 3D navigated procedures and their controls. CONCLUSIONS: This study concludes that 3D navigation may have higher surgical success rates than 2D fluoroscopy and freehand navigation; increased surgeon comfort with riskier procedures on more complex segments of the spine may explain the slight increase in complication rates observed since 2004; and there is a need for improvement in 3D navigation tools to decrease operative time and radiation exposure.

Abstract 2230: Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA)

Abstract Background: The point of prostate cancer (CaP) diagnosis (PPCD) instantly leads to a life changing experience for Black men, with diverse emotional reactions that includes fear, denial, overwhelmingness, cancer fatalism etc. Black men diagnosed with CaP expressed several needs at the PPCD, including time to reflect on the diagnosis, being comfortable, emotional support, psycho-oncology support and social determinants of health (SDOH) navigation. Given that Black men are diverse in terms of their needs at the PPCD, precision intervention is needed to support them. Aim: The aim was to develop, implement, and establish the acceptance and usability of a Virtual Reality Assistant (ViRA) that will provide precision intervention tailored to the needs of Black men at the PPCD. This study is one of the five iCCaRE for Black Men projects focused on survivorship care. Methodology: The development of the ViRA was guided by CaP survivors through qualitative study. Reflective, analytic, and interpretive memos were used to generate action plans for the development of the ViRA. Based on a comprehensive PPCD ViRA intervention guide created by the team, the ViRA prototype was developed with mobile immersive technologies that integrated SDOH navigation, standard CaP psycho-oncology support and emotional support. The goal was to have the intervention personalized to everyone based on participant-provided information. Alpha testing of the ViRA is ongoing and will be completed on November 20, 2023. Participants are three prostate cancer survivors and three clinicians. The assessments will confirm the accuracy of the ViRA predictions and the functionality of the ViRA. Results: We developed the ViRA SDOH screening and navigation tool to identify participants’ needs and appropriately connect them with relevant support services and resources in their communities. The emotional support intervention was based on four CaP survivors as virtual reality avatars, providing empathetic rapport through self-disclosure and sharing of survivorship stories in different settings (home, clinic, barbershop etc). The psycho-oncology support intervention was developed with the guidance of a psycho-oncologist, with her avatar providing psychoeducation about the PPCD experience, reify and concretize the PPCD experience, and foster hope using the basic tenets of Problem-Solving Therapy. The results of the alpha testing and the modified ViRA will be presented during the conference. Conclusion: Meeting the needs of Black men at the PPCD requires a personalized and decentralized approach, which would allow Black men to access support anywhere. The presentation will unveil the iCCaRE ViRA, a smart and connected personalized AR-enabled intervention that will deliver SDOH navigation, CaP psycho-oncology support and emotional support tailored to the needs of Black men. Citation Format: Folakemi T. Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Roxana Dronca, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Vinessa Gordon, iCCaRE for Black Men Consortium. Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2230.

Abstract 998: Pursuing leadership in literacy to ameliorate head and neck cancer disparities

Abstract Overview of Proposed Research. Head and neck cancers are a deadly cancer that ranks among the six most common cancers worldwide. (American Cancer Society, 2021). Studies have shown greater disease burden among minority populations for head and neck cancer, higher mortality rates and lower oral cancer knowledge, but limited evidence has defined the underlying causes of late stage diagnoses and access to the healthcare system (Suzuki et al, 2019). More specifically, in comparison to the national rates, South Carolina is among the top ten for head and neck cancers (Community Outreach, Hollings Cancer Center, MUSC, 2019). Dental and primary care play a critical role delivering quality patient education, prevention, risk reduction and treatment regimes. However, there is a paucity of information published on the value of designing and implementing a health literacy program to prioritize head and neck cancer screening and prevention. Rural communities face unique challenges to achieving optimal oral health, impacted mainly by geographic location and socioeconomic status (IOM&NRC, 2011). More specifically, rural southern states such as SC continues to have a tremendous shortage of primary care providers. SC currently has 44 of 46 counties designated as geographic Primary Care and Dental Health Professional Shortage Areas and approximately 25% of SC citizenry are living in rural areas (HRSA, 2018). Because the vast majority of the state has challenges with availability of primary care and dental providers, this potentially exacerbates access to care inequities for rural and underserved minority populations. To enhance the quality and equity of oral cancer prevention in rural SC, it is critical that we prioritize strategies to elevate the significance of head and neck cancer risks. Therefore, the need to design and deliver innovative strategies to increase opportunities that intersect the healthcare system and community is inevitable. In this regard, we propose PULL A-HEAD, Pursuing Leadership in Literacy to Ameliorate HEAd and neck cancer Disparities. PULL A-HEAD is aimed to develop and implement a community-centered approach design for increasing the health literacy and efficacy of navigating the healthcare system for early detection of head and neck cancers. In this presentation we will share outcome and impact results of a community-centered, health literacy program in collaboration with our Regional Medical Library - Region 2 (RML2), National Library of Medicine partners at the Medical University of South Carolina. The program (i.e. PULL A-HEAD) will emphasize the delivery of health literacy education and health systems navigation tools to improve the early detection of head and neck cancers. Citation Format: Joni D. Nelson, Irene M. Lubker. Pursuing leadership in literacy to ameliorate head and neck cancer disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 998.

Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study.

Childhood cancer survivors are at increased risk for underinsurance and health insurance-related financial burden. Interventions targeting health insurance literacy (HIL) to improve the ability to understand and use health insurance are needed. We codeveloped a four-session health insurance navigation tools (HINT) intervention, delivered synchronously by a patient navigator, and a corresponding booklet. We conducted a randomized pilot trial with survivors from the Childhood Cancer Survivor Study comparing HINT with enhanced usual care (EUC; booklet). We assessed feasibility, acceptability, and preliminary efficacy (HIL, primary outcome; knowledge and confidence with health insurance terms and activity) on a 5-month survey and exit interviews. Among 231 invited, 82 (32.5%) survivors enrolled (53.7% female; median age 39 years, 75.6% had employer-sponsored insurance). Baseline HIL scores were low (mean = 28.5; 16-64; lower scores better); many lacked knowledge of Affordable Care Act (ACA) provisions. 80.5% completed four HINT sessions, and 93.9% completed the follow-up survey. Participants rated HINT's helpfulness a mean of 8.9 (0-10). Exit interviews confirmed HINT's acceptability, specifically its virtual and personalized delivery and helpfulness in building confidence in understanding one's coverage. Compared with EUC, HINT significantly improved HIL (effect size = 0.94. P < .001), ACA provisions knowledge (effect size = 0.73, P = .003), psychological financial hardship (effect size = 0.64, P < .006), and health insurance satisfaction (effect size = 0.55, P = .03). Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors to improve HIL. Randomized trials to assess the efficacy and sustainability of health insurance navigation on HIL and financial burden are needed.

Advancing sanitary surveillance: Innovating a live-feed sewer monitoring framework for effective water level and chamber cover detections

Efficient sanitation system management relies on vigilant sewage surveillance to uphold environmental hygiene. The absence of robust monitoring infrastructure jeopardizes unimpeded conduit flow, leading to floods and contamination. The accumulation of harmful gases in sewer chambers, coupled with tampered lids, compounds sewer network challenges, resulting in structural damage, disruptions, and safety risks from accidents and gas inhalation. Notably, even vehicular transit is vulnerable, facing collisions due to inadequately secured manholes. The core objective of this research was to deconstruct and synthesize a prototype blueprint for a live-feed sewer monitoring framework (LSMF). This involves creating a data gathering nexus (DGN) and empirically assessing diverse wireless sensing implements (WSI) for precision. Simultaneously, a geographic information matrix (GIM) was developed with algorithms to detect sewer surges, blockages, and missing manhole covers. Three scrutinized sensors—the LiDar TF-Luna, laser TOF400 VL53L1X, and ultrasonic JSN-SR04T—were evaluated for their ability to measure water levels in sewer vaults. The results showed that the TF-Luna LiDar sensor performed favorably within the 1.0–5.0 m range, with a standard deviation of 0.44–1.15. The TOF400 laser sensor ranked second, with a more variable standard deviation of up to 104 as obstacle distance increased. In contrast, the JSN-SR04T ultrasonic sensor exhibited lower standard deviation but lacked consistency, maintaining readings of 0.22–0.23 m within the 2.0–5.0 m span. The insights from this study provide valuable guidance for sustainable solutions to sewer surveillance challenges. Moreover, employing a logarithmic function, TF-Luna Benewake exhibited reliability at approximately 84.5%, while TOF400 VL53L1X adopted an exponential equation, boasting reliability approaching approximately 89.6%. With this navigational tool, TF-Luna Benewake maintained accuracy within ±10 cm for distances ranging from 8 to 10 m, showcasing its exceptional performance.

Racialized Emotions as Maps and Compasses for Students of Color Navigating a Predominantly White University

Students of color in predominantly White institutions (PWI’s) encounter racial microaggressions, the often subtle, but powerful, offensive experiences that are steeped in racism and occur in the course of everyday life. They also experience racial microaffirmations—moments where their racial identities or racialized realities are affirmed, validated, supported, or protected. We employ sociologist Bonilla-Silva’s concept of racialized emotions to analyze 16 student narratives describing racial microaggressions and racial microaffirmations; Bonilla-Silva defines racialized emotions as those that arise specifically within one’s racial hierarchy and shape one’s experiences within it. We find that racialized emotions are like navigational tools. Like maps, they allow students to understand the terrain of racial interaction. Like compasses, they help students find their way through said terrain in a predominantly White, often racist, institution. This article makes a distinctive contribution by exploring the relationship between racialized emotions and racial microaggressions and microaffirmations within a higher education context.

ElemeNT 2023: an enhanced tool for detection and curation of core promoter elements.

Prediction and identification of core promoter elements and transcription factor binding sites is essential for understanding the mechanism of transcription initiation and deciphering the biological activity of a specific locus. Thus, there is a need for an up-to-date tool to detect and curate core promoter elements/motifs in any provided nucleotide sequences. Here, we introduce ElemeNT 2023-a new and enhanced version of the Elements Navigation Tool, which provides novel capabilities for assessing evolutionary conservation and for readily evaluating the quality of high-throughput transcription start site (TSS) datasets, leveraging preferential motif positioning. ElemeNT 2023 is accessible both as a fast web-based tool and via command line (no coding skills are required to run the tool). While this tool is focused on core promoter elements, it can also be used for searching any user-defined motif, including sequence-specific DNA binding sites. Furthermore, ElemeNT's CORE database, which contains predicted core promoter elements around annotated TSSs, is now expanded to cover 10 species, ranging from worms to human. In this applications note, we describe the new workflow and demonstrate a case study using ElemeNT 2023 for core promoter composition analysis of diverse species, revealing motif prevalence and highlighting evolutionary insights. We discuss how this tool facilitates the exploration of uncharted transcriptomic data, appraises TSS quality, and aids in designing synthetic promoters for gene expression optimization. Taken together, ElemeNT 2023 empowers researchers with comprehensive tools for meticulous analysis of sequence elements and gene expression strategies. ElemeNT 2023 is freely available at https://www.juven-gershonlab.org/resources/element-v2023/. The source code and command line version of ElemeNT 2023 are available at https://github.com/OritAdato/ElemeNT. No coding skills are required to run the tool.

Controlling Traffic Congestion in a Residential Area via GLOSA Development

The phenomenon of traffic congestion started in the second half of the twentieth century. This arose because of our society’s constant increase in demand for mobility. The excessive traffic of vehicles attempting to use the same infrastructure at the same time is what causes congestion. The consequences are well-known: delays, air pollution, reduced speed, and dissatisfaction (which may lead to risky maneuvers, reducing pedestrian and other driver safety). Our objective is to simulate the change in traffic patterns brought about by app users in residential areas (using navigational tools like Google Maps and Apple Maps), where the majority of navigational tools provide shortcuts that go through residential areas. In addition to discouraging navigation apps from directing drivers through residential areas during peak hours to mitigate pollution levels, by developing an algorithm based on the technology of Green Light Optimized Speed Advisory (GLOSA) and implementing it in a simulated environment (VISSIM), we can see the effect of changing the duration of red lights while keeping green lights constant. Overall, this solution can be implemented to change the times of traffic lights without the need for supplies, additional equipment, or warning signs because most cities’ traffic lights are already remotely controlled. In addition, this procedure is temporary to provide some freedom and does not adhere to the speed specified for drivers who wish to pass through residential areas outside of rush hour.

Ketocyanine-Based Fluorescent Probe Revealing the Polarity Heterogeneity of Lipid Droplets and Enabling Accurate Diagnosis of Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) has gradually become a pronoun for terrifying death owing to its high mortality rate. With the progression of HCC, lipid droplets (LDs) in HCC cells exhibit specific variations such as increased LDs number and decreased polarity, which can serve as the diagnostic target. However, developing an effective method to achieve HCC diagnosis and reveal LDs polarity heterogeneity is still a crucial challenge. Herein, the first high-performance LDs-targeting probe (1) is reported based on ketocyanine strategy with ultrasensitive polarity-responding ability and near-infrared emission. Probe 1 shows excellent sensitivity to polarity parameter Δf (0.027-0.290) with 808-fold fluorescence enhancement and the emission wavelength red-shifts 91nm. In HCC cells, probe 1 shows a 2.5- to 5.9-fold fluorescence enhancement compared with normal and other cancer cells which exceeds clinical threshold of 2.0, indicating probe 1 can distinguish HCC cells. The LDs polarity heterogeneity is revealed and it displays a sequence, HCC cells < other cancer cells < normal cells, which may provide useful insight to engineer LDs-targeting probes for HCC cell discrimination. Finally, probe 1 realizes accurate HCC diagnosis on the cellular, organ, and in vivo levels, providing a satisfying tool for clinical HCC diagnosis and surgical navigation.

Implementasi Multibeam Echosounder sebagai Alat Bantu Pencarian Rambu Penuntun yang Runtuh di Alur Pelayaran Sungai Kapuas Pontianak

The Pontianak Kapuas River has a narrow shipping lane with a one-way route system. To reduce the danger in sailing in the shipping channel, a navigation tool is needed in the form of cardinal buoy. Based on the information obtained, there is a cardinal buoy 1 that has collapsed and endangered the shipping lanes. So it is necessary to carry out a hydrographic-bathymetric survey using the Multibeam Echosounder (MBES) technology. This survey aims to identify the coordinates and direction of the cardinal buoy object. The sounding method is a method used to obtain water depth data in the survey area. After processing the data, it was found that the coordinates of the cardinal buoy that collapsed were 0°4'29" N - 109°10'02" E and experienced a position shift of around ± 38 meters. The cardinal buoy that have been found do not block the shipping lanes because of their position as far as 240.39 meters from the shipping lanes. For this reason, the cardinal buoy that has collapsed does not need to be lifted, only a marker bouy is given,

Exploring software navigation tools for liver tumour angiography: a scoping review.

Liver cancer presents a growing global health concern, necessitating advanced approaches for intervention. This review investigates the use and effectiveness of software navigation in interventional radiology for liver tumour procedures. In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, a scoping review was conducted of the literature published between 2013 and 2023 sourcing articles through MEDLINE, Scopus, CINAHL and Embase. Eligible studies focused on liver cancer, utilised cone-beam computed tomography (CBCT), and employed software for intervention. Twenty-one articles were deemed eligible for data extraction and analysis. Categorised by type, software applications yielded diverse benefits. Feeder detection software significantly enhanced vessel identification, reducing non-target embolisation by up to 43%. Motion correction software demonstrated a 20% enhancement in image quality, effectively mitigating breathing-induced motion artefacts. Liver perfusion software facilitated efficient tumour targeting while simultaneously reducing the occurrence of side effects. Needle guide software enabled precise radiofrequency ablation needle placement. Additionally, these software applications provided detailed anatomical simulations. Overall, software integration resulted in shorter procedures, reduced radiation exposure and decreased contrast media usage. This scoping review highlights the innovative yet relatively underexplored role of software navigation for liver tumour procedures. The integration of software applications not only enhances procedural efficiency but also bolsters operator confidence, and contributes to improved patient outcomes. Despite the current lack of uniformity and standardisation, these software-driven advancements hold significant promise for transforming liver tumour interventions. To realise these benefits, further research is needed to explore the clinical impact and optimal utilisation of software navigation tools in interventional radiology.

Land Emissions and Removals Navigator (LEARN) Tool: Data Sources and Calculation Methods, Version 1.1

This technical note describes data and methods that enable communities in the United States to include forests and trees outside forests in their greenhouse gas (GHG) inventories using the Land Emissions and Removals Navigator (LEARN) tool. LEARN is an interactive web tool that provides automated analysis of the GHG impacts of forests and trees at the community scale. This is a living document that will be updated as improvements to the tool and its data sources are completed.

Fibre orientation atlas guided rapid segmentation of white matter tracts.

Fibre tract delineation from diffusion magnetic resonance imaging (MRI) is a valuable clinical tool for neurosurgical planning and navigation, as well as in research neuroimaging pipelines. Several popular methods are used for this task, each with different strengths and weaknesses making them more or less suited to different contexts. For neurosurgical imaging, priorities include ease of use, computational efficiency, robustness to pathology and ability to generalise to new tracts of interest. Many existing methods use streamline tractography, which may require expert neuroimaging operators for setting parameters and delineating anatomical regions of interest, or suffer from as a lack of generalisability to clinical scans involving deforming tumours and other pathologies. More recently, data-driven approaches including deep-learning segmentation models and streamline clustering methods have improved reproducibility and automation, although they can require large amounts of training data and/or computationally intensive image processing at the point of application. We describe an atlas-based direct tract mapping technique called 'tractfinder', utilising tract-specific location and orientation priors. Our aim was to develop a clinically practical method avoiding streamline tractography at the point of application while utilising prior anatomical knowledge derived from only 10-20 training samples. Requiring few training samples allows emphasis to be placed on producing high quality, neuro-anatomically accurate training data, and enables rapid adaptation to new tracts of interest. Avoiding streamline tractography at the point of application reduces computational time, false positives and vulnerabilities to pathology such as tumour deformations or oedema. Carefully filtered training streamlines and track orientation distribution mapping are used to construct tract specific orientation and spatial probability atlases in standard space. Atlases are then transformed to target subject space using affine registration and compared with the subject's voxel-wise fibre orientation distribution data using a mathematical measure of distribution overlap, resulting in a map of the tract's likely spatial distribution. This work includes extensive performance evaluation and comparison with benchmark techniques, including streamline tractography and the deep-learning method TractSeg, in two publicly available healthy diffusion MRI datasets (from TractoInferno and the Human Connectome Project) in addition to a clinical dataset comprising paediatric and adult brain tumour scans. Tract segmentation results display high agreement with established techniques while requiring less than 3 min on average when applied to a new subject. Results also display higher robustness than compared methods when faced with clinical scans featuring brain tumours and resections. As well as describing and evaluating a novel proposed tract delineation technique, this work continues the discussion on the challenges surrounding the white matter segmentation task, including issues of anatomical definitions and the use of quantitative segmentation comparison metrics.

Enmeshed with the digital: satellite navigation and the phenomenology of drivers’ spaces

This paper aims to develop a theoretical interpretation of how satellite navigation transforms drivers’ experience of automotive spaces. The use of satellite navigation has, so far, been predominantly studied from a cognitivist perspective based on the computer model of cognition and the theory of spatial disengagement. Experimental studies have concluded that over-reliance on digital navigation tools diminishes spatial orientation and spatial memory. According to the dominant interpretation, satellite navigation causes disengagement from space. After addressing these approaches, the paper introduces an embodied perspective of satellite navigation. This is accomplished by applying the phenomenology of perception of Maurice Merleau-Ponty, whose notions, such as perception, body schema, motor habit, and virtual body, illuminate otherwise undertheorized dimensions of drivers’ spaces. By using digital tools for wayfinding, drivers’ body schema, virtual body, and perception of space are modified, thereby enabling an engagement with convoluted ‘mesh spaces.’ This new term is integral to the interpretation of drivers’ spaces, as well as being distinct from that of ‘hybrid space,’ although both aim to conceptualize spaces, including physical objects and their visual representations. Conclusions will be drawn against the broader context of the mediatization of everyday life.

Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model

PurposeThe goal of this preclinical study is to assess the functionality, technical feasibility, and safety of a new vascular robotic LIBERTYR 3 System, in the microcatheterization of vascular targets using a range of guidewires and microcatheters.Material and methodsAn anesthetized pig served as an arterial model for the robotic device (LIBERTYR3; Microbot Medical Ltd, Yoqneam, IL). The primary efficacy endpoint was the evaluation of its capability to selectively catheterize predetermined distal arterial branches in the liver, kidneys, and mesenteric arteries (technical success), under fluoroscopy guidance. The primary safety endpoint was the occurrence of angiographic acute catheterization-related complications (dissection, thrombosis, embolism, perforation). The catheterizations were conducted by two interventional radiologists that present different work experience in endovascular procedures (18 and 2 years respectively), using a variety of microcatheters and wires. Various procedural parameters such as functionality, practicality, ease of use, and time required for selective catheterization, were evaluated, and recorded.ResultsAll pre-determined arteries were successfully selectively catheterized (100% technical success), by both operators. No angiographic acute complications occurred. The microcatheters and wires were manipulated using the remote portable console in an effortless manner that maintained a high level of accuracy. Mean time for selective catheterization was 131 ± 82 s. The robot's conversion function to manual operation was successfully demonstrated.ConclusionRobotic navigation and catheterization of selected target arteries were accomplished without observable vascular damage, suggesting that the LIBERTYR 3 robotic system is a reliable and safe tool for robotic-assisted endovascular navigation. Further experimental studies are required to evaluate safety and efficacy prior to introduction into clinical practice.

The Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules: Systematic Review and Meta-Analysis

BackgroundIdentification of peripheral pulmonary nodules (PPNs) are becoming increasingly common with modern imaging and lung cancer screening programs. Navigational bronchoscopy has been developed to augment the diagnostic yield of sampling these nodules. Cone beam computed tomography (CBCT) is one navigational tool which can be used alongside the historical gold standard of fluoroscopy and radial endobronchial ultrasound (r-EBUS). Research questionsTo assess the diagnostic yield and safety profile of combining CBCT with r-EBUS for the diagnosis of PPNs. Study design and methodsEmbase, PubMed and Cochrane Central were searched in March 2023. Eligible studies used CBCT with r-EBUS as the primary navigation technique. The primary outcome; diagnostic yield, was analysed using random effects meta-analysis. Additional subgroup analysis was based on the use of additional navigational technologies. Risk of bias was assessed using the Critical Appraisal Skills programme (CASP) tool for diagnostic studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the quality of outcomes. ResultsFourteen studies (n=865 patients, n=882 lesions) were included. The risk of bias was significant as assessed using the CASP tool, which identified multiple confounders. The pooled diagnostic yield of combined CBCT and r-EBUS guided biopsy for the diagnosis of PPNs was 80% (95%CI 76-84%). Subgroup analysis of diagnostic yield for CBCT and r-EBUS alone was 80% (95%CI 76-83%). The diagnostic yield of CBCT, r-EBUS combined with additional navigational technology (electromagnetic navigational bronchoscopy, virtual bronchoscopic navigation and robotic assisted bronchoscopy) was 80% (95%CI 73-87%). The quality of outcomes was assessed as low to very low using the GRADE tool. There was a 2.01% pneumothorax rate and 1.08% bleeding rate. Although heterogeneously reported, total radiation dose was between 19.59Gycm2 and 85.9Gycm2 resulting in an approximate effective dose range of 3.1 to 13.8mSv InterpretationCBCT and r-EBUS for the diagnosis of PPN’s has a high diagnostic yield and acceptable safety profile. Studies showed moderate heterogeneity with significant bias and hence generalizability of the study is limited and further prospective trials are required. Trial RegistrationProspero CRD42023410221

A novel image-guided laparoscopic liver resection with integrated fluorescent imaging and artificial intelligence: A preliminary study.

568 Background: Technology innovations improve surgical techniques. ICG fluorescence imaging is beneficial for real time navigation tool during surgery and enables accurate surgery. Recently, the prediction of anatomical structures by artificial intelligence (AI) is expected to support surgeons as navigation tool. We developed a visual-support AI system to perform the laparoscopic liver resection (LLR) using ICG fluorescence imaging and AI technology. Methods: Procedure: ICG fluorescence imaging was used for liver mapping and securing surgical margin. AI model development and evaluation: Over 430 images extracted from 13 videos of LLR for hepatocellular carcinoma and colorectal liver metastasis was used to develop and evaluate the AI algorithm at Anaut Inc. The annotation was performed on video frames capturing a LLR performed by 2 surgeons for hepatic vein and Glisson sheath. The performance of AI on unlearned LH videos was evaluated quantitatively using Intersection-Over-Union (IOU) and Dice coefficients, and qualitatively on a five-point scale (from 1 to 5) by 10 hepato-biliary-pancreatic surgeons using 35 randomly extracted still images from the analyzed videos. Results: ICG fluorescence imaging could visualize the demarcation line and clarified the boundaries of the liver transected surface. The hepatic veins and Glisson sheath were appeared in the parenchymal transection plane during segmentectomy and securing surgical margin, and this AI system enabled to recognize and display these vascular structures through color-coding under bleeding and ICG fluorescent imaging without visual discrepancies. The AI model accurately recognized vascular structures of any size (IoU=0.33, Dice=0.44) in real-time (&lt;0.12 s) In the qualitative evaluation by surgeons, the mean sensitivity score was 4.10 ± 0.92 (range 3.61–4.76). Additionally, this AI system also recognized vascular structures during robot-assisted liver resection. Conclusions: This is the first study demonstrating that AI can precisely identify vascular structures during LLR. Novel image-guided LLR using ICG fluorescent imaging and artificial intelligence is expected to provide safer and more accurate LLR, thereby contributing to reduce complications and improve survival rates.

Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study.

Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.

Pre-Operative Computed Tomography Scan Assessment of Variations in Olfactory Fossa Depth among Adults

Abstract Context: The paranasal sinus Computed Tomography (CT) scan is important in the evaluation of patients with sino-nasal pathologies and serves as a tool for navigation during endoscopic sinus surgery (ESS). The risk of skull base injury during ESS is assessed using the depth of the olfactory fossa, which has been shown to have racial variations. We aimed to use Keros classification to study the variations in the depth of the olfactory fossa at a specialized tertiary ENT hospital in Kaduna, Northwest Nigeria. Setting and Design: It was a retrospective cross-sectional study conducted at the radiology department of the National Ear Centre, Kaduna. Materials and Methods: All CT scans of the paranasal sinuses from January 2021 – January 2022 were retrieved and reviewed. Coronal CT scans of patients, 18 years and above, were included. Those who had skull-based surgery and those with tumors of the paranasal sinuses were excluded. Statistical Analysis Used: Data were entered in Statistical Product and Service Solutions (SPSS) version 25. Results: A total of one hundred and six (106) CT scans were studied which resulted in 212 depths of olfactory fossa measurements. The age range of participants was 18–81 years with a mean age of 41.1 ± 14.18 years. The male-to-female ratio was 1:1.08. Keros type II was found to be the most prevalent (68.4%) generally, as well as across gender and laterality distribution, with statistically significant difference between males and females, and no significant difference between the right and left sides. Conclusion: Type II Keros classification was the most common across gender and laterality distributions, with statistically significant differences between males and females. Cognizance of individual variations in preoperative assessments and surgical planning is imperative in ensuring safe and satisfactory surgical outcomes. We recommend further studies with a larger sample size and from different regions of the country.