High-speed fluidic processing circuits for dynamic control of haptic and robotic systems.

Fluidic logic circuits simplify system design for soft robotics by eliminating bulky components while enabling operation in a range of hostile environments that are incompatible with electronics but at the expense of limited computational capabilities and response times on the order of seconds. This paper presents a four-terminal fluidic transistor optimized for fast switching times, reduced component count, low unit cost, and high reproducibility to achieve complex fluidic control circuits while maintaining flow rates of liters per minute. A ring oscillator using three fluidic transistors achieves oscillation frequencies up to a kilohertz with full signal propagation, tolerating billions of cycles without failure.

Use of the Lean Manufacturing Principles to Improve Total Parenteral Nutrition Logistics and Clinical Outcomes in the Neonatal Patient Population.

Unlabelled: Total parenteral nutrition (TPN) is one of the most frequently used pharmaceuticals administered to patients in our Neonatal Intensive Care Unit (NICU). Initially, the total interdepartmental processing time (ordering, manufacturing, and delivery between NICU and Pharmacy) averaged 15.2 hours.

Standardised early warning scores in rural interfacility transfers: A pilot study into their potential as a decision-making aid.

Introduction: While 12.4% of British Columbians live rurally, only 2.0% of specialists practise rurally, making interfacility transport of high-acuity patients vital.

Surveillance and Management of Troponin Elevation after Vascular Surgery.

Background: Postopertive troponin elevation may occur without typical or atypical cardiac symptoms and is associated with an increased 30-day morbidity and mortality. The objective of the study was to implement a quality improvement initiative of postoperative troponin surveillance algorithm aimed at intensifying medical management after vascular surgery.

Methods: We conducted a single-center study of postoperative troponin surveillance after vascular surgery (n = 201) at a tertiary care, academic medical center from January to December 2016.

Not all deep vein thrombosis is created equal: Incidence of preexisting chronic deep vein thrombosis among high-risk traumatized patients.

Background: Traumatized patients are at risk of developing deep vein thrombosis (DVT) and DVT prophylaxis is the standard of care. The Centers for Medicare and Medicaid Services classifies DVT as a hospital-acquired condition and can deny payment for treatment of DVT and, in addition, place financial penalties on hospitals with higher than acceptable rates of DVT, unless the DVT was preexisting. We sought to determine the rate of preexisting chronic DVT among symptomatic traumatized inpatients at our ACS-verified Level 1 trauma center.

Postoperative opioid prescribing patterns and use after vascular surgery.

The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients ( n = 110) about opioid use and pain management perceptions.

Prospective Study of Postoperative Glycemic Control with a Standardized Insulin Infusion Protocol after Infrainguinal Bypass and Open Abdominal Aortic Aneurysm Repair.

Background: The aim of this study is to examine the effect of moderate postoperative glycemic control in diabetic and nondiabetic patients undergoing infrainguinal bypass (INFRA) or open abdominal aortic aneurysm (OAAA) repair.

Methods: In a single center prospective study, we investigated postoperative glycemic control using a standardized insulin infusion protocol after elective INFRA bypass (n = 53, 62%) and OAAA repair (n = 33, 38%) between January 2013 and March 2015. The primary end point was optimal glycemic control, defined as having ≥85% of blood glucose values within the 80-150 mg/dL target range.

Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study.

Purpose: In this study, we examine three-dimensional (3D) proctoring tools (i.e., semitransparent ghost tools overlaid on the surgeon's field of view) on realistic surgical tasks.

TRAPEZE: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of chemotherapy with zoledronic acid, strontium-89, or both, in men with bony metastatic castration-refractory prostate cancer.

Background: Bony metastatic castration-refractory prostate cancer is associated with a poor prognosis and high morbidity. TRAPEZE was a two-by-two factorial randomised controlled trial of zoledronic acid (ZA) and strontium-89 (Sr-89), each combined with docetaxel. All have palliative benefits, are used to control bone symptoms and are used with docetaxel to prolong survival.

Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747).

Objective: To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).

Patients And Methods: Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs.

Deformable Model-Based Methods for Shape Control of a Haptic Jamming Surface.

Haptic Jamming, the approach of simultaneously controlling mechanical properties and surface deformation of a tactile display via particle jamming and pneumatics, shows promise as a tangible, shape-changing human-computer interface. Previous research introduced device design and described the force-displacement interactions for individual jamming cells. The work in this article analyzes the shape output capabilities of a multi-cell array.

Clinical Outcomes and Survival Following Treatment of Metastatic Castrate-Refractory Prostate Cancer With Docetaxel Alone or With Strontium-89, Zoledronic Acid, or Both: The TRAPEZE Randomized Clinical Trial.

Importance: Bony metastatic castrate-refractory prostate cancer (CRPC) has a poor prognosis and high morbidity. Zoledronic acid (ZA) is commonly combined with docetaxel in practice but lacks evidence that combining is effective, and strontium-89 (Sr89) is generally used palliatively in patients unfit for chemotherapy. Phase 2 analysis of the TRAPEZE trial confirmed combining the agents was safe and feasible, and the objectives of phase 3 include assessment of the treatments on survival.

Controllable surface haptics via particle jamming and pneumatics.

The combination of particle jamming and pneumatics allows the simultaneous control of shape and mechanical properties in a tactile display. A hollow silicone membrane is molded into an array of thin cells, each filled with coffee grounds such that adjusting the vacuum level in any individual cell rapidly switches it between flexible and rigid states. The array clamps over a pressure-regulated air chamber with internal mechanisms designed to pin the nodes between cells at any given height.

An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients.

We examined patient-specific predictors of high cost for endovascular (EVAR) and open (OPEN) repair of abdominal aortic aneurysm (AAA). Vascular Study Group of Northern New England data specific to Fletcher Allen Health Care were merged with cost data from the same source. We retrospectively analyzed 389 elective AAA repairs (230 EVAR, 159 OPEN) between 2003 and 2011 to determine clinical characteristics that contribute to membership in the upper quartile of cost (UQC) versus the remaining three quartiles.

Shared quality data are associated with increased protamine use and reduced bleeding complications after carotid endarterectomy in the Vascular Study Group of New England.

Objective: The goal of this study was to evaluate whether protamine usage after carotid endarterectomy (CEA) increased within the Vascular Study Group of New England (VSGNE) in response to studies indicating that protamine reduces bleeding complications associated with CEA without increasing the risk of stroke.

Methods: We reviewed 10,059 CEAs, excluding concomitant coronary bypass, performed within the VSGNE from January 2003 to July 2012. Protamine use and reoperation for bleeding were evaluated monthly using statistical process control.

Variation in smoking cessation after vascular operations.

Objective: Smoking is the most important modifiable risk factor for patients with vascular disease. The purpose of this study was to examine smoking cessation rates after vascular procedures and delineate factors predictive of postoperative smoking cessation.

Methods: The Vascular Study Group of New England registry was used to analyze smoking status preoperatively and at 1 year after carotid endarterectomy, carotid artery stenting, lower extremity bypass, and open and endovascular abdominal aortic aneurysm repair between 2003 and 2009.

Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.

Introduction: Reduced work hours and concerns over patient safety have encouraged surgical educators to find methods to advance resident skills more efficiently. Simulation provides the opportunity to improve technical surgical skills outside the operating room. We hypothesized that practice on surgical task simulators would improve residents' technical performance of vascular anastomotic technique.

The impact of diabetes on postoperative outcomes following lower-extremity bypass surgery.

Objective: The effect of diabetes type (noninsulin dependent vs insulin dependent) on outcomes after lower-extremity bypass (LEB) has not been clearly defined. Therefore, we analyzed associations between diabetes type and outcomes after LEB in patients with critical limb ischemia.

Methods: We performed a retrospective analysis of 1977 infrainguinal LEB operations done for critical limb ischemia between 2003 and 2010 within the Vascular Study Group of New England.

Use of a postoperative insulin protocol decreases wound infection in diabetics undergoing lower extremity bypass.

Objective: Strict glucose control in patients undergoing coronary bypass grafting has been shown to decrease infectious complications, arrhythmias, and mortality. Our objective was to determine if strict glucose control reduced morbidity after lower extremity bypass (LEB).

Methods: A prospective pilot study at a single institution within the Vascular Study Group of New England was conducted from January 2009 to December 2010.

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples.

Background: Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes.

Factors associated with death 1 year after lower extremity bypass in Northern New England.

Background: Using 30-day operative mortality reported with lower extremity bypass (LEB) in preoperative decision making may underestimate the actual death rate encountered before patients have truly recovered from surgery, especially in elderly, debilitated patients with significant tissue loss. Therefore, we examined preoperative, patient-level risk factors that predict survival within the first year following LEB.

Methods: Using our regional quality improvement initiative in 11 hospitals in Northern New England, we studied 2306 LEB procedures performed in 2031 patients between January 2003 and December 2007.

Factors associated with amputation or graft occlusion one year after lower extremity bypass in northern New England.

Background: Optimal patient selection for lower extremity bypass surgery requires surgeons to predict which patients will have durable functional outcomes following revascularization. Therefore, we examined risk factors that predict amputation or graft occlusion within the first year following lower extremity bypass.

Methods: Using our regional quality-improvement initiative in 11 hospitals in northern New England, we studied 2,306 lower extremity bypass procedures performed in 2,031 patients between January 2003 and December 2007.