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Purpose: Robotics has evolved rapidly in terms of mechanical design and control in the past few years. Collaborative robots that have direct contact with humans are being introduced in various fields, including industrial and medical services. Because collaborative robot systems are being introduced rapidly, the safety of the humans who work with them is becoming an important issue. In this study, we investigated skin injuries resulting from a collision between robots and humans using a freefall experiment system., Methods: We particularly focused on closed skin injuries caused by a collision. To induce a closed injury, we struck mini-pigs with cubic-edge square and semi-sphere impactors at collision speeds of 1 and 3 m/s. We did not observe any open injuries with those conditions. Closed injuries were observed in the dermal layer of the skin after the collision test at both speeds and with both impactors., Results: The collagen fiber in the dermal layer was separated and fragmented, and the subcutaneous fat layer became dense as a result of the collision., Conclusions: We closely observed and analyzed the histopathologic changes in the dermal and subcutaneous layers with intact epidermis after mechanical trauma to the inner skin layers., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The purpose of this study was to describe the current evidence found through a patent search about robotics used to assist nurses in providing care. The authors used a modified seven-step strategy of searching patents according to the US Patent and Trademark Office guidelines. The nursing robotic search was performed in four databases including the US Patent and Trademark Office issued patent database, the US Patent and Trademark Office published patent application database, the European Patent Office database, and Relecura. Keywords reflecting the scope of the term "robot" were defined for the purposes of this specific search. This broad search yielded large numbers of patents germane to nursing care. These results were narrowed using keywords and the Cooperative Patent Classification schemes to determine relevance, ensure rigor, and capture the most relevant results. This review of patents suggests robots for nursing care are proliferating. The opportunity for robotics in nursing is emerging in industry. Although nursing will likely benefit from robotics, we must determine the appropriate place to include robots in nursing care delivery.

Cow routines and behavioral responses are altered substantially following the installation of robot milking. The present study was designed to analyze the effect that switching from milking parlor to automatic milking system (AMS) had on the culling rate (due to various causes) of dairy cattle. For this purpose, culling records and causes for culling were tracked in 23 dairy farms in the Galicia region (NW Spain). The animals in these farms were monitored for 5 years. For the present study, that length of time was divided into three different stages, as follows: 2 years before switching from a milking parlor to AMS (stage 1), the 1st year following the implementation of AMS (stage 2) and the 2nd and 3rd years succeeding the implementation of AMS (stage 3). Cox models for survival analysis were used to estimate the time to culling due to different reasons during stage 1 in relation to stages 2 and 3. The data indicated that the risk of loss due to death or emergency slaughter decreased significantly following the installation of AMS. In contrast, the risk of culling due to low production, udder problems, infertility or lameness increased significantly. Low-production cows (such as cows in advanced lactation due to infertility) or sick cows (such as mastitic or lame cows) allegedly have a noticeable effect both on the performance and the amortization of the cost of AMS, which in turn would lead to a higher probability of elimination than in conventional systems.

Objective: The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system., Methods: The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well., Results: This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world., Conclusions: The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532).

Interaction control plays an important role in rehabilitation devices to ensure training safety and efficacy. Compliance adaptation of interaction is vital for enabling robot movements to better suit the patient's requirements as human joint characteristics vary. This paper proposes an interactive compliance control scheme on a wrist rehabilitation device (WR e D) for enhanced training safety and efficacy. This control system consists of a low-level trajectory tracking loop and a high-level admittance loop. Experiments were conducted with zero load and human interaction, respectively. Satisfactory trajectory tracking responses were obtained, with the normalized root mean square deviation (NRMSD) values being 1.08% with zero load and the NRMSD values no greater than 1.4% with real-time disturbance and interaction from human users. Results demonstrate that such an interactive compliance control method can adaptively adjust the range of training motions and encourage active engagement from human users simultaneously. These findings suggest that the proposed control method of the WR e D has great potentials for clinical applications due to enhanced training safety and efficacy. Future work will focus on evaluating its efficacy on a large sample of participants.

Purpose: Robotic stabilization of a therapeutic radiation beam with respect to a dynamically moving tumor target can be accomplished either by moving the radiation source, the patient, or both. As the treatment beam is on during this process, the primary goal is to minimize exposure of normal tissue to radiation as much as possible when moving the target back to the desired position. Due to the complex mechanical structure of 6 degree-of-freedom (6DoF) robots, it is not intuitive as to what 6 dimensional (6D) correction trajectory is optimal in achieving such a goal. With proportional-integrative-derivative (PID) and other controls, the potential exists that the controller may generate a trajectory that is highly curved, slow, or suboptimal in that it leads to unnecessary exposure of healthy tissue to radiation. This work investigates a novel feedback planning method that takes into account a robot's mechanical joint structure, patient safety tolerances, and other system constraints, and performs real-time optimization to search the entire 6D trajectory space in each time cycle so it can respond with an optimal 6D correction trajectory., Methods: Computer simulations were created for two 6DoF robotic patient support systems: a Stewart-Gough platform for moving a patient's head in frameless maskless stereotactic radiosurgery, and a linear accelerator treatment table for moving a patient in prostate cancer radiation therapy. Motion planning was formulated as an optimization problem and solved at real-time speeds using the L-BFGS algorithm. Three planning methods were investigated, moving the platform as fast as possible (platform-D), moving the target along a straight-line (target-S), and moving the target based on the fastest descent of position error (target-D). Both synthetic motion and prior recorded human motion were used as input data and output results were analyzed., Results: For randomly generated 6D step-like and sinusoidal synthetic input motion, target-D planning demonstrated the smallest net trajectory error in all cases. On average, optimal planning was found to have a 45% smaller target trajectory error than platform-D control, and a 44% smaller target trajectory error than target-S planning. For patient head motion compensation, only target-D planning was able to maintain a ≤0.5mm and ≤0.5deg clinical tolerance objective for 100% of the treatment time. For prostate motion, both target-S planning and target-D planning outperformed platform-D control., Conclusions: A general 6D target trajectory optimization framework for robotic patient motion compensation systems was investigated. The method was found to be flexible as it allows control over various performance requirements such as mechanical limits, velocities, acceleration, or other system control objectives., Competing Interests: A patent application titled: SYSTEMS AND METHODS FOR DETERMINING 6DOF CORRECTION TRAJECTORIES IN COMPENSATING MOVEMENT OF A TREATMENT TARGET IN A PATIENT has been submitted by Rodney Wiersma to the US patent office and is currently under review. There are no further patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Does the presence of a robot co-worker influence the performance of humans around it? Studies of motor contagions during human-robot interactions have examined either how the observation of a robot affects a human's movement velocity, or how it affects the human's movement variance, but never both together. Performance however, has to be measured considering both task speed (or frequency) as well as task accuracy. Here we examine an empirical repetitive industrial task in which a human participant and a humanoid robot work near each other. We systematically varied the robot behavior, and observed whether and how the performance of a human participant is affected by the presence of the robot. To investigate the effect of physical form, we added conditions where the robot co-worker torso and head were covered, and only the moving arm was visible to the human participants. Finally, we compared these behaviors with a human co-worker, and examined how the observed behavioral affects scale with experience of robots. Our results show that human task frequency, but not task accuracy, is affected by the observation of a humanoid robot co-worker, provided the robot's head and torso are visible., Competing Interests: The authors have declared that no competing interests exist.

We present a biologically motivated model for visual self-localization which extracts a spatial representation of the environment directly from high dimensional image data by employing a single unsupervised learning rule. The resulting representation encodes the position of the camera as slowly varying features while being invariant to its orientation resembling place cells in a rodent's hippocampus. Using an omnidirectional mirror allows to manipulate the image statistics by adding simulated rotational movement for improved orientation invariance. We apply the model in indoor and outdoor experiments and, for the first time, compare its performance against two state of the art visual SLAM methods. Results of the experiments show that the proposed straightforward model enables a precise self-localization with accuracies in the range of 13-33cm demonstrating its competitiveness to the established SLAM methods in the tested scenarios., Competing Interests: The authors have declared that no competing interests exist.

Background: Surgical robot systems have been used in laparoendoscopic single-site surgery (LESS) to improve patient outcomes. A magnetic anchoring surgical robot system for LESS can effectively extend the operation space., Methods: A robot system based on visual servo control for LESS is proposed. It includes a magnetic anchoring robot and a control subsystem, in which an uncalibrated visual servo control method obtains an accurate positioning capability of the robot for LESS., Results: The results of the simulation and the tissue experiment show that the robot system can successfully accomplish the expected control functionalities for LESS. The average positioning error of the proposed system is 1.622 mm., Conclusion: The magnetic anchoring robot system is able to implement the autonomous positioning of its end-effector through the proposed control approach according to experimental results., (Copyright © 2018 John Wiley & Sons, Ltd.)

Background: An assist-as-needed robot-assisted gait training protocol was recently developed. It allows active movement during training, but its exact criteria remain unknown. Asymmetric step length is a common abnormal gait pattern in hemiplegic stroke patients. We compared the effects of assist-as-needed robot-assisted gait training on the unaffected and affected limbs of hemiplegic stroke patients., Method: Twenty-four chronic stroke patients with asymmetric step lengths were randomly assigned to 1 of 2 groups. Twelve completed the study protocol. Group 1 underwent 20 sessions of assist-as-needed robot-assisted gait training for the unaffected limb and fully-assisted robot-assisted training for the affected limb. Group 2 underwent 20 sessions of robot-assisted gait training using the opposite protocol. Clinical measurements were obtained and 3-dimensional gait analyses were performed at baseline and after 10 and 20 training sessions., Results: Clinical measurements improved in both groups after 20 training sessions. The unaffected limb's step length asymmetry ratio and hip maximal extension moment significantly improved in group 1. The affected limb's maximal dorsiflexion angle for the ankle in the swing phase significantly improved in group 2., Conclusion: Application of the assist-as-needed training mode for the unaffected limb helped improve step length asymmetry in chronic stroke patients.

Objective: To investigate the use of a robotic assessment tool to quantify sensorimotor, visuospatial attention, and executive function impairments in individuals with traumatic brain injury (TBI)., Setting: Foothills Hospital (Calgary, Canada)., Participants: Twenty-three subjects with first-time TBI in the subacute to chronic phase participated in this study. Normative data were collected from 275 to 494 neurologically intact control subjects for each robotic task., Design: A prospective observational case series. Subjects with TBI completed brief clinical cognitive and motor assessments followed by robotic assessments of upper limb reaching, position sense, bimanual motor ability, attention, and visuospatial skills. Scores of subjects with TBI were compared with normative data., Main Measures: Robotic task performance was computed for each subject on each task, as well as performance on specific task parameters. Clinical assessments included the Montreal Cognitive Assessment, Fugl-Meyer upper extremity assessment, and Purdue Peg Board., Results: Subjects with TBI demonstrated a variety of deficits on robotic tasks. The proportion of TBI subjects who were significantly different from controls ranged from 36% (dominant arm reaching) to 60% (bimanual object hitting task)., Conclusion: Robotic measures allowed us to quantify a range of impairments specific to each subject, and offer an objective tool with which to examine these abilities after TBI.

Background:  While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level.   METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be physically present.

Introduction: Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI)., Materials and Methods: Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy -/+  tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters., Results: When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS., Conclusions: TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.

With tiny and limited nervous systems, insects demonstrate a remarkable ability to fly through complex environments. Optic flow has been identified to play a crucial role in regulating flight conditions and navigation in flies and bees. In robotics, optic flow has been widely studied thanks to the low computational requirements. However, with only monocular visual information, optic flow is inherently devoid of a scale factor required for estimating the absolute distance. In this paper, we propose a strategy for estimating the flight altitude of a flying robot with a ventral camera by combining the optic flow with measurements from an inertial measurement unit. Instead of using the prevalent feature-based approach for calculation of optic flow, we implement a direct method that evaluates the flow information via image gradients. We show that the direct approach notably simplifies the computation steps compared to the feature-based method. When combined with an extended Kalman filter for fusion of inertial measurement units measurements, the flight altitude can be estimated in real time. We carried out extensive flight tests in different settings. Among 31 hovering and vertical flights near the altitude of 40 cm, we achieved the RMS errors in the altitude estimate of 2.51 cm. Further analysis of factors that affect the quality of the flow and the distance estimate is also provided.

Obstacles and swimming fish in flow create a wake with an alternating left/right vortex pattern known as a Kármán vortex street and reverse Kármán vortex street, respectively. An energy-efficient fish behavior resembling slaloming through the vortex street is called Kármán gaiting. This paper describes the use of a bioinspired array of pressure sensors on a Joukowski foil to estimate and control flow-relative position in a Kármán vortex street using potential flow theory, recursive Bayesian filtering, and trajectory-tracking feedback control. The Joukowski foil is fixed in downstream position in a flowing water channel and free to move on air bearings in the cross-stream direction by controlling its angle of attack to generate lift. Inspired by the lateral-line neuromasts found in fish, the sensing and control scheme is validated using off-the-shelf pressure sensors in an experimental testbed that includes a flapping device to create vortices. We derive a potential flow model that describes the flow over a Joukowski foil in a Kármán vortex street and identify an optimal path through a Kármán vortex street using empirical observability. The optimally observable trajectory is one that passes through each vortex in the street. The estimated vorticity and location of the Kármán vortex street are used in a closed-loop control to track either the optimally observable path or the energetically efficient gait exhibited by fish. Results from the closed-loop control experiments in the flow tank show that the artificial lateral line in conjunction with a potential flow model and Bayesian estimator allow the robot to perform fish-like slaloming behavior in a Kármán vortex street. This work is a precursor to an autonomous robotic fish sensing the wake of another fish and/or performing pursuit and schooling behavior.

Objective: With an elderly population that is set to more than double by 2050 worldwide, there will be an increased demand for elderly care. This poses several impediments in the delivery of high-quality health and social care. Socially assistive robot (SAR) technology could assume new roles in health and social care to meet this higher demand. This review qualitatively examines the literature on the use of SAR in elderly care and aims to establish the roles this technology may play in the future., Design: Scoping review., Data Sources: Search of CINAHL, Cochrane Library, Embase, MEDLINE, PsychINFO and Scopus databases was conducted, complemented with a free search using Google Scholar and reference harvesting. All publications went through a selection process, which involved sequentially reviewing the title, abstract and full text of the publication. No limitations regarding date of publication were imposed, and only English publications were taken into account. The main search was conducted in March 2016, and the latest search was conducted in September 2017., Eligibility Criteria: The inclusion criteria consist of elderly participants, any elderly healthcare facility, humanoid and pet robots and all social interaction types with the robot. Exclusions were acceptability studies, technical reports of robots and publications surrounding physically or surgically assistive robots., Results: In total, 61 final publications were included in the review, describing 33 studies and including 1574 participants and 11 robots. 28 of the 33 papers report positive findings. Five roles of SAR were identified: affective therapy, cognitive training, social facilitator, companionship and physiological therapy., Conclusions: Although many positive outcomes were reported, a large proportion of the studies have methodological issues, which limit the utility of the results. Nonetheless, the reported value of SAR in elderly care does warrant further investigation. Future studies should endeavour to validate the roles demonstrated in this review., Systematic Review Registration: NIHR 58672., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: People use social media to express perceptions, attitudes and a wide range of concerns regarding human life., Aim: This study aims at analysing the ongoing discussions on the internet microblog Twitter and offers some coming predicaments regarding developments in geriatric nursing regarding nursing robots., Methods: Data were retrospectively collected from Twitter. 1322 mentions were included in the final analyses, where principles of interpreting data by using netnography were utilized., Results: Many ideas are presented expressing functional, psychological and social aspects of robots in nursing care. Most postings come from metropolitan cities around the globe. The discussion focuses on market-driven, science fiction solutions for aged care. Twitter users overall seem to be positive using various nursing robots in aged care. These discussions offer a window into the attitudes and ideas of this group of users., Conclusion: We suggest that monitoring Twitter discussions on social media can provide valuable insights into current attitudes as well as forecast coming trends.

The dominant practices of physical oceanography have recently shifted from being based on ship-based ocean sampling and sensing to being based on remote and robotic sensing using satellites, drifting floats and remotely operated and autonomous underwater vehicles. What are the implications of this change for the social relations of oceanographic science? This paper contributes to efforts to address this question, pursuing a situated view of ocean sensing technologies so as to contextualize and analyze new representations of the sea, and interactions between individual scientists, technologies and the ocean. By taking a broad view on oceanography through a 50-year shift from ship-based to remote and robotic sensing, I show the ways in which new technologies may provide an opportunity to fight what Oreskes has called 'ideologies of scientific heroism'. In particular, new sensing relations may emphasize the contributions of women and scientists from less well-funded institutions, as well as the ways in which oceanographic knowledge is always partial and dependent on interactions between nonhuman animals, technologies, and different humans. Thus, I argue that remote and robotic sensing technologies do not simply create more abstracted relations between scientists and the sea, but also may provide opportunities for more equitable scientific practice and refigured sensing relations.

Objectives: This scoping study is the first step of a multiphase, international project aimed at designing a homecare robot that can provide functional support, track physical and psychological well-being, and deliver therapeutic intervention specifically for individuals with mild cognitive impairment., Design: Observational requirements gathering study., Participants and Settings: Semistructured interviews were conducted with 3 participant groups: (1) individuals with memory challenges, mild cognitive impairment (MCI), or mild dementia (patients; n = 9); (2) carers of those with MCI or dementia (carers; n = 8); and (3) those with expertise in MCI or dementia research, clinical care, or management (experts; n = 16). Interviews took place at the university, at dementia care facilities or other workplaces, at participant's homes, or via skype (experts only)., Measurements: Semistructured interviews were conducted, transcribed, and reviewed., Results: Several key themes were identified within the 4 topics of: (1) daily challenges, (2) safety and security, (3) monitoring health and well-being, and (4) therapeutic intervention., Conclusions: A homecare robot could provide both practical and therapeutic benefit for the mildly cognitively impaired with 2 broad programs providing routine and reassurance; and tracking health and well-being. The next phase of the project aims to program homecare robots with scenarios developed from these results, integrate components from project partners, and then test the feasibility, utility, and acceptability of the homecare robot., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

This paper proposes a novel control method to minimize muscle energy for power-assistant robotic systems that support the intended motions of a user under unknown external perturbations, using surface electromyogram (sEMG) signals. Conventional control methods based on force/torque (F/T) sensors have limitations to detect human intentions and could, presumably, misunderstand or distort such intentions because of external perturbations of the interaction forces, such as those found in activities of daily living. F/T sensors measure the sum of the applied force, including unknown external forces and human intention; thus, a power-assistant robot controller cannot exactly decompose the real human force. In this paper, we describe a counterexample that cannot be supported by conventional force-sensor-based control methods. We also verify why these control methods may guide human behavior in the wrong direction, and thus, have limitations under unknown external perturbations. We then propose a new control method to minimize the muscle energy indicated by sEMG signals. The proposed control approach is fundamentally based on the concept of power-assistance, in which a robot can reduce the users expended muscle energy while performing given tasks. The proposed control approach is verified through experiments using a power-assistant robotic system for the upper limbs under external perturbations.

Background: Hepatocellular carcinoma has a growing incidence worldwide, and represents a leading cause of death in patients with cirrhosis. Nowadays, minimally invasive approaches are spreading in every field of surgery and in liver surgery as well., Materials and Methods: We retrospectively reviewed demographics, clinical, and pathologic characteristics and short-term outcomes of patients who had undergone minimally invasive resections for hepatocellular carcinoma at our institution between June 2012 and May 2016., Results: No significant differences in demographics and comorbidities were found between patients in the laparoscopic (n = 24) and robotic (n = 22) groups, except for the rates of cirrhotic patients (91.7% and 68.2%, respectively, P = 0.046). Perioperative data analysis showed that the operative time (mean, 211 and 318 min, respectively, P < 0.001) was the only parameter in favor of laparoscopy. Conversely, robotic-assisted resections were related to less Clavien I-II postoperative complications (22 cases versus 13 cases; P = 0.03). As regards resection margins, the two groups were similar with no statistically significant differences in rates of disease-free resection margins., Conclusions: A modern hepatobiliary center should offer both open and minimally invasive approaches to liver disease to provide the best care for each patient, according to the individual comorbidities, risk factors, and personal quality of life expectations. Our results show that the robotic approach is a reliable tool for accurate oncologic surgery, comparable to the laparoscopic approach. Robotic surgery also allows the surgeon to safely approach liver segments that are difficult to resect in laparoscopy, namely segments I-VII-VIII., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Vision system plays an important role in the field of indoor robot. Saliency detection methods, capturing regions that are perceived as important, are used to improve the performance of visual perception system. Most of state-of-the-art methods for saliency detection, performing outstandingly in natural images, cannot work in complicated indoor environment. Therefore, we propose a new method comprised of graph-based RGB-D segmentation, primary saliency measure, background distribution measure, and combination. Besides, region roundness is proposed to describe the compactness of a region to measure background distribution more robustly. To validate the proposed approach, eleven influential methods are compared on the DSD and ECSSD dataset. Moreover, we build a mobile robot platform for application in an actual environment, and design three different kinds of experimental constructions that are different viewpoints, illumination variations and partial occlusions. Experimental results demonstrate that our model outperforms existing methods and is useful for indoor mobile robots.

Purpose: Telemedicine is increasingly utilized in the evaluation of critically ill patients, including those with decreased level of consciousness (LOC) or coma. Improving access to providers with neurologic expertise affords earlier triage and directed patient management. However, objective data regarding the reliability of using standardized coma scales, traditionally employed at the bedside for remote assessment, are largely lacking., Hypothesis: Bedside and remote assessments of patients with decreased LOC, using either the Glasgow Coma Scale (GCS) or Full scale Of UnResponsiveness (FOUR), score are equivalent., Methods: Prospective trial comparing the reliability of bedside and remote coma assessments using GCS or FOUR score clinical evaluation tools utilizing robotic telepresence technology. Total scores of the GCS and FOUR score were compared between bedside and remote physician assessors by paired t-test and Pearson correlation coefficient (PCC)., Results: One hundred subjects were enrolled. Mean age was 70.8 (±15.9) years and the average examination time took 5.16 (±2.04) minutes. Mean GCS total score at bedside was 7.5 (±3.67) versus examination conducted remotely 7.23 (±3.85); difference in scores was 0.25 (±0.10); p = 0.01. Mean FOUR total score at bedside was 9.63 (±4.76) versus remote 9.21 (±4.74); difference in scores was 0.40 (±2.00); p = 0.05. PCC for GCS was 0.966; p < 0.001, and for FOUR score 0.912; p < 0.001. Ninety-five percent of remote providers rated GCS and 89% rated FOUR score as good (4/5) regarding overall satisfaction and ease of use., Conclusions: Differences between total bedside and remote GCS and FOUR scores were small. Furthermore, PCCs between remote and bedside assessments were excellent: 0.97 (GCS) and 0.91 (FOUR). These results suggest that LOC can be reliably assessed using existing robotic telemedicine technology. Telemedicine could be adopted to help evaluate critically ill patients in neurologically underserved areas.

Neurological disorders frequently affect walking function which is one of the most fundamental skills to improve quality of life and autonomy, and Lokomat has been a key piece for gait's rehabilitation. In this study, a diagnosis about the development of the Robot-assisted therapy rehabilitation with Lokomat in Colombia is made. The study was performed by collecting some anthropometric and demographic data of the patients that use Lokomat, followed by a survey of cognitive aspects. With the purpose to compare the current state of the robotic therapies it was found that in Colombia the benefits of this treatment have not being fully exploited. Regarding the cognitive aspects, most of the patients that use Lokomat as a rehabilitation therapy feel comfortable (47%), very safe (68%) and have a perpective of significant results with the therapy (68%). However, when compared the number of patients in therapy with Lokomat with the number of the population that has gait disabilities, it is found that few Colombians have access to this type of therapy.

The processes underlying the generation of motor adaptation in response to mechanical perturbations during human walking have been subject to debate. We used a robotic system to apply mechanical perturbations to step length and step height over consecutive gait cycles. Specifically, we studied perturbations affecting only step length, only step height, and step length and height in combination. Both step-length and step-height perturbations disrupt normal walking patterns, but step-length perturbations have a far greater impact on locomotor stability. We found a selective process of motor adaptation in that participants failed to adapt to step-height perturbations but strongly adapted to step-length perturbations, even when these adaptations increased metabolic cost. These results indicate that motor adaptation during human walking is primarily driven by locomotor stability, and only secondarily by energy expenditure and walking pattern preservation. These findings have substantial implications for the design of protocols for robot-assisted gait rehabilitation., (Copyright © 2017, American Association for the Advancement of Science.)

Background: We evaluated the efficacy, toxicity, and dose responses of re-irradiation with stereotactic body radiotherapy (SBRT) in patients with recurrent non- small cell lung cancer (NSCLC) after previous irradiation., Patients and Methods: 28 patients were included. Previous median radiation doses were 54 and 66 Gy. The median interval time between previous radiotherapy and SBRT was 14 months. The median follow-up time after SBRT was 9 months (range 3-93 months). To evaluate the effectiveness of SBRT, local control, overall survival, and treatment-related toxicity were reported., Results: SBRT doses and fractionation ranged from 60 to 30 Gy and from 3 to 8, respectively, according to previous doses, location of the recurrence, and interval time. 65% of tumor recurrences overlapped with previous treatment, while 35% of tumors recurred outside of the previous treatment. 4 patients had local progression after SBRT at their first follow-up. The Kaplan-Meier estimates of the 1- and 2-year actuarial overall survival were 71 and 42%, respectively. The mean survival following SBRT was 32.8 months, and the median survival was 21 months. No grade 3 or higher toxicities were observed., Conclusion: Robotic SBRT is a tolerable treatment option with manageable toxicity which can be used with radical or palliative intent in carefully selected patients with locally recurrent tumors after previous irradiation., (© 2017 S. Karger GmbH, Freiburg.)

This article describes factors affecting the accuracy of transpedicle screw placements performed with the Renaissance robot-guided system and reviews the relevant literature. Between January 2013 and January 2015, Renaissance robot-guided spinal surgery was performed in 125 patients at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. The surgeries included 662 transpedicle screw implants and 49 Kirschner wire (K-wire) reimplants performed by intraoperative repositioning. The lead author evaluated the accuracy of all K-wire insertions and classified their accuracy into 3 categories relative to the preoperative plan for transpedicle screw placement. For cases in which screws required repositioning after the registration step, factors affecting pedicle screw placement were determined according to the consensus of 3 experienced spinal surgeons. According to the scheme developed by Kuo et al (PLoS One 2016;11:e0153235), the K-wire placement accuracies before and after repositioning were respectively classified as follows: 76.1% and 77.6% in type I; 12.2% and 17.7% in type IIa; 4.3% and 4.5% in type IIb; 6.4% and 0% in type IIIa; and 1% and 1% in type IIIb. The percentage of screws requiring repositioning due to drilling error was 85.7% (42/49). Comparisons of preoperative and postoperative function showed significantly improved accuracy. This study showed that inaccurate pedicle screw placement mainly results from errors in preoperative planning, mounting, registration, drilling, and robot assembly. Pedicle screw placement using a bone-mounted miniature robot system requires meticulous preoperative planning to minimize these errors., Competing Interests: The authors have no conflicts of interest to disclose.

Background: The gait recovery is a realist goal in the rehabilitation of almost Stroke patients. Over the last years, the introduction of robotic technologies in gait rehabilitation of stroke patients has had a greatest interest., Objective: The aim of this study was to evaluate efficacy of Robotic Gait Training (RGT) in chronic stroke patients., Methods: Fourteen chronic stroke patients were divided into two groups. Six patients received RGT, eight patients received traditional gait rehabilitation. Patients were assessed with clinical scales, as well as with gait analysis, at the beginning and at the end of the treatment., Results: Significant changes in some clinical scales for both the groups were detected. In the robotic group, patients showed higher percentage changes in the MRC scale (p = 0.020), in the 6MWT (p = 0.043) and in the Ashworth scale (hip: p = 0.008; knee: p = 0.043; ankle: p = 0.043) when compared with the traditional group. With respect to the gait analysis, we did not found any difference neither in the within-group analysis, nor in the between-group analysis., Conclusions: Both rehabilitation treatments do not change the compensatory strategies in chronic patients but the RGT offers to the patients a more intensive and controlled gait training increasing the gait endurance and decreasing spasticity in the lower limb.

Background: During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases)., Purpose: This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders., Conclusions: Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.

With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots.

Review Question/objective: The objective of this review is to synthesize the best available evidence on the effectiveness of robotic assistive devices in the rehabilitation of adult stroke patients for recovery of impairments in the upper and lower limbs. The secondary objective is to investigate the sustainability of treatment effects associated with use of robotic devices.The specific review question to be addressed is: can robotic assistive devices help adult stroke patients regain motor movement of their upper and lower limbs?

Background: Behavioral problems may affect individuals with dementia, increasing the cost and burden of care. Pet therapy has been known to be emotionally beneficial for many years. Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets. Robotic pet therapy offers an alternative to traditional pet therapy., Objective: The study rigorously assesses the effectiveness of the PARO robotic pet, an FDA approved biofeedback device, in treating dementia-related symptoms., Methods: A randomized block design with repeated measurements guided the study. Before and after measures included reliable, valid tools such as: RAID, CSDD, GDS, pulse rate, pulse oximetry, and GSR. Participants interacted with the PARO robotic pet, and the control group received standard activity programs. Five urban secure dementia units comprised the setting., Results: 61 patients, with 77% females, average 83.4 years in age, were randomized into control and treatment groups. Compared to the control group, RAID, CSDD, GSR, and pulse oximetry were increased in the treatment group, while pulse rate, pain medication, and psychoactive medication use were decreased. The changes in GSR, pulse oximetry, and pulse rate over time were plotted for both groups. The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate, while GSR had several weeks when changes were similar between groups., Conclusions: Treatment with the PARO robot decreased stress and anxiety in the treatment group and resulted in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia.

Several arboreal mammals have the ability to rapidly and repeatedly jump vertical distances of 2 m, starting from rest. We characterize this performance by a metric we call vertical jumping agility. Through basic kinetic relations, we show that this agility metric is fundamentally constrained by available actuator power. Although rapid high jumping is an important performance characteristic, the ability to control forces during stance also appears critical for sophisticated behaviors. The animal with the highest vertical jumping agility, the galago ( Galago senegalensis ), is known to use a power-modulating strategy to obtain higher peak power than that of muscle alone. Few previous robots have used series-elastic power modulation (achieved by combining series-elastic actuation with variable mechanical advantage), and because of motor power limits, the best current robot has a vertical jumping agility of only 55% of a galago. Through use of a specialized leg mechanism designed to enhance power modulation, we constructed a jumping robot that achieved 78% of the vertical jumping agility of a galago. Agile robots can explore venues of locomotion that were not previously attainable. We demonstrate this with a wall jump, where the robot leaps from the floor to a wall and then springs off the wall to reach a net height that is greater than that accessible by a single jump. Our results show that series-elastic power modulation is an actuation strategy that enables a clade of vertically agile robots., (Copyright © 2016, American Association for the Advancement of Science.)

This paper presents a robust satisficing decision-making method for Unmanned Aerial Vehicles (UAVs) executing complex missions in an uncertain environment. Motivated by the info-gap decision theory, we formulate this problem as a novel robust satisficing optimization problem, of which the objective is to maximize the robustness while satisfying some desired mission requirements. Specifically, a new info-gap based Markov Decision Process (IMDP) is constructed to abstract the uncertain UAV system and specify the complex mission requirements with the Linear Temporal Logic (LTL). A robust satisficing policy is obtained to maximize the robustness to the uncertain IMDP while ensuring a desired probability of satisfying the LTL specifications. To this end, we propose a two-stage robust satisficing solution strategy which consists of the construction of a product IMDP and the generation of a robust satisficing policy. In the first stage, a product IMDP is constructed by combining the IMDP with an automaton representing the LTL specifications. In the second, an algorithm based on robust dynamic programming is proposed to generate a robust satisficing policy, while an associated robustness evaluation algorithm is presented to evaluate the robustness. Finally, through Monte Carlo simulation, the effectiveness of our algorithms is demonstrated on an UAV search mission under severe uncertainty so that the resulting policy can maximize the robustness while reaching the desired performance level. Furthermore, by comparing the proposed method with other robust decision-making methods, it can be concluded that our policy can tolerate higher uncertainty so that the desired performance level can be guaranteed, which indicates that the proposed method is much more effective in real applications., Competing Interests: The authors have declared that no competing interests exist.

This purpose of this retrospective study is validation of an intraoperative robotic grading classification system for assessing the accuracy of Kirschner-wire (K-wire) placements with the postoperative computed tomography (CT)-base classification system for assessing the accuracy of pedicle screw placements.We conducted a retrospective review of prospectively collected data from 35 consecutive patients who underwent 176 robotic assisted pedicle screws instrumentation at Kaohsiung Medical University Hospital from September 2014 to November 2015. During the operation, we used a robotic grading classification system for verifying the intraoperative accuracy of K-wire placements. Three months after surgery, we used the common CT-base classification system to assess the postoperative accuracy of pedicle screw placements. The distributions of accuracy between the intraoperative robot-assisted and various postoperative CT-based classification systems were compared using kappa statistics of agreement.The intraoperative accuracies of K-wire placements before and after repositioning were classified as excellent (131/176, 74.4% and 133/176, 75.6%, respectively), satisfactory (36/176, 20.5% and 41/176, 23.3%, respectively), and malpositioned (9/176, 5.1% and 2/176, 1.1%, respectively)In postoperative CT-base classification systems were evaluated. No screw placements were evaluated as unacceptable under any of these systems. Kappa statistics revealed no significant differences between the proposed system and the aforementioned classification systems (P <0.001).Our results revealed no significant differences between the intraoperative robotic grading system and various postoperative CT-based grading systems. The robotic grading classification system is a feasible method for evaluating the accuracy of K-wire placements. Using the intraoperative robot grading system to classify the accuracy of K-wire placements enables predicting the postoperative accuracy of pedicle screw placements., Competing Interests: The authors have no conflicts of interest to disclose.

Automatic milking systems (AMS), one of the earliest precision livestock farming developments, have revolutionized dairy farming around the world. While robots control the milking process, there have also been numerous changes to how the whole farm system is managed. Milking is no longer performed in defined sessions; rather, the cow can now choose when to be milked in AMS, allowing milking to be distributed throughout a 24 h period. Despite this ability, there has been little attention given to milking robot utilization across 24 h. In order to formulate relevant research questions and improve farm AMS management there is a need to determine the current knowledge gaps regarding the distribution of robot utilization. Feed, animal and management factors and their interplay on levels of milking robot utilization across 24 h for both indoor and pasture-based systems are here reviewed. The impact of the timing, type and quantity of feed offered and their interaction with the distance of feed from the parlour; herd social dynamics, climate and various other management factors on robot utilization through 24 h are provided. This novel review draws together both the opportunities and challenges that exist for farm management to use these factors to improved system efficiency and those that exist for further research.

Over the last few decades, flexible steerable robotic needles for percutaneous intervention have been the subject of significant interest. However, there still remain issues related to (a) steering the needle's direction with less damage to surrounding tissues and (b) increasing the needle's maximum curvature for better controllability. One widely used approach is to control the fixed-angled bevel-tip needle using a "duty-cycle" algorithm. While this algorithm has shown its applicability, it can potentially damage surrounding tissue, which has prevented the widespread adoption of this technology. This situation has motivated the development of a new steerable flexible needle that can change its curvature without axial rotation, while at the same time producing a larger curvature. In this article, we propose a novel curvature-controllable steerable needle. The proposed robotic needle consists of two parts: a cannula and a stylet with a bevel-tip. The curvature of the needle's path is controlled by a control offset, defined by the offset between the bevel-tip and the cannula. As a result, the necessity of rotating the whole needle's body is decreased. The duty-cycle algorithm is utilized to a limited degree to obtain a larger radius of curvature, which is similar to a straight path. The first prototype of 0.46 mm (outer diameter) was fabricated and tested with both in vitro gelatin phantom and ex vivo cow liver tissue. The maximum curvatures measured 0.008 mm(-1) in 6 wt% gelatin phantom, 0.0139 mm(-1) in 10 wt% gelatin phantom, and 0.0038 mm(-1) in cow liver. The experimental results show a linear relationship between the curvature and the control offset, which can be utilized for future implementation of this control algorithm., (© IMechE 2016.)

The aim of this study was to increase knowledge on therapy and educational objectives professionals work on with children with autism spectrum disorder (ASD) and to identify corresponding state of the art robots. Focus group sessions (n = 9) with ASD professionals (n = 53) from nine organisations were carried out to create an objectives overview, followed by a systematic literature study to identify state of the art robots matching these objectives. Professionals identified many ASD objectives (n = 74) in 9 different domains. State of the art robots addressed 24 of these objectives in 8 domains. Robots can potentially be applied to a large scope of objectives for children with ASD. This objectives overview functions as a base to guide development of robot interventions for these children.

Numerous algorithms have been proposed to allow legged robots to learn to walk. However, most of these algorithms are devised to learn walking in a straight line, which is not sufficient to accomplish any real-world mission. Here we introduce the Transferability-based Behavioral Repertoire Evolution algorithm (TBR-Evolution), a novel evolutionary algorithm that simultaneously discovers several hundreds of simple walking controllers, one for each possible direction. By taking advantage of solutions that are usually discarded by evolutionary processes, TBR-Evolution is substantially faster than independently evolving each controller. Our technique relies on two methods: (1) novelty search with local competition, which searches for both high-performing and diverse solutions, and (2) the transferability approach, which combines simulations and real tests to evolve controllers for a physical robot. We evaluate this new technique on a hexapod robot. Results show that with only a few dozen short experiments performed on the robot, the algorithm learns a repertoire of controllers that allows the robot to reach every point in its reachable space. Overall, TBR-Evolution introduced a new kind of learning algorithm that simultaneously optimizes all the achievable behaviors of a robot.

Background: The volume of robot-assisted operations has drastically increased over the past decade. New programs have focused on training surgeons, whereas resident training has lagged behind. The objective of this study was to evaluate our institutional experience with resident participation in thoracic robotic surgery cases since the initiation of our program., Methods: The first 100 robotic thoracic surgery cases at our institution were retrospectively reviewed and categorized into three sequential cohorts. Procedure type, patient and operative characteristics, level of resident participation (primary surgeon [PS] or assistant), and postoperative variables were evaluated., Results: Of the first 100 cases, 38% were lung resections, 23% were esophageal operations, and 20% were sympathectomies. The distribution of cases changed over time with the proportion of pulmonary resections significantly increasing. Patient age (P < 0.05), body mass index (P = not significant [NS]), and comorbidities (P = NS) increased over time. Resident participation as PS increased from 33%-59% between the early and late cohorts (P < 0.05). A subset analysis of the 20 lobectomies (7 attending PS, 13 residents) showed similar patient characteristics (P = NS): age (67 versus 69), body mass index (29.5 versus 26.1), and American Society of Anesthesiologists category (2.8 versus 2.8). Operative and postoperative characteristics were also similar (P = NS) regardless of PS: operative time (260 versus 249 min), estimated blood loss (187 versus 203 mL), and length of stay (4.8 versus 4.7 d)., Conclusions: Residents can participate as the PS in a variety of thoracic operations during the implementation of a robotics program. Operative time, estimated blood loss, and length of stay were similar regardless of level of resident participation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: We aimed to compare outcomes of open and robot-assisted artificial urinary sphincter (AUS) implantation in female patients., Methods: The charts of all female patients who underwent an AUS implantation between 2008 and 2014 in a single center were retrospectively reviewed. From 2008 to 2012, AUS were implanted using an open approach and from 2013 to 2014 using a robot-assisted approach. Perioperative and functional parameters were compared between groups. The primary endpoint was continence status., Results: Twenty-four women were assessed: 16 in the open group and eight in the robot-assisted group. Three patients had neurogenic stress urinary incontinence. Most patients had undergone previous procedures for urinary incontinence (15 in the open group and seven in the robotic group). Mean operative time was similar in both groups (214 vs. 211 min; p = 0.90). Postoperative complicationsrate was lower in the robot-assisted group (25 vs. 75 %; p = 0.02). There was a trend toward a lower intraoperative complication rate (37.5 vs. 62.5 %; p = 0.25), decreased blood loss (17 ml vs. 275 ml; p = 0.22), and shorter length of stay (3.5 vs. 9.3 days; p = 0.09) in the robot-assisted group. Continence rates were comparable in both groups (75 vs. 68.8 %; p = 0.75). Three AUS explantations were needed in the open group (18.8 %) compared with one in the robot-assisted group (12.5 %; p = 0.70)., Conclusions: In female patients, the robot-assisted approach compared with open AUS implantation could decrease intraoperative and postoperative complication rates, length of hospital stay, and blood loss.