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Objective: To compare international opioid prescribing patterns for patients undergoing robotic assisted laparoscopic prostatectomy. To our knowledge, this is the first study to assess international opioid prescribing trends among urologists.Methods: An anonymous Web-based survey assessing the frequency and quantity of opioid prescriptions for robotic assisted laparoscopic prostatectomy was designed using Qualtrics software. The survey was distributed to urologists internationally via Twitter and email in early 2021. Prescribing patterns were analyzed based on country of practice in three groups: United States, Canada, and all other countries.Results: 160 participants from 26 countries completed the survey including the United States (51%), Greece (19%), Canada (9%), Israel (3.1%). The percentage of providers prescribing post-discharge opioids significantly differed between Canada, the United States, and other countries (86%, 63%, and 11%, respectively, P <.0001). There was a significant difference between years of experience in those who provide opioids compared to those who do not (8 years vs 5 years, P = .0004). The average morphine milligram equivalents (MME) provided in those who did prescribe opioids was greatest in the United States but was not significantly different between groups (mean MME: United States 58 mg, Canada 46 mg, all others 54 mg; P = .63). Attending physicians prescribed more MME than trainees (residents, fellows) on average (attending mean MME = 75 mg, trainee mean MME = 40 mg, P = .017).Conclusion: Opioid prescriptions after robotic assisted prostatectomy are common in North America and used sparingly in the rest of the world. [ABSTRACT FROM AUTHOR]

Breast conserving surgery plus accelerated partial breast irradiation is increasingly popular for early-stage breast cancer patients with promising clinical outcomes. However, the identification of the seroma cavity on CT can be challenging, leading to inaccuracy and inconsistency in seroma contouring. For brachytherapy techniques this presents additional challenges. Three-dimensional ultrasound (3DUS) technology will significantly improve target visualization and implant accuracy. In this work, we introduce a robotic 3DUS system with a spatial tracking arm that has great potential for improved visual guidance in breast brachytherapy, and describe the calibration and commissioning process for this system. The robotic 3DUS system consists of a 3D-printed probe holder, customizable for any commercial ultrasound transducer (BKMedical 8811 for our system), a motor that drives the probe simultaneously both linearly and rotationally to acquire hybrid 3DUS images, an ultrasound transparent TPX plate that supports the probe motion, a spatially-tracked counterbalanced arm, and software for visualization and target segmentation (Figure 1a). The tracking arm consists of five encoded joints, shown in Figure 1a, and allows arm movement to provide sufficient tracking space in clinical use. The linear accuracy of the 3DUS scan was evaluated using a phantom composed of strings separated by 10.00±0.05 mm in three dimensions in a 7.25% isopropyl alcohol solution (22°C). Volume segmentation accuracy was evaluated by imaging and segmenting a sphere (1.2cc) embedded in an ultrasound phantom. Lavenberg-Marquardt based nonlinear regression was used to determine the optimal calibration parameters for each joint, which corrects the rotational deviations of each joint and translational offsets of the end-effector (the transducer). An optical tracking device (Polaris Spectra, Northern Digital Inc., Canada) was used for arm calibration. A total of 202 data points distributed in a 360×650×95mm3 working space were collected, among which, 80% (162 points) were used to calibrate the encoder parameters. The rest were used to evaluate spatial tracking accuracy. The 3DUS scanning volume is 5cm × 10cm × scan depth (from 5.2cm to 8.0cm). For a commonly used scan depth (6.0cm), the image resolution is 0.075mm, 0.082mm, and 0.33mm in lateral, axial, and elevational direction, respectively. The mean linear scan accuracy was within 2% in all directions, and the volume segmentation accuracy was 3%, all below TG128 action levels. Mean deviations between the mechanical and optical tracking are 0±0.5mm, 0±0.7mm, and0±0.8mm in three dimensions (plotted in Figure1b), with a mean Euclidean distance of 1.0±0.5mm. We have developed, calibrated and commissioned a robotic 3DUS system for breast brachytherapy. The imaging and tracking accuracies were both excellent for clinical use. The spatial tracking arm has exciting potential to achieve rigid registration to other imaging modalities or the implant templates that are used in interstitial partial breast brachytherapy. The authors would like to thank the support of NSERC and the OICR Imaging Program. [ABSTRACT FROM AUTHOR]

While assistive robots receive growing attention as a potential solution to support older adults to live independently, several scholars question the underlying social, ethical and health policy assumptions. One perplexing issue is determining whether assistive robots should be introduced to supplement caregivers or substitute them. Current state of knowledge indicates that users and caregivers consider that robots should not aim to replace humans, but could perform certain tasks. This begs the question of the nature and scope of the tasks that can be delegated to robots and of those that should remain under human responsibility. Considering that such tasks entail a range of actions that affect the meaning of caregiving and care receiving, this article offers sociological insights into the ways in which members of the public reason around assistive actions, be they performed by humans, machines or both. Drawing on a prospective public deliberation study that took place in Quebec (Canada) in 2014 with participants (n = 63) of different age groups, our findings clarify how they envisage what robots can and cannot do to assist older people, and when and why delegating certain tasks to robots becomes problematic. A better understanding of where the publics draw a limit in the substitution of humans by robots refocuses policymakers' attention on what good care entails in modern healthcare systems. [ABSTRACT FROM AUTHOR]

Abstract: Remote robotic data provides different information than that obtained from immersion in the field. This significantly affects the geological situational awareness experienced by members of a mission control science team. In order to optimize science return from planetary robotic missions, these limitations must be understood and their effects mitigated to fully leverage the field experience of scientists at mission control. Results from a 13-day analogue deployment at the Mistastin Lake impact structure in Labrador, Canada suggest that scale, relief, geological detail, and time are intertwined issues that impact the mission control science team’s effectiveness in interpreting the geology of an area. These issues are evaluated and several mitigation options are suggested. Scale was found to be difficult to interpret without the reference of known objects, even when numerical scale data were available. For this reason, embedding intuitive scale-indicating features into image data is recommended. Since relief is not conveyed in 2D images, both 3D data and observations from multiple angles are required. Furthermore, the 3D data must be observed in animation or as anaglyphs, since without such assistance much of the relief information in 3D data is not communicated. Geological detail may also be missed due to the time required to collect, analyze, and request data. We also suggest that these issues can be addressed, in part, by an improved understanding of the operational time costs and benefits of scientific data collection. Robotic activities operate on inherently slow time-scales. This fact needs to be embraced and accommodated. Instead of focusing too quickly on the details of a target of interest, thereby potentially minimizing science return, time should be allocated at first to more broad data collection at that target, including preliminary surveys, multiple observations from various vantage points, and progressively smaller scale of focus. This operational model more closely follows techniques employed by field geologists and is fundamental to the geologic interpretation of an area. Even so, an operational time cost/benefit analyses should be carefully considered in each situation, to determine when such comprehensive data collection would maximize the science return. Finally, it should be recognized that analogue deployments cannot faithfully model the time scales of robotic planetary missions. Analogue missions are limited by the difficulty and expense of fieldwork. Thus, analogue deployments should focus on smaller aspects of robotic missions and test components in a modular way (e.g., dropping communications constraints, limiting mission scope, focusing on a specific problem, spreading the mission over several field seasons, etc.). [Copyright &y& Elsevier]

Abstract: The Special Purpose Dextreous Manipulator (Dextre) is the latest addition to the on-orbit segment of the Mobile Servicing System (MSS); Canada''s contribution to the International Space Station (ISS). Launched in March 2008, the advanced two-armed robot is designed to perform various ISS maintenance tasks on robotically compatible elements and on-orbit replaceable units using a wide variety of tools and interfaces. The addition of Dextre has increased the capabilities of the MSS, and has introduced significant complexity to ISS robotics operations. While the initial operations concept for Dextre was based on human-in-the-loop control by the on-orbit astronauts, the complexities of robotic maintenance and the associated costs of training and maintaining the operator skills required for Dextre operations demanded a reexamination of the old concepts. A new approach to ISS robotic maintenance was developed in order to utilize the capabilities of Dextre safely and efficiently, while at the same time reducing the costs of on-orbit operations. This paper will describe the development, validation, and on-orbit demonstration of the operations concept for ground-based tele-robotics control of Dextre. It will describe the evolution of the new concepts from the experience gained from the development and implementation of the ground control capability for the Space Station Remote Manipulator System; Canadarm 2. It will discuss the various technical challenges faced during the development effort, such as requirements for high positioning accuracy, force/moment sensing and accommodation, failure tolerance, complex tool operations, and the novel operational tools and techniques developed to overcome them. The paper will also describe the work performed to validate the new concepts on orbit and will discuss the results and lessons learned from the on-orbit checkout and commissioning of Dextre using the newly developed tele-robotics techniques and capabilities. [Copyright &y& Elsevier]