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Introduction: The risk of liver injury in patients with atrial fibrillation (AF) using nonvitamin K antagonist oral anticoagulants (NOACs) has not been previously examined using liver function tests as the primary outcome in the real-world setting. This study assessed the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests., Methods: Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016, identified using the Hong Kong Clinical Database and Reporting System, were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio. Risk of liver injury, defined as laboratory test values >3 times the upper limit of normal of alanine aminotransferase or aspartate aminotransferase and >2 times the upper limit of normal of total bilirubin, was compared between NOAC and warfarin users using Cox proportional hazards regression., Results: After propensity score matching, 13,698 patients were included, of which 141 (2.1%) NOAC users and 232 (3.4%) warfarin users developed liver injury. The hazard ratio (HR) for NOAC vs warfarin users was 0.71 (95% confidence interval: 0.58-0.89). When comparing individual NOACs, only dabigatran (hazard ratio: 0.63; 95% confidence interval: 0.48-0.82) was associated with a lower risk of liver injury., Discussion: Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin. However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.

Optical motion-capture systems can be used to animate characters in real time based on human demonstrations. However, most approaches do not consider the detailed finger movements necessary for object manipulation. The proposed online motion-capture framework encourages natural motions by automatically guiding the avatar's motion toward the desired behavior based on a set of captured reference motions for the same behavior. The proposed motion controller imitates the user's finger and body gestures to enable performance-based animation of human avatars that can manipulate virtual objects in real time.

Background: Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures., Methods: Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures., Results: Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements., Conclusions: Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education., (© The Author(s) 2015.)

A new type of organic dyad that can induce low-energy photosensitization has been developed; electron donor and electron acceptor units are boron dipyrromethene (BODIPY) and ortho-carborane (o-Cb), respectively. The new dyads consist of a V-shaped BODIPY-(o-Cb)-BODIPY molecular array in which two BODIPY units are substituted onto two adjacent carbon atoms of the central o-Cb. In the presence of the o-Cb unit, as an electron acceptor, significant fluorescence quenching was observed which indicated that photoinduced electron transfer (PET) had occurred from the end-on BODIPY units to the central o-Cb with PET efficiencies of 63-71%. As a result, the corresponding cationic and anionic species that are responsible for the charge transfer state were detected by the serial spectroelectrochemical studies: cationic BODIPY radicals at 400 nm at the applied voltage of 1.44 V and broad absorption bands of anionic o-Cb radicals in the range of 250-490 nm at -1.84 V. Transient absorption studies further confirmed the BODIPY radical anion at 540 nm and the o-Cb radical anion at 350-475 nm with a structureless broad band.

Background: Providing augmented visual feedback is one way to enhance robot-assisted surgery (RAS) training. However, it is unclear whether task specificity should be considered when applying augmented visual feedback., Methods: Twenty-two novice users of the da Vinci Surgical System underwent testing and training in 3 tasks: simple task, bimanual carrying (BC); intermediate task, needle passing (NP); and complex task, suture tying (ST). Pretraining (PRE), training, and posttraining (POST) trials were performed during the first session. Retention trials were performed 2 weeks later (RET). Participants were randomly assigned to 1 of 4 feedback training groups: relative phase (RP), speed, grip force, and video feedback groups. Performance measures were time to task completion (TTC), total distance traveled (D), speed (S), curvature, relative phase, and grip force (F)., Results: Significant interaction for TTC and curvature showed that the RP feedback training improved temporal measures of complex ST task compared to simple BC task. Speed feedback training significantly improved the performance in simple BC task in terms of TTC, D, S, curvature, and F even after retention. There was also a lesser long-term effect of speed feedback training on complex ST task. Grip force feedback training resulted in significantly greater improvements in TTC and curvature for complex ST task. For the video feedback training group, the improvements in most of the outcome measures were evident only after RET., Conclusions: Task-specific augmented feedback is beneficial to RAS skills learning. Particularly, the RP and grip force feedback could be useful for training complex tasks.

Electron accepting capability is greatly improved for B-phenylated tri-phenyl-o-carborane (1) through a favorable electronic interaction between the two adjoining phenyl-π* and cage carbon-σ* orbitals.

Background: The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation., Methods: Here, 14 medical students performed 2 fundamental surgical tasks-bimanual carrying (BC) and peg transfer (PT)-in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined., Results: Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P < .001) tasks. The time to task completion and the total distance traveled were significantly decreased in both surgical tasks in the VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining., Conclusions: Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game.

This study determined the muscle effort and fatigue of the upper extremity while performing fundamental surgical skills training tasks. Ten novices performed three tasks (precision cutting, needle passing, and peg transfer) using either a virtual simulator or a laparoscopic box-trainer. Their electromyography (EMG) activities in both proximal and distal parts of upper extremity were measured. Significantly more muscle effort were required to complete tasks with the box-trainer, whereas similar muscle fatigue levels between tasks were found in both training environments. These EMG results demonstrated how the virtual trainer could provide meaningful physiological value to the surgeon training in laparoscopic surgery.

Evaluation of the learning curve for robotic surgery has shown reduced errors and decreased task completion and training times compared with regular laparoscopic surgery. However, most training evaluations of robotic surgery have only addressed short-term retention after the completion of training. Our goal was to investigate the amount of surgical skills retained after 3 months of training with the da Vinci™ Surgical System. Seven medical students without any surgical experience were recruited. Participants were trained with a 4-day training program of robotic surgical skills and underwent a series of retention tests at 1 day, 1 week, 1 month, and 3 months post-training. Data analysis included time to task completion, speed, distance traveled, and movement curvature by the instrument tip. Performance of the participants was graded using the modified Objective Structured Assessment of Technical Skills (OSATS) for robotic surgery. Participants filled out a survey after each training session by answering a set of questions. Time to task completion and the movement curvature was decreased from pre- to post-training and the performance was retained at all the corresponding retention periods: 1 day, 1 week, 1 month, and 3 months. The modified OSATS showed improvement from pre-test to post-test and this improvement was maintained during all the retention periods. Participants increased in self-confidence and mastery in performing robotic surgical tasks after training. Our novel comprehensive training program improved robot-assisted surgical performance and learning. All trainees retained their fundamental surgical skills for 3 months after receiving the training program.

Carborane-based host materials were prepared to fabricate deep blue phosphorescence organic light-emitting diodes (PHOLEDs), which constituted three distinctive geometrical structures stemming from the corresponding three different isomeric forms of carboranes, namely, ortho-, meta-, and para-carboranes. These materials consist of two carbazolyl phenyl (CzPh) groups as photoactive units on each side of the carborane carbons to be bis[4-(N-carbazolyl)phenyl]carboranes, o-Cb, m-Cb, and p-Cb. To elaborate on the role of the carboranes, comparative analogous benzene series (o-Bz, m-Bz, and p-Bz) were prepared, and their photophysical properties were compared to show that advantageous photophysical properties were originated from the carborane structures: high triplet energy. Unlike m-Bz and p-Bz, carborane-based m-Cb and p-Cb showed an unconjugated nature between two CzPh units, which is essential for the blue phosphorescent materials. Also, the carborane hosts showed high glass transition temperatures (T(g)) of 132 and 164 °C for m-Cb and p-Cb, respectively. Albeit p-Cb exhibited slightly lower hole mobility when compared to p-Bz, it still lies at the high end hole mobility with a value of 1.1 × 10(-3) cm(2)/(V s) at an electric field of 5 × 10(5) V/cm. Density functional theory (DFT) calculations revealed that triplet wave functions were effectively confined and mostly located at either side of the carbazolyl units for m-Cb and p-Cb. Low-temperature PL spectra indeed provided unequivocal data with higher triplet energy (T(1)) of 3.1 eV for both m-Cb and p-Cb. p-Cb was successfully used as a host in deep blue PHOLEDs to provide a high external quantum efficiency of 15.3% and commission internationale de l'elcairage (CIE) coordinates of (0.15, 0.24).

The objective of this study was to determine the muscle activities of upper extremities while performing fundamental surgical training tasks using a virtual simulator. Six subjects performed virtual cutting tasks and their muscle activities of upper extremities were measured. The results demonstrated a significant increase in muscle activities in both proximal and distal upper extremities, which are the common areas of occurrence of injury after prolonged practice. This study suggests that the upper trapezius and the extensor digitorum are essential prime movers to perform surgical training tasks. These muscles should be monitored for performance assessment in future studies.

The title compound, [1-(CH(3))(3)NCH(2)-1,2-C(2)B(10)H(11)](+)·I(-) or C(6)H(22)B(10)N(+)·I(-), was obtained by the reaction of (1,2-dicarba-closo-dodeca-boran-yl)dimethyl-methanamine with methyl iodide. The asymmetric unit contains two iodide anions and two (o-carboran-yl)tetra-methyl-ammonium cations. The bond lengths and angles in the carborane cage are within normal ranges, but the N-C(methyl-ene)-C(cage) angle is very large [120.2 (2)°] because of repulsion between the carborane and tetra-methyl-ammonium units. In the crystal, ions are linked through C-H⋯I hydrogen bonds.

The title compound, C(38)H(48)NOP, isolated from the reaction of (2-diphenylphosphanyl-4,6-di-tert-butyl)phenol with 2,6-diisopropylphenyl azide at 273 K, can act as an N,O-bidentate ligand. Crystal structure analysis shows a deviation from ideal tetrahedral symmetry around the P atom. The molecule exists as a monomer in the solid state, whose conformation is stabilized via multiple intramolecular hydrogen bonds. Geometric parameters from both experimental and theoretical calculations are compared., (© 2011 International Union of Crystallography)

The purpose of this study was to investigate the muscle activation and the muscle frequency response of the dominant arm muscles (flexor carpi radialis and extensor digitorum) and hand muscles (abductor pollicis and first dorsal interosseous) during robotic surgical skills training in a virtual environment. The virtual surgical training tasks consisted of bimanual carrying, needle passing and mesh alignment. The experimental group (n=5) was trained by performing four blocks of the virtual surgical tasks using the da Vinci™ surgical robot. During the pre- and post-training tests, all subjects were tested by performing a suturing task on a "life-like" suture pad. The control group (n=5) performed only the suturing task without any virtual task training. Differences between pre- and post-training tests were significantly greater in the virtual reality group, as compared to the control group in the muscle activation of the hand muscle (abductor pollicis) for both the suture tying and the suture running (p<0.05). In conclusion, changes in electrographic activity shows that training in virtual reality leads to specific changes in neuromotor control of robotic surgical tasks.

We used a cognitive architecture (ACT-R) to explore the procedural learning of surgical tasks and then to understand the process of perceptual motor learning and skill decay in surgical skill performance. The ACT-R cognitive model simulates declarative memory processes during motor learning. In this ongoing study, four surgical tasks (bimanual carrying, peg transfer, needle passing, and suture tying) were performed using the da Vinci © surgical system. Preliminary results revealed that an ACT-R model produced similar learning effects. Cognitive simulation can be used to demonstrate and optimize the perceptual motor learning and skill decay in surgical skill training.

Background: Modern surgical practice often requires multitasking in operating rooms, generally full of distractions. The purpose of this research was to investigate the effect of distraction on robot-assisted surgical skill performance in medical students and residents., Methods: Fourteen subjects performed a suture-tying task with the da Vinci(™) surgical system with distractive secondary tasks simultaneously. The time to task completion, speed and the total distance travelled were analysed. Two-way repeated-measures ANOVA were applied. The scores of secondary tasks were analysed., Results: A significant secondary task effect was found with an increase of the time to task completion (p = 0.003) and decreased average speed (p < 0.001). The performance of secondary task for residents was significantly better than students., Conclusions: The performance of a robot-assisted surgical task was negatively affected by secondary tasks. However, residents with more surgical experience demonstrated a larger attention capacity for multitasking. Therefore, understanding how medical trainees respond to the distractive secondary tasks while performing robot-assisted surgical task is important in developing a surgical training programme based on the concept of attention., (Copyright © 2010 John Wiley & Sons, Ltd.)

Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

Background: Controlling surgical task speed and maintaining accuracy are vital components of robotic surgical skills. This study was designed to investigate the relationship between accuracy and speed for robot-assisted surgical skills., Methods: Ten participants were asked to alternately touch two circular targets with various dimensions and distances between two targets, using the da Vinci Surgical System. The design of this study was based on Fitt's law. Statistical correlations between the index of difficulty (ID) and the movement time (MT), as well as the ID and the smoothness of the movement, were analysed., Results: A significant linear correlation between MT and ID was shown. Speed was reduced to maintain accuracy as the level of task difficulty increased. There was no significant correlation between the smoothness of the movement and ID., Conclusions: The trade-off between speed and accuracy plays an important role in robot-assisted surgical proficiency., (Copyright 2010 John Wiley & Sons, Ltd.)

Background: An operating room is a noisy environment. How noise affects performance during robotic surgery remains unknown. We investigated whether noise during training with the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) would affect the performance of simple operative tasks by the surgeon., Methods: Twelve medical students performed 3 inanimate operative tasks (bimanual carrying, suture tying, and mesh alignment) on the da Vinci Surgical System with or without the presence of noise. Prerecorded noise from an actual operating room was used. The kinematics of the robotic surgical instrument tips and the muscle activation patterns of the subjects were evaluated., Results: We found noise effects for all 3 tasks with increases in the time to task completion (23%; P=.046), the total distance traveled (8%; P=.011) of the surgical instrument tips, and the muscle activation volume (87%; P=.015) with the presence of noise. We confirmed that the mesh alignment task was the most difficult task with the greatest time to task completion and the greatest muscle activation volume, whereas the suture tying task and the bimanual carrying could be considered the intermediate and the least difficult task, respectively. The noise effects were significantly greater while performing more difficult tasks., Conclusion: Our findings demonstrated that noise degraded robotic surgical performance; however, the impact of noise on robotic surgery will depend on the level of difficulty of the task. Subsequent research is required to identify how different types of noise, such as random or rhythmic sounds, affect the performance of operative tasks using robots such as the da Vinci., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Aim: To investigate the influence of eccentric scanning on retinal nerve fiber layer (RNFL) analysis using Stratus optical coherence tomography (OCT) in normal Koreans when the eccentricity of scanning occurs in 4 different directions., Methods: Thirty-one eyes of 31 persons underwent 1 concentric disk-centered and 4 superiorly, inferiorly, nasally and temporally eccentric RNFL OCT scans., Results: The average RNFL thickness measured by temporally eccentric scanning (115.1 microm) was significantly greater when compared with that found by concentric scanning (107.1 microm; p < 0.0001). The proportions of eyes outside normal limits on the RNFL analysis map using the criterion of >or=1 clock hour abnormal at the <1% level in superiorly (12/31, 38.7%), nasally (16/32, 51.6%) and temporally (12/31, 38.7%) eccentric scans were significantly different in comparison with the concentric (4/31, 12.9%) scan (p < 0.05)., Conclusion: An off-centered OCT scan affected RNFL thickness measurement and its interpretation., ((c) 2009 S. Karger AG, Basel.)

The preparation of an 1,3-alternate calix[4]arene tetraphosphane ligand, 25,26,27,28-tetrakis{2-(diphenylphosphino)ethoxy}calix[4]arene (4), is described. Ligand 4 is obtained in four steps in 17% overall yield. Reaction of 4 with AgBF4 produced the encapsulated two silver complex [Ag2{(P,P,P,P)-tetraphencalix[4]arene}](BF4)2. The solid-state structure shows that the encapsulated silver undergoes a substantial pi-interaction by two opposite arene rings. Rhodation of 4 employing [Rh(cot)2]BF4 yielded the encapsulated complex with a bent coordination mode. Two organometallic fragments inclusioned inside a 1,3-alternate calix[4]arene tetraphosphane was also achieved by the reaction of 4 with [PtH(PPh3)2 (thf)]+. Full characterization includes X-ray structural studies of compounds 4-6.

A series of novel tetrahomodioxacalix[4]biscrowns with crown-2, crown-3, crown-4, crown-5, and crown-6 units were synthesized. Conformations of each product are dependent on the base used and their conformation stabilities. All conformations were proven by NMR spectra and/or X-ray crystal structures. The 1,3-alternate homodioxacalix[4]biscrown-4 (4b) shows the best selectivity for K+, whereas the 1,3-alternate homodioxacalix[4]crown-5 (5) does for Cs+. Those selectivities are attributable to electrostatic interaction between the metal ion and the crown ring, as well as a pi-metal complexation. However, the C-1,2-alternate conformation does not take the metal ions regardless of the crown species as a result of steric hindrance from the methylene bridge of an ArCH2Ar unit., (Copyright 2004 American Chemical Society)

The 1,4-alternate tetrahomodioxacalix[4]arene tetraamide 4 with four p-phenyl groups on its upper rim was synthesized. In two-phase metal picrate extraction, 4 exhibited Pb2+ selectivity with formation of a 1:1 complex in chloroform. In the solid-state structure of the 4*Pb(Pic)2 complex, Pb2+ is bound by the carbonyl oxygens of two adjacent amide groups and an aryl-alkyl ether oxygen atom of one of these amide-containing substituents. The crystal structure and 1H NMR spectrum of the 4*Pb2+ complex reveals pi-metal ion complexation of one aromatic ring in the ligand with Pb2+.

The title compound, [Cu(C(24)H(46)N(6)O(2))]Cl(2).8H(2)O, contains a centrosymmetric cation, with the anions and water molecules on general sites. The coordination geometry around the Cu(II) ion is an axially elongated octahedron, with Cu-N distances of 2.0448 (17) and 2.0847 (17) A, and a Cu-O1 distance of 2.3138 (16) A.

The short carbonyl bond in the title compound, [Cu(2)(C(7)H(4)NO(3)S)(4)(C(3)H(4)N(2))(4)] [Liu, Huang, Li & Lin (1991). Acta Cryst. C47, 41-43], is an artifact of disorder in the isothiazol-3(2H)-one 1,1-dioxide part of the 1,2-benzisothiazol-3(2H)-one entity. In the present redetermination, all bond dimensions in the centrosymmetric dinuclear molecule are normal. The five-coordinate Cu atom shows trigonal-bipyramidal coordination. Hydrogen bonds from the imidazole donor ligand link adjacent molecules into a two-dimensional layer structure.

The 17-crown-5 unit, C(26)H(26)Br(2)O(5), consisting of a 1,2-bis(bromomethyl) group, three benzo groups and diethylene glycol, was prepared from the reaction of 1,2,4,5-tetrakis(bromomethyl)benzene and bis-phenol in the presence of sodium hydride as a base. This molecule seems to offer an internal cavity for the formation of a host--guest complex.

The title compound, [CuCl(C16H14N4)2]ClO4, consists of a mononuclear complex cation and a perchlorate anion. The coordination of the copper(II) ion exhibits a trigonal bipyramidal geometry, where the equatorial plane is composed of the Cl atom and two N atoms of the two pyridazine rings, and the axial positions are occupied by the N atoms of two methylpyridine rings.

A new calix[4]-crowned azacrown ether, C(51)H(59)NO(11)S, consisting of four phenyl rings in a 1,3-alternate conformation was synthesized from the reaction of 25, 27-bis(5-chloro-3-oxapentyloxy)calix[4]crown-5 and p-toluenesulfonamide in the presence of Cs(2)CO(3). A crown-5 loop was attached on the two facing lower rims of the calix[4]arene and the N-tosyl azacrown group was attached on the other set of lower rims of the calix[4]arene backbone. This molecule seems to offer an inside cavity for the formation of a host-guest complex.

The title compound, (S)-(+)-4-[5-(2-oxo-4, 5-dihydroimidazol-1-ylsulfonyl)indolin-1 -ylcarbonyl ]anilinium chloride (S)-(+)-1-[1-(4-aminobenzoyl)indoline-5- sulfonyl]-4-phenyl-4, 5-dihydroimidazol-2-one, C(24)H(23)N(4)O(4)S(+).Cl(-). C(24)H(22)N(4)O(4)S, crystallizes in space group C2 from a CH(3)OH/CH(2)Cl(2) solution. In the crystal structure, there are two different conformers with their terminal C(6) aromatic rings mutually oriented at angles of 67.69 (14) and 61.16 (15) degrees. The distances of the terminal N atoms (of the two conformers) from the chloride ion are 3.110 (4) and 3.502 (4) A. There are eight distinct hydrogen bonds, i.e. four N-H...Cl, three N-H...O and one N-H...N, with one N-H group involved in a bifurcated hydrogen bond with two acceptors sharing the H atom. C-H...O contacts assist in the overall hydrogen-bonding process.

A new motion detection system has been developed using a laser beam and a Schottky barrier silicon photodiode. The system broadens the scope of gravitational center stabilography by facilitating the quantitative assessment of tremors of body appendages such as the hands and even the head. The system also eliminates cumbersome platforms and wire attachments previously used in gravitational center stabilography. The subject is asked to aim the beam at the photodiode. A quantitative off-center variation parameter, ARDS (Average Radial Distance Squared multiplied by time), was utilized in units of cm2 sec. A preliminary evaluation of the system shows that it is suitable for rapidly screening large numbers of subjects for localised neuromuscular control.