Статті в журналах: "Flexible Medical Instruments"

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De Greef, Aline, Pierre Lambert, and Alain Delchambre. "Towards flexible medical instruments: Review of flexible fluidic actuators." Precision Engineering 33, no. 4 (October 2009): 311–21. http://dx.doi.org/10.1016/j.precisioneng.2008.10.004.

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He, Chaojiang, Yanlin He, Changxin Yu, Fei Luo, and Lianqing Zhu. "Optical fiber shape sensing of flexible medical instruments with temperature compensation." Optical Fiber Technology 74 (December 2022): 103123. http://dx.doi.org/10.1016/j.yofte.2022.103123.

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Sweigert, Patrick, Adam Van Huis, Eric Marcotte, and Bipan Chand. "Flexible Endoscopy: The Fundamentals." Digestive Disease Interventions 02, no. 04 (December 2018): 289–98. http://dx.doi.org/10.1055/s-0038-1675754.

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Endoscopy highlights the intersection of technological advancements and medical application. Innovation in optics, illumination, imaging, and manufacturing has allowed for the development of a complex array of instruments for use by endoscopists. Flexible gastrointestinal (GI) endoscopy has emerged to become a well-established minimally invasive aspect of prevention, diagnosis, and treatment of GI disease.Flexible endoscopes and their associated instruments and platforms are described, acknowledging that such lists are dynamic. The procedure environment is also described in terms of location, equipment, ergonomics, personnel involved, and recovery considerations.Recommendations from GI and anesthesiology associations are outlined to summarize current practices in the administration of sedative drugs to reduce patient discomfort, allow for a technically successful procedure, and reduce patient memory of the procedure.The training process for GI endoscopy is described for general surgery residents and GI fellows. Training involves didactic and technical curriculum along with mentor-supervised endoscopic procedures. After the completion of training, residents and fellows proceed through a credentialing process, which culminates in granting privileges to an individual to perform GI endoscopic procedures. Once in practice, providers must stay up to date on the ever-changing world of medical documentation, coding, and billing to ensure appropriate reimbursement.

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Cheng, Zhuo-Qi, Jiale He, Liang Zhou, Yu Li, Pengjie Lin, Jing Guo, Shuting Cai, and Xiaoming Xiong. "Smart handheld device with flexible wrist and electrical bioimpedance sensor for tissue inspection." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 236, no. 3 (December 1, 2021): 416–26. http://dx.doi.org/10.1177/09544119211060100.

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With the evolving demands of surgical intervention, there is a strong need for smaller and functionally augmented instruments to improve surgical outcomes, operational convenience, and diagnostic safety. Owing to the narrow and complicated anatomy, the probe head of the medical instrument is required to possess both good maneuverability and compact size. In addition, the development of medical instrument is moving toward patient-specialized, of which the articulation positions can be customized to reach the target position. To fulfill these requirements, this study presents the design of a smart handheld device which equips with a low cost, easy control, disposable flexible wrist, and an electrical bioimpedance sensor for medical diagnosis. Prototype of the device is made and tested. The experimental results demonstrate that the proposed device can provide accurate manipulation and effective tissue detection, showing a great potential in various medical applications.

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Okayasu, Haruna, Jun Okamoto, Hiroshi Iseki, and Masakatsu G. Fujie. "Development of a Hydraulically-Driven Flexible Manipulator for Neurosurgery." Journal of Robotics and Mechatronics 17, no. 2 (April 20, 2005): 149–57. http://dx.doi.org/10.20965/jrm.2005.p0149.

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Minimally invasive surgery has recently become a key word in medical engineering. In this operation, to facilitate the introduction of surgical instruments, spatulas which push tissues aside and retain the approach path to the affected area as well as workspace for the insertion of such instruments are necessary. Therefore, a new type of hydraulically-driven flexible manipulator for neurosurgery has been developed. Including an attached balloon and using only physiological saline for the drive system, the safety of the brain tissue, especially in terms of pressure, is assured as is the simplicity of the mechanism. In addition, this provides the advantage of MRI compatibility. Following several positive evaluations, the effectiveness of this manipulator has been proven as a new type of medical device.

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McIntosh, Roger L., and Alfred Yau. "A Flexible and Robust Peer-to-Peer Architecture with XML-Based Open Communication for Laboratory Automation." JALA: Journal of the Association for Laboratory Automation 8, no. 1 (February 2003): 38–45. http://dx.doi.org/10.1016/s1535-5535-04-00240-0.

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Traditional lab automation systems are highly centralized: dispatch and coordination of activities are mediated by a system controller, usually via a single, monolithic control procedure. This approach, while conceptually simple, makes changes to the system difficult; adding or removing instruments and functionality can be a daunting task. In addition, most automated systems are tied to particular development languages and protocols, making operation in heterogeneous environments (i.e., the real world) problematic, since instrument software comes in many different implementations. We present a peer-to-peer architecture for lab automation, using an XML-based communication protocol. The architecture consists of peer instrument servers, an XML communication layer, and an open control center. Each instrument peer can control, be controlled by, and communicate information to other instrument peers to fulfill the automation task. Our protocol is based on XML-RPC, a lightweight communication standard built atop HTTP. This provides an open and flexible means of peer-to-peer interfacing. The control center serves as a convenient, Web-based interface to manage the instruments. The automated procedure can be distributed across all available instrument peers (each instrument assigned a set of responsibilities); the controller implements a limited set of high-level instructions. The software components included in our prototype system are implemented in various programming languages, including Java, C/C++, Visual Basic, and LabVIEW. Our approach facilitates rapid development of laboratory automation systems.

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Caceres, Adrian. "Neuroendoscopy - Surgical instruments." Archives of Pediatric Neurosurgery 3, no. 1(January-April) (January 31, 2021): e732021. http://dx.doi.org/10.46900/apn.v3i1(january-april).73.

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Objective: A thorough knowledge of the endoscope and associated hardware is essential to adequately apply neuroendoscopic techniques in the treatment of cerebral and spinal diseases. The purpose of this presentation is to discuss general principles regarding neuroendoscopy instruments and provide some useful tips for those initiating and/or delving deeper in the field. Methods: The development, evolution and correct use of endoscopic instruments are reviewed, as per the author’s own wide experience and medical literature data. Results/Discussion: Both basic endoscopic surgical tools – lens systems, light sources, coagulation and recording devices, adapted scissors and forceps, etc. – along with advanced tools – holders, laser diodes, aspiration devices, arthropumps, etc. – were shown. Differences between rigid and flexible endoscopes were discussed, as well as specific features of the various current commercially available endoscopes (StorzÔ and BBraunÔ). Lastly, surgical aspects regarding positioning and neuroendoscopic approaches were also summarized. Conclusion: The field of neuroendoscopy is continually evolving. This basic knowledge of the neuroendoscopic tools is fundamental and must be combined with further technical refinements to achieve the best results in our clinical Pediatric Neurosurgery practice https://youtu.be/pvxAPjQGC08

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Khan, Fouzia, Abdulhamit Donder, Stefano Galvan, Ferdinando Rodriguez y. Baena, and Sarthak Misra. "Pose Measurement of Flexible Medical Instruments Using Fiber Bragg Gratings in Multi-Core Fiber." IEEE Sensors Journal 20, no. 18 (September 15, 2020): 10955–62. http://dx.doi.org/10.1109/jsen.2020.2993452.

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Khan, Fouzia, Alper Denasi, David Barrera, Javier Madrigal, Salvador Sales, and Sarthak Misra. "Multi-Core Optical Fibers With Bragg Gratings as Shape Sensor for Flexible Medical Instruments." IEEE Sensors Journal 19, no. 14 (July 15, 2019): 5878–84. http://dx.doi.org/10.1109/jsen.2019.2905010.

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Sudarevic, Boban, Joel Troya, Karl-Hermann Fuchs, Alexander Hann, Andras Vereczkei, and Alexander Meining. "Design and Development of a Flexible 3D-Printed Endoscopic Grasping Instrument." Applied Sciences 13, no. 9 (May 4, 2023): 5656. http://dx.doi.org/10.3390/app13095656.

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(1) Background: Interventional endoscopic procedures are growing more popular, requiring innovative instruments and novel techniques. Three-dimensional printing has demonstrated great potential for the rapid development of prototypes that can be used for the early assessment of various concepts. In this work, we present the development of a flexible endoscopic instrument and explore its potential benefits. (2) Methods: The properties of the instrument, such as its maneuverability, flexibility, and bending force, were evaluated in a series of bench tests. Additionally, the effectiveness of the instrument was evaluated in an ex vivo porcine model by medical experts, who graded its properties and performance. Furthermore, the time necessary to complete various interventional endoscopic tasks was recorded. (3) Results: The instrument achieved bending angles of ±216° while achieving a bending force of 7.85 (±0.53) Newtons. The time needed to reach the operating region was 120 s median, while it took 70 s median to insert an object in a cavity. Furthermore, it took 220 s median to insert the instrument and remove an object from the cavity. (4) Conclusions: This study presents the development of a flexible endoscopic instrument using three-dimensional printing technology and its evaluation. The instrument demonstrated high bending angles and forces, and superior properties compared to the current state of the art. Furthermore, it was able to complete various interventional endoscopic tasks in minimal time, thus potentially leading to the improved safety and effectiveness of interventional endoscopic procedures in the future.

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Kost, Gerald J. "Preventing Medical Errors in Point-of-Care Testing." Archives of Pathology & Laboratory Medicine 125, no. 10 (October 1, 2001): 1307–15. http://dx.doi.org/10.5858/2001-125-1307-pmeipo.

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Abstract Objective.—To prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. Participants.—Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. Evidence.—This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. Consensus Process.—Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. Conclusions.—The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes. (Arch Pathol Lab Med. 2001;1307–1315)

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Matsui, Yoichi, Hironori Ryota, Tatsuma Sakaguchi, Kazuyoshi Nakatani, Hideyuki Matsushima, So Yamaki, Satoshi Hirooka, Tomohisa Yamamoto, and A.-Hon Kwon. "Comparison of a Flexible-tip Laparoscope with a Rigid Straight Laparoscope for Single-incision Laparoscopic Cholecystectomy." American Surgeon 80, no. 12 (December 2014): 1245–49. http://dx.doi.org/10.1177/000313481408001227.

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This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC.

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Albertin, Fauzia, Matteo Bettuzzi, Rosa Brancaccio, Maria Pia Morigi, and Franco Casali. "X-Ray Computed Tomography In Situ: An Opportunity for Museums and Restoration Laboratories." Heritage 2, no. 3 (July 19, 2019): 2028–38. http://dx.doi.org/10.3390/heritage2030122.

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X-ray Computed Tomography (X-ray CT) is a sophisticated non-destructive imaging technique to investigate structures and materials of complex objects, and its application can answer many conservation and restoration questions. However, for Cultural Heritage investigations, medical CT scanners are not optimized for many case-studies: These instruments are designed for the human body, are not flexible and are difficult to use in situ. To overcome these limitations and to safely investigate works of art on site—in a restoration laboratory or in a museum—the X-ray Tomography Laboratory of the University of Bologna designed several CT systems. Here we present two of these facilities and the results of important measurement campaigns performed in situ. The first instrument, light and flexible, is designed to investigate medium-size objects with a resolution of a few tens of microns and was used for the CT analysis of several Japanese theater masks belonging to the collection of the “L. Pigorini” Museum (Rome). The second is designed to analyze larger objects, up to 200 cm and was used to investigate the collection of the so-called “Statue Vestite” (devotional dressed statues) of the Diocesan Museum of Massa.

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Link, Doug, and Michael Kollar. "Improved Design of a High Density 3D Multichip Module for Class I Medical Devices." International Symposium on Microelectronics 2010, no. 1 (January 1, 2010): 000119–26. http://dx.doi.org/10.4071/isom-2010-ta4-paper3.

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Today's powerful DSP based hearing instruments demand both high density and low cost microelectronic packaging solutions. In turn, this demand drives innovation and substantial collaboration among design and manufacturing personnel and suppliers. Conventional design and process envelopes are challenged and new problems arise. Rapid failure analysis and root cause identification are essential in this global, fast-paced development arena. Here we introduce a novel high density multichip module designed for placement onto a flexible, folded hearing aid SMD assembly and discuss the challenges faced by the design team. Delamination, electrochemical migration, and thermal stress failure mechanisms identified during design verification testing are examined, along with the techniques and tools of failure analysis and problem solutions.

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Dobre, Ciprian, Lidia Băjenaru, Rozeta Drăghici, Gabriel-Ioan Prada, Alexandru Balog, and Anna Marie Herghelegiu. "Sustainable Health-Related Quality of Life in Older Adults as Supported by the vINCI Technology." Sensors 23, no. 4 (February 18, 2023): 2287. http://dx.doi.org/10.3390/s23042287.

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The vINCI technology represents an innovative instrument developed specifically but not exclusively for older adults by technology researchers together with a medical team specialized in geriatrics and gerontology. It was designed to be independently and effortlessly used by older adults in the comfort and safety of their own environment. It is a modular and flexible platform that can integrate a large array of various sensors and can easily adapt to specific healthcare needs. The pilot study tested sensors and standardized instruments capable of evaluating several care-related parameters and of generating personalized feedback for the user dedicated to optimizing physical activity level, social interaction, and health-related quality of life. Moreover, the system was able to detect and signal events and health-related aspects that would require medical assistance. This paper presents how the innovative vINCI technology improves quality of life in older adults. This is evidenced by the results obtained following the clinical validation of the vINCI technology by older adults admitted to the Ana Aslan National Institute of Gerontology and Geriatrics (NIGG) in Bucharest.

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Arnault, Denise Saint, and Shizuka Shimabukuro. "The Clinical Ethnographic Interview: A user-friendly guide to the cultural formulation of distress and help seeking." Transcultural Psychiatry 49, no. 2 (December 22, 2011): 302–22. http://dx.doi.org/10.1177/1363461511425877.

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Transcultural nursing, psychiatry, and medical anthropology have theorized that practitioners and researchers need more flexible instruments to gather culturally relevant illness experience, meaning, and help seeking. The state of the science is sufficiently developed to allow standardized yet ethnographically sound protocols for assessment. However, vigorous calls for culturally adapted assessment models have yielded little real change in routine practice. This paper describes the conversion of the Diagnostic and Statistical Manual IV, Appendix I Outline for Cultural Formulation into a user-friendly Clinical Ethnographic Interview (CEI), and provides clinical examples of its use in a sample of highly distressed Japanese women.

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Phattharapornjaroen, Phatthranit, Viktor Glantz, Eric Carlström, Lina Dahlén Holmqvist, Yuwares Sittichanbuncha, and Amir Khorram-Manesh. "The Feasibility of Implementing the Flexible Surge Capacity Concept in Bangkok: Willing Participants and Educational Gaps." International Journal of Environmental Research and Public Health 18, no. 15 (July 22, 2021): 7793. http://dx.doi.org/10.3390/ijerph18157793.

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The management of emergencies consists of a chain of actions with the support of staff, stuff, structure, and system, i.e., surge capacity. However, whenever the needs exceed the present resources, there should be flexibility in the system to employ other resources within communities, i.e., flexible surge capacity (FSC). This study aimed to investigate the possibility of creating alternative care facilities (ACFs) to relieve hospitals in Bangkok, Thailand. Using a Swedish questionnaire, quantitative data were compiled from facilities of interest and were completed with qualitative data obtained from interviews with key informants. Increasing interest to take part in a FSC system was identified among those interviewed. All medical facilities indicated an interest in offering minor treatments, while a select few expressed interest in offering psychosocial support or patient stabilization before transport to major hospitals and minor operations. The non-medical facilities interviewed proposed to serve food and provide spaces for the housing of victims. The lack of knowledge and scarcity of medical instruments and materials were some of the barriers to implementing the FSC response system. Despite some shortcomings, FSC seems to be applicable in Thailand. There is a need for educational initiatives, as well as a financial contingency to grant the sustainability of FSC.

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Nagraj, S., D. Wall, and E. Jones. "Trainees' perceptions of the current operating theatre educational environment." Bulletin of the Royal College of Surgeons of England 89, no. 10 (November 1, 2007): 358–60. http://dx.doi.org/10.1308/147363507x245193.

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Tales of consultant surgeons throwing their instruments across the operating theatre seem like history. Surgery is now a more flexible, female-friendly and intellectually challenging speciality than it has ever been. Why is it then that there is a problem both in North America and in the United Kingdom in attracting and keeping young doctors in surgical training schemes? In the USA, there is evidence that increasing numbers of surgical trainees are leaving surgical residency programmes. Fewer medical students are choosing a surgical career, due to inadequate income for the level of commitment, inadequate family time and the high stress associated with the profession.

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Sutton, Erica, Sheree Carter Chase, Rosemary Klein, Yue Zhu, Carlos Godinez, Yassar Youssef, and Adrian Park. "Development of Simulator Guidelines for Resident Assessment in Flexible Endoscopy." American Surgeon 79, no. 1 (January 2013): 14–22. http://dx.doi.org/10.1177/000313481307900109.

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Virtual reality (VR) simulators may hold a role in the assessment of trainee abilities independent of their role as instructional instruments. Thus, we piloted a course in flexible endoscopy to surgical trainees who had met Accreditation Council for Graduate Medical Education endoscopy requirements to establish the relationship between metrics produced by a VR endoscopic simulator and trainee ability. After a didactic session, we provided faculty instruction to senior residents for Case 1 upper endoscopy and colonoscopy modules on the CAE Endoscopy VR. Course conclusion was defined as a trainee meeting all proficiency standards in basic endoscopic procedures on the simulator. Simulator metrics and course evaluation comprised data. Eleven and eight residents participated in the colonoscopy and upper endoscopy courses, respectively. Average time to reach proficiency standards for esophagogastroduodenoscopy was 6 and 13 minutes for colonoscopy after a median of one (range, one to two) and one (range, one to four) task repetitions, respectively. Faculty instruction averaged 7.5 minutes of instruction per repetition. A subjective course evaluation demonstrated that the course improved learners’ knowledge of the subject and comfort with endoscopic equipment. Within a VR-based curriculum, experienced residents rapidly achieved task proficiency. The resultant scores may be used as simulator guidelines for resident assessment and readiness to perform flexible endoscopy.

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Silber, Israel, Robert C. Jackson, Ann M. Fridlind, Andrew S. Ackerman, Scott Collis, Johannes Verlinde, and Jiachen Ding. "The Earth Model Column Collaboratory (EMC<sup>2</sup>) v1.1: an open-source ground-based lidar and radar instrument simulator and subcolumn generator for large-scale models." Geoscientific Model Development 15, no. 2 (February 1, 2022): 901–27. http://dx.doi.org/10.5194/gmd-15-901-2022.

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Abstract. Climate models are essential for our comprehensive understanding of Earth's atmosphere and can provide critical insights on future changes decades ahead. Because of these critical roles, today's climate models are continuously being developed and evaluated using constraining observations and measurements obtained by satellites, airborne, and ground-based instruments. Instrument simulators can provide a bridge between the measured or retrieved quantities and their sampling in models and field observations while considering instrument sensitivity limitations. Here we present the Earth Model Column Collaboratory (EMC2), an open-source ground-based lidar and radar instrument simulator and subcolumn generator, specifically designed for large-scale models, in particular climate models, but also applicable to high-resolution model output. EMC2 provides a flexible framework enabling direct comparison of model output with ground-based observations, including generation of subcolumns that may statistically represent finer model spatial resolutions. In addition, EMC2 emulates ground-based (and air- or space-borne) measurements while remaining faithful to large-scale models' physical assumptions implemented in their cloud or radiation schemes. The simulator uses either single particle or bulk particle size distribution lookup tables, depending on the selected scheme approach, to perform the forward calculations. To facilitate model evaluation, EMC2 also includes three hydrometeor classification methods, namely, radar- and sounding-based cloud and precipitation detection and classification, lidar-based phase classification, and a Cloud Feedback Model Intercomparison Project Observational Simulator Package (COSP) lidar simulator emulator. The software is written in Python, is easy to use, and can be straightforwardly customized for different models, radars, and lidars. Following the description of the logic, functionality, features, and software structure of EMC2, we present a case study of highly supercooled mixed-phase cloud based on measurements from the U.S. Department of Energy Atmospheric Radiation Measurement (ARM) West Antarctic Radiation Experiment (AWARE). We compare observations with the application of EMC2 to outputs from four configurations of the NASA Goddard Institute for Space Studies (GISS) climate model (ModelE3) in single-column model (SCM) mode and from a large-eddy simulation (LES) model. We show that two of the four ModelE3 configurations can form and maintain highly supercooled precipitating cloud for several hours, consistent with observations and LES. While our focus is on one of these ModelE3 configurations, which performed slightly better in this case study, both of these configurations and the LES results post-processed with EMC2 generally provide reasonable agreement with observed lidar and radar variables. As briefly demonstrated here, EMC2 can provide a lightweight and flexible framework for comparing the results of both large-scale and high-resolution models directly with observations, with relatively little overhead and multiple options for achieving consistency with model microphysical or radiation scheme physics.

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Wolcott, Barbara. "Renaissance Technologist." Mechanical Engineering 122, no. 08 (August 1, 2000): 46–50. http://dx.doi.org/10.1115/1.2000-aug-1.

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This article observes that in the present competitive world, it is important for an engineer to be adaptable, entrepreneurial, and versatile. According to a private marketing consultant in Cambria, CA, Vicki Clift, ‘Engineers must consider themselves self-employed no matter where they work, or for whom.’ Clift strongly urges engineers to develop cross-industry interests, suggesting that a space engineer can move to medical instruments. Clift recommends that people ‘cross pollinate,’ for instance, by taking ideas from the medical industry that could apply to aerospace. He suggests compiling a list of five or so people and meeting with them on a regular basis. One large contributing factor for the change in employment is the result of an even greater change in the way large contracts are bid today. The state of Oregon recognized the importance of teaming when it established a grant program called Flexible Networks to help businesses form alliances for new markets and opportunities for growth.

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Hannula, Simo Pekka, Outi Söderberg, Timo Jämsä, and V. K. Lindroos. "Shape Memory Alloys for Biomedical Applications." Advances in Science and Technology 49 (October 2006): 109–18. http://dx.doi.org/10.4028/www.scientific.net/ast.49.109.

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NiTi shape memory alloy (SMA) products appeared to the medical markets in 1980’s, their global market being more than US$ 130 billion in 2002. In most medical applications material must be biocompatible. NiTi offers the bodytemperature activated shape memory effect (SME), superelasticity (SE) and the damping capacity, which all can be applied in medical use. The dental arch wires and stents are benefiting from SE. The NiTi vena cava filters obtain their umbrella shaped mesh when SMEactivated. Generally the NiTi tubes and guidewires are applied in the minimally invasive medical procedures and in the interventional radiology. There are numerous steerable, hingeless, kink resistant, highly flexible clinical instruments that may provide constant force. NiTi is used for the dental implants and the attachments of the partial dentures and for the orthopaedics. In the latter one the main applications are the clamps for connecting bone fractures or parts for e.g. the spinal bentcalibration bar. Miniaturization has enabled small SMAactuators that are applicable in active endoscopes with allround bending and in actuators for kidney or heart pumps. The main risks using NiTi are the insecure fatigue life and possible cytotoxicity.

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Kellam, Hugh. "A Conceptual Framework and Evaluation Tool for Mobile Learning Experiences." International Journal of Virtual and Personal Learning Environments 11, no. 1 (January 2021): 1–22. http://dx.doi.org/10.4018/ijvple.2021010101.

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There is an identified need in the research literature for the design, implementation, and evaluation of a conceptual framework for creating contextual, interactive mobile learning. This article details how the conceptual framework was implemented and tested in an online learning course for physicians, nurses, and healthcare professionals at medical organizations across Ontario. The conceptual framework and evaluation instruments were revised based on identified best practices and feedback from study participants. This provided a practical, evidence-based tool for informing the effective design of mobile learning. Results indicated that the design of the framework to include context-specific content, guided participation delivery, flexible and intuitive usability, formal online and informal mobile structure, and access to communities of practice all resulted in practical, applicable learning outcomes and a high degree of learner satisfaction.

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Spychalska, Kamila, Dorota Zając, Sylwia Baluta, Kinga Halicka, and Joanna Cabaj. "Functional Polymers Structures for (Bio)Sensing Application—A Review." Polymers 12, no. 5 (May 18, 2020): 1154. http://dx.doi.org/10.3390/polym12051154.

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In this review we present polymeric materials for (bio)sensor technology development. We focused on conductive polymers (conjugated microporous polymer, polymer gels), composites, molecularly imprinted polymers and their influence on the design and fabrication of bio(sensors), which in the future could act as lab-on-a-chip (LOC) devices. LOC instruments enable us to perform a wide range of analysis away from the stationary laboratory. Characterized polymeric species represent promising candidates in biosensor or sensor technology for LOC development, not only for manufacturing these devices, but also as a surface for biologically active materials’ immobilization. The presence of biological compounds can improve the sensitivity and selectivity of analytical tools, which in the case of medical diagnostics is extremely important. The described materials are biocompatible, cost-effective, flexible and are an excellent platform for the anchoring of specific compounds.

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Ghezeljeh, Tahereh Najafi, Sahar Keyvanloo Shahrestanaki, Ali Abbasi, Fatemeh Ghonodi, and Azita Emami. "Nursing and midwifery students’ knowledge and concerns about COVID-19: a descriptive-analytical study." International Journal of Public Health Science (IJPHS) 11, no. 2 (June 1, 2022): 431. http://dx.doi.org/10.11591/ijphs.v11i2.21237.

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The coronavirus disease 2019 (COVID-19) pandemic has changed educational trends for all university students, including nursing and midwifery students (NMSs). In the future, these students will play critical roles in healthcare delivery systems. The purpose of the study was to examine knowledge, fear, and anxiety about COVID-19 among NMSs. A cross-sectional descriptive-analytical study involved 600 NMSs were performed through an online survey from February to March 2021 in Iran University of Medical Sciences. Data gathering was done using a demographic questionnaire, the COVID-related Knowledge Questionnaire, The Fear of COVID-19 Scale, and the Corona Disease Anxiety Scale. Instruments were provided to students through WhatsApp, Telegram, or email. The study instruments were completely answered by 415 students. Their age was 24.63±4.97 years, on average. Most participants were female (62.2%) and single (76.9%). The mean scores of their knowledge, fear, and anxiety about COVID-19 were respectively 13.41±1.32 (in the possible range of 0–15), 21.93±6.78 (in the possible range of 7–35), and 19.82±12.77 (in the possible range of 0–54). NMSs have great knowledge, relatively great fear, and mild anxiety about COVID-19. Flexible educational programs, close monitoring of fear and anxiety, and effective need-based education are necessary for NMSs, particularly during pandemics.

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Ahmad Narihan, Mohammad Zulkarnaen, Dayangku Norlida Awang Ojep, Madzlifah Ahadon, Than Aye Than, Leh Shii Law, and Shazrina Ahmad Razali. "Time to Flip? Feedback from UNIMAS Medical Students Towards Implementation of Flipped Pathology Classroom." Education in Medicine Journal 15, no. 1 (March 31, 2023): 41–58. http://dx.doi.org/10.21315/eimj2023.15.1.4.

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This study aimed to explore the perception of year two preclinical medical students towards flipped classroom over conventional teaching method through qualitative and quantitative approaches. The study involved 110 year two preclinical medical students at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak from October 2020 to January 2021. Five one-hour pathology lectures were divided into two parts covering different topics of the lecture. The first half hour used conventional teaching, while the second half hour used flipped classroom. Student feedback was collected through a 19-item, self-administered questionnaire comprising 15 quantitative questions in three structured instruments and four qualitative open-ended questions. The score for mean perception of flipped classroom was significantly different according to place of residence while the mean knowledge acquisition score was significantly different among students using different internet sources. In addition, for examination preparation, slightly more than one third preferred traditional classroom. Six aspects of improvement on flipped classroom were identified: learning materials; teaching methods; quality of resource materials; class activity and interaction; choices of topics for flipped classroom; and time, pace, and atmosphere of lessons. Three aspects of significance of flipped classroom were captured, which included facilitating understanding and revision; flexible time, ability to ask and answer; and ability to share, focus and identify mistakes. A flipped classroom shows much potential in medical education. Future studies on feedback from students are needed to improve the flipped classroom to suit the Malaysian context.

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Ou, Xiangyu, Xue Chen, Xianning Xu, Lili Xie, Xiaofeng Chen, Zhongzhu Hong, Hua Bai, et al. "Recent Development in X-Ray Imaging Technology: Future and Challenges." Research 2021 (December 26, 2021): 1–18. http://dx.doi.org/10.34133/2021/9892152.

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X-ray imaging is a low-cost, powerful technology that has been extensively used in medical diagnosis and industrial nondestructive inspection. The ability of X-rays to penetrate through the body presents great advances for noninvasive imaging of its internal structure. In particular, the technological importance of X-ray imaging has led to the rapid development of high-performance X-ray detectors and the associated imaging applications. Here, we present an overview of the recent development of X-ray imaging-related technologies since the discovery of X-rays in the 1890s and discuss the fundamental mechanism of diverse X-ray imaging instruments, as well as their advantages and disadvantages on X-ray imaging performance. We also highlight various applications of advanced X-ray imaging in a diversity of fields. We further discuss future research directions and challenges in developing advanced next-generation materials that are crucial to the fabrication of flexible, low-dose, high-resolution X-ray imaging detectors.

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Pusztahelyi, Réka. "Liability for Intelligent Robots from the Viewpoint of the Strict Liability Rule of the Hungarian Civil Code." Acta Universitatis Sapientiae Legal Studies 8, no. 2 (January 19, 2020): 213–30. http://dx.doi.org/10.47745/ausleg.2019.8.2.05.

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The European Parliament resolution of 16 February 2017 on Civil Law Rules on Robotics proposed that the strict liability and the risk management approach are alternative legal instruments to achieve the goals set out by this instrument. The evolution of strict liability is parallel with technological change; our question here is whether the elaborated rules are appropriate for managing new problems. For establishing accountability, the question arises: who is to be held liable for damages and based on which form of liability? Setting aside the issues of product liability and setting aside the independent liability of the most sophisticated autonomous robots having ‘electronic personality’, this essay concentrates on liability questions of the user, and it examines the strict liability rules instituted by the Hungarian Civil Code and their application in practice. According to the results of our previous research, the judicial practice regarding the general clause of liability for dangerous activity (Section 6:535. HCC) is quite flexible and covers the liability issues of damage caused by artificial intelligence. We observed also that the criterion ‘dangerous’ means less and less risk of damage within normal circumstances, and this statement of fact in practice also successfully competes with other strict liability rules (i.e. product liability for malfunctioning medical devices, liability for dangerous animals, etc.). The capacity of the ‘keeper’ or ‘operator’ of the robot and the emerging new types of risks are also touched upon.

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Citardi, Martin J., and Seth J. Kanowitz. "A Cadaveric Model for Balloon-Assisted Endoscopic Paranasal Sinus Dissection without Fluoroscopy." American Journal of Rhinology 21, no. 5 (September 2007): 579–83. http://dx.doi.org/10.2500/ajr.2007.21.3081.

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Background Recently, balloon catheter (BC) dilatation of paranasal sinus ostia has been introduced. In this procedure, a balloon-tipped catheter is placed across a sinus ostium over a flexible wire under fluoroscopic guidance, and inflation of the balloon enlarges the ostium. Some rhinologists have criticized this procedure for its failure to remove tissue and bone, especially in the setting of sinonasal polyposis. This project seeks to develop strategies for incorporating BC technology into standard functional endoscopic sinus surgery procedures. Methods Endoscopic sinus dissection of three human cadaveric heads was performed with conventional instruments supplemented by lacrimal duct BCs (LacriCATH; Quest Medical, Allen, TX). No fluoroscopy was used. Each dissection was videotaped for later review. Results For frontal recess dissection, these steps were performed under endoscopic visualization: (1) passage of the BC between frontal recess partitions, (2) BC inflation, and (3) removal of fractured frontal recess partitions with conventional instruments. This approach was used successfully in each frontal recess. Under endoscopic visualization, a BC was passed into the sphenoid ostium and inflated; this maneuver successfully dilated each sphenoid ostium. It was not feasible to reliably pass the BC through the natural maxillary ostium. Each BC was inflated to 8 atm for 30 seconds. No evidence of orbital or skull base injury was noted. No fluoroscopy was used. Conclusion BCs may be used as adjunctive instrumentation for endoscopic sinus dissection without fluoroscopy. This strategy warrants additional technical and clinical development.

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Schild, L. R., F. Boehm, L. Kienle, A. Seitz, L. A. Kahrs, T. M. Boeckers, J. Greve, T. K. Hoffmann, and P. J. Schuler. "Evaluation of a curved surgical prototype in a human larynx." European Archives of Oto-Rhino-Laryngology 278, no. 8 (April 22, 2021): 2927–35. http://dx.doi.org/10.1007/s00405-021-06791-9.

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Abstract Purpose It is not always possible to create linear access to the larynx using a rigid operating laryngoscope for microlaryngoscopy. In this study, we evaluate the usability of a novel curved surgical prototype with flexible instruments for the larynx (sMAC) in a simulation dummy and human body donor. Methods In a user study (n = 6), head and neck surgeons as well as medical students tested the system for visualization quality and accessibility of laryngeal landmarks on an intubation dummy and human cadaver. A biopsy of the epiglottis was taken from the body donor. Photographic and time documentation was carried out. Results The sMAC system demonstrated general feasibility for laryngeal surgery. Unlike conventional microlaryngoscopy, all landmarks could be visualized and manipulated in both setups. Biopsy removal was possible. Visibility of the surgical field remained largely unobstructed even with an endotracheal tube in place. Overall handling of the sMAC prototype was satisfactorily feasible at all times. Conclusion The sMAC system could offer an alternative for patients, where microlaryngoscopy is not applicable. A clinical trial has to clarify if the system benefits in clinical routine.

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Zhang, Wensheng, Weifang Xing, Xiaojing Zhong, Minzhen Zhu, and Jinzhao He. "Emergency thrombectomy for cerebrovascular occlusion in a patient with mirror-image dextrocardia: a case report." Journal of International Medical Research 50, no. 1 (January 2022): 030006052110727. http://dx.doi.org/10.1177/03000605211072785.

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Cases of patients complicated with dextrocardia who suffer from acute cerebral infarction with large vessel occlusion and receive emergency thrombectomy are particularly rare and have not been widely reported. This article aimed to increase the awareness and knowledge of these cases. We report the case of a patient with mirror-image dextrocardia who suffered from cerebral infarction with large vessel occlusion and received emergency thrombectomy. A male patient in his early 60s with dextrocardia had acute cerebral infarction with posterior circulation large vessel occlusion and underwent emergency thrombectomy. During the operation, the rapid confirmation of dextrocardia and use of flexible interventional instruments helped establish a pathway for blood flow. We used an intracranial thrombectomy stent and intracranial balloon dilation catheter to restore the cerebral blood supply. The Modified Rankin Scale score was 0 at 3 months after thrombectomy, indicating a good prognosis of the patient. Acute cerebral infarction with large vessel occlusion in patients with dextrocardia is extremely rare. Emergency thrombectomy is feasible to recanalize cerebral blood flow and give patients a chance to recover.

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Shanbehzadeh, Mostafa, Hadi Kazemi-Arpanahi, Hassan Bostan, and Raoof Nopour. "Using Electronic Data Capture for Cardiovascular Electrophysiology Invasive Procedures: An Important Step Towards Interoperable Clinical Registries." Frontiers in Health Informatics 9, no. 1 (October 18, 2020): 48. http://dx.doi.org/10.30699/fhi.v9i1.236.

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Introduction: The capture and integration of structured data from point of care into clinical registries has been a challenge. However, this effort is very important toward a qualitative patient care and research. Collection, organization and interpretation of clinical data can help to improve evidence-based medicine practices. Worksheets data capture are prevalent, but, not flexible, protected, workflow pleasant, and user friendly and do not support the creation of standardized and interoperable data. The aim of this study was to design and implement an Electronic Data Capture (EDC) instruments to be use in context of cardiovascular invasive procedures.Material and Methods: This descriptive and developmental study conducted in three phases as follows. (1) data standardization according national and international data element templates published by specialized societies; (2) developing of an initial data collection and clinical research workflow (3), establishing of electronic case reports using Research Electronic Data Capture (REDCap) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy rule.Results: Three case report forms was developed that included demographics, medical history, physical examination, laboratory tests, radiology examinations, Electrophysiology (EP) procedures, as well as medications and follow-up information. Data-entry validation criteria have been implementing in electronic data collection instrument to assure validity and precision when data enter in electronic form.Conclusion: This paper describes the process used to create an EDC application. Data collection applications were successfully develop as an a priori step in a clinical research for assisting data collection and management in a case of cardiovascular EP invasive procedures.

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Karo-Karo, Siddik, and Marjones Hardy H. Sihombing. "Tinjauan Perancangan Tracer (Outguide) Pada Unit Penyimpanan Rekam Medis Di RSU Imelda Pekerja Indonesia Tahun 2022." Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI) 8, no. 1 (February 28, 2023): 87–93. http://dx.doi.org/10.52943/jipiki.v8i1.1175.

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Tracer (outguide) is a substitute for medical records that will be removed from storage for any purpose. A good tracer should be made of strong and colorful materials. The function of the tracer is to show where medical record documents are when they are not in storage. Tracers can also improve efficiency and accuracy by showing where medical records are stored when they return. The purpose of this study was to redesign the tracer at Imelda Workers' Hospital in Indonesia by replacing materials, shapes, and designs to make it easier for officers to carry out their duties, namely inserting tracers into the shelves between the densely packed medical record files. The research method used is descriptive qualitative research. And the research instruments used are interview guidelines and observation check lists. The tracer (outguide) at Imelda Workers' Hospital in Indonesia has not been used for about a year because all tracers (outguides) have been damaged. The tracer (outguide) was damaged because the material was too stiff and broke easily when the officer inserted the tracer into the storage rack between the dense medical record files. RSU Imelda Workers Indonesia requires a tracer (outguide) made of strong, durable, not easily damaged, torn, broken and researchers have redesigned the tracer (outguide) as the results in the design above, namely by using flexible mica plastic material with a thickness of 0.70 mm , and the color chosen by the researcher in this design is black. The shape and size of the tracer (outguide) in this design is the same as the shape and size of the previous tracer (outguide) in Imelda Workers' Hospital in Indonesia. medical devices with new materials and designs such as the results in this design.

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Mao, Pengsu, Haoran Li, and Zhibin Yu. "A Review of Skin-Wearable Sensors for Non-Invasive Health Monitoring Applications." Sensors 23, no. 7 (March 31, 2023): 3673. http://dx.doi.org/10.3390/s23073673.

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The early detection of fatal diseases is crucial for medical diagnostics and treatment, both of which benefit the individual and society. Portable devices, such as thermometers and blood pressure monitors, and large instruments, such as computed tomography (CT) and X-ray scanners, have already been implemented to collect health-related information. However, collecting health information using conventional medical equipment at home or in a hospital can be inefficient and can potentially affect the timeliness of treatment. Therefore, on-time vital signal collection via healthcare monitoring has received increasing attention. As the largest organ of the human body, skin delivers significant signals reflecting our health condition; thus, receiving vital signals directly from the skin offers the opportunity for accessible and versatile non-invasive monitoring. In particular, emerging flexible and stretchable electronics demonstrate the capability of skin-like devices for on-time and continuous long-term health monitoring. Compared to traditional electronic devices, this type of device has better mechanical properties, such as skin conformal attachment, and maintains compatible detectability. This review divides the health information that can be obtained from skin using the sensor aspect’s input energy forms into five categories: thermoelectrical signals, neural electrical signals, photoelectrical signals, electrochemical signals, and mechanical pressure signals. We then summarize current skin-wearable health monitoring devices and provide outlooks on future development.

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Wallace, Dora, Allan Hildesheim, and Ligia A. Pinto. "Comparison of Benchtop Microplate Beta Counters with the Traditional Gamma Counting Method for Measurement of Chromium-51 Release in Cytotoxic Assays." Clinical Diagnostic Laboratory Immunology 11, no. 2 (March 2004): 255–60. http://dx.doi.org/10.1128/cdli.11.2.255-260.2004.

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ABSTRACT The most traditional method used to measure the lytic activity of cytotoxic T lymphocytes or natural killer (NK) cells is the chromium release assay (CRA). No study has been reported that systematically compares the traditional gamma counting method with various benchtop microplate scintillation formats to measure chromium release. Here we investigated the utilization of microplate beta counters in comparison with the traditional gamma counting method to quantitate antigen-specific cytolysis, lymphokine-activated killer (LAK) activity, and NK activity in the CRA. Supernatants from standard CRA (n = 7) were directly transferred to a 96-well microplate containing either a solid scintillant (Lumaplate) or a liquid scintillant (flexible beta plate). Samples were quantified by using two benchtop microplate beta counters, Wallac Microbeta Trilux (Lumalux and Trilux methods, respectively) and Packard TopCount instruments (TopCount method). These results were then compared with data from an identical assay run in parallel using the traditional gamma counting method (LKB). The lytic activity for influenza virus-stimulated effectors measured in the benchtop microplate beta counters using Lumalux and Trilux methods exhibited excellent correlations with the one measured in the traditional LKB (r = 0.967 and 0.968, respectively). The TopCount method demonstrated a similar correlation (r = 0.966). Similar findings were observed for LAK and NK activity. The 96-well microplate format, specifically the dry-scintillant Lumaplates, offers several advantages over the traditional gamma counting format. Most notable are the reductions in sample volume needed and in the total sample preparation and counting time. Furthermore, this system reduces the amount of dry and mixed radioactive waste generated while using the same instrument for gamma- and beta-emitting isotopes.

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Gou, Xunjie, Zeshui Xu, and Huchang Liao. "Hesitant Fuzzy Linguistic Possibility Degree-Based Linear Assignment Method for Multiple Criteria Decision-Making." International Journal of Information Technology & Decision Making 18, no. 01 (January 2019): 35–63. http://dx.doi.org/10.1142/s0219622017500377.

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Hesitant fuzzy linguistic term set (HFLTS), as a flexible tool to represent people’s uncertain cognition, has attracted lots of scholars’ research interests, and a series of methodologies have been proposed to deal with a variety of decision-making problems. In this paper, we develop a hesitant fuzzy linguistic possibility degree-based linear assignment (HFL-PDLA) method to tackle the multiple criteria decision-making (MCDM) problems under hesitant fuzzy linguistic environment. Firstly, we define the possibility degree of hesitant fuzzy linguistic element (HFLE). Additionally, some relevant concepts related to the HFL-PDLA method are proposed, such as the relative difference matrix, the rank contribution matrix, the optimal permutation matrix, etc. Furthermore, the algorithm of the HFL-PDLA method is given to deal with hesitant fuzzy linguistic MCDM problems. Moreover, we apply the HFL-PDLA method to deal with a practical case which is to select the optimal treatment technology for disposing the outspent or old medical apparatuses and instruments in West China Hospital (WCH). Finally, we show the advantages of the HFL-PDLA method by making some comparative analyses with the TOPSIS method, the VIKOR method the PROMETHEE method and the LINMAP method.

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Asratyan, A. A., M. A. Kazaryan, N. A. Lyabin, I. V. Ponomarev, V. I. Sachkov, and H. Li. "D.Sc. in Chemistry, Head of the Labora tory, Siberian Physical-Technical Insti tute of Tomsk State University." Alternative Energy and Ecology (ISJAEE), no. 31-36 (January 6, 2019): 97–120. http://dx.doi.org/10.15518/isjaee.2018.31-36.097-120.

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The article considers and analyzes an important stage in the development of laser systems for metal vapor from the point of view of biomedical applications. Since the advent of the first generation of domestic medical facilities with pulsed lasers on metal vapors, in particular, copper vapors (LSM), which were created in the FSUE “Research and Production Enterprise ‘Istok’”, not much time has passed. Now similar studies are widely developed and include a variety of uses, for instance, in oncology for treatment with photodynamic therapy (PDT), angioplasty of intravascular destruction of atherosclerotic lesions, dermatology and cosmetology for the treatment of facial skin defects, as well as otorhinolaryngology, gynecology, proctology, urology, and others. In that cases, doctors use the Yantar-2Fand Yakhroma-2 installations, developed on the basis of the “Kurs” LPM with radiation wavelengths λ = 510.6 nm and 578 nm and the average radiation power Prad= 5–10 W and tunable in wavelengths in the range of λ = 620–670 nm. Laser radiation is delivered to the affected area of a bio-object using a flexible light-guide cable with a diameter of 400, 600 or 800 μm fiber, which is one of the most convenient medical instruments. A compact and air-cooled medical installation of the new generation “Yakhroma-Med” based on the pulsed LPM “Kulon” with an average radiation power at the output of the light-guide cable Prad= 1–3 W uses in dermatology and cosmetology (together with the Lebedev Physics Institute of the Russian Academy of Sciences). Today, YakhromaMed is the leader in non-ablative technologies and is optimal for removing vascular, pigmented and unstained skin defects, treating acne and smoothing wrinkles. It is used in more than 100 clinics in Russia and abroad. Moreover, for scientific and practical medicine in the field of oncology, low-intensity laser therapy and surgery, dermatology and cosmetology, etc., a compact air-cooled industrial multifunctional high-intensity medical unit “Kulon-Med” (similar to Yakhroma-Med) based on two pulsed lasers was developed: LM “Kulon” with an average radiation power Prad= 10 W and LVRK with radiation tunable in wavelengths in the range λ = 620–750 nm and radiation power Prad= 1–3 W (together with Ltd. NPP VELIT, Kurchatov Institute and the Hertzen Hermitage Research and Development Institute). The laser radiation is transported using four flexible light-guide cables with a conductive quartz fiber diameter of 400 and 600 μm, which makes it possible to perform a therapeutic and prophylactic procedure simultaneously in several rooms. Medical facilities of this class have been put in many medical institutions. This report on the use of CVL in medicine says only about the developments in theMoscow region.

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Matviychuk, Bohdan, Artur Hurayevskyy, Andrii Stasyshyn, and Yaroslav Korol. "HISTORY OF DEVELOPMENT OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY IN LVIV CLINICAL EMERGENCY CARE HOSPITAL." Acta Medica Leopoliensia 27, no. 3-4 (December 23, 2021): 160–72. http://dx.doi.org/10.25040/aml2021.3-4.160.

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Aim. The analysis of the history of minimally invasive surgery in a clinical emergency care hospital and the clinical cases associated with first robot-assisted operations. Materials and Methods. We have analyzed 10180 inpatients' maps and protocols of surgical operations from 2002 to 2019. We have also studied the first minimally invasive interventions in the Clinic of Surgery and Endoscopy affiliated to the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University and the municipal non-profit institution "Lviv Clinical Emergency Care Hospital". Results and Discussion. Until the early 1990s, the development of surgical technology took place mainly due to the talents of individual surgeons and their persistence in implementing new treatment methods. The directions of work of our Department of Endoscopic Surgery included the introduction of minimally invasive (laparoscopic) surgical interventions and endoscopic interventions using flexible endoscopy. Robot-assisted operation on a patient with diaphragmatic hernia using da Vinci surgical system was performed with three 8.5 mm robotic instruments and two 5 mm laparoscopic ones. The operation lasted for 6 hours. There were no intra- and postoperative complications. The patient was discharged home in satisfactory condition on the 3rd post-op day. Robot-assisted surgery for complicated gallstone disease was performed with three 8.5 mm robotic instruments and one 5 mm laparoscopic one. The operation lasted for 3 hours. Conclusions. 1. The introduction of modern technologies and minimally invasive interventions results primarily from activities of the clinic's staff, the head of the structural unit and the hospital administration, as well as from the high professional level of surgeons. 2. The usage of minimally invasive, laparoscopic, endoscopic techniques, as well as that of da Vinci surgical system in clinical practice will improve therapeutic outcomes and quality of life among patients with surgical disorders.

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Fung, Tan, Duong, Schivo, Littlefield, Delplanque, Davis, and Kenyon. "Design and Benchmark Testing for Open Architecture Reconfigurable Mobile Spirometer and Exhaled Breath Monitor with GPS and Data Telemetry." Diagnostics 9, no. 3 (August 21, 2019): 100. http://dx.doi.org/10.3390/diagnostics9030100.

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Portable and wearable medical instruments are poised to play an increasingly important role in health monitoring. Mobile spirometers are available commercially, and are used to monitor patients with advanced lung disease. However, these commercial monitors have a fixed product architecture determined by the manufacturer, and researchers cannot easily experiment with new configurations or add additional novel sensors over time. Spirometry combined with exhaled breath metabolite monitoring has the potential to transform healthcare and improve clinical management strategies. This research provides an updated design and benchmark testing for a flexible, portable, open access architecture to measure lung function, using common Arduino/Android microcontroller technologies. To demonstrate the feasibility and the proof-of-concept of this easily-adaptable platform technology, we had 43 subjects (healthy, and those with lung diseases) perform three spirometry maneuvers using our reconfigurable device and an office-based commercial spirometer. We found that our system compared favorably with the traditional spirometer, with high accuracy and agreement for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), and gas measurements were feasible. This provides an adaptable/reconfigurable open access “personalized medicine” platform for researchers and patients, and new chemical sensors and other modular instrumentation can extend the flexibility of the device in the future.

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Gruionu, Lucian Gheorghe, Anca Loredana Udriștoiu, Andreea Valentina Iacob, Cătălin Constantinescu, Răzvan Stan, and Gabriel Gruionu. "Feasibility of a lung airway navigation system using fiber-Bragg shape sensing and artificial intelligence for early diagnosis of lung cancer." PLOS ONE 17, no. 12 (December 7, 2022): e0277938. http://dx.doi.org/10.1371/journal.pone.0277938.

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Currently early diagnosis of malignant lesions at the periphery of lung parenchyma requires guidance of the biopsy needle catheter from the bronchoscope into the smaller peripheral airways via harmful X-ray radiation. Previously, we developed an image-guided system, iMTECH which uses electromagnetic tracking and although it increases the precision of biopsy collection and minimizes the use of harmful X-ray radiation during the interventional procedures, it only traces the tip of the biopsy catheter leaving the remaining catheter untraceable in real time and therefore increasing image registration error. To address this issue, we developed a shape sensing guidance system containing a fiber-Bragg grating (FBG) catheter and an artificial intelligence (AI) software, AIrShape to track and guide the entire biopsy instrument inside the lung airways, without radiation or electromagnetic navigation. We used a FBG fiber with one central and three peripheral cores positioned at 120° from each other, an array of 25 draw tower gratings with 1cm/3nm spacing, 2 mm grating length, Ormocer-T coating, and a total outer diameter of 0.2 mm. The FBG fiber was placed in the working channel of a custom made three-lumen catheter with a tip bending mechanism (FBG catheter). The AIrShape software determines the position of the FBG catheter by superimposing its position to the lung airway center lines using an AI algorithm. The feasibility of the FBG system was tested in an anatomically accurate lung airway model and validated visually and with the iMTECH platform. The results prove a viable shape-sensing hardware and software navigation solution for flexible medical instruments to reach the peripheral airways. During future studies, the feasibility of FBG catheter will be tested in pre-clinical animal models.

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Dzarnoski, John, and Susie Johansson. "Embedding Active and Passive Devices in Medical Electronics." Additional Conferences (Device Packaging, HiTEC, HiTEN, and CICMT) 2014, DPC (January 1, 2014): 000786–814. http://dx.doi.org/10.4071/2014dpc-tp16.

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Efforts to increase the packaging efficiency of microelectronic systems have been extensive and continuous over the past few decades. Evidence of this can be seen even before the expansion of the space program by the United States in 1961 and the race to the moon; one of the first settings where size was truly limited and miniaturization of electronics was a necessity. In the 1950's the world saw its first major size reduction of electronic component with the phase out of the vacuum tube in favor of the transistor. The transistor saw its first major commercial use in 1952 via hybrid vacuum tube transistor technology. While many industries benefitted from the shift, in 1954 the hearing aid industry specifically experienced major improvements owing to the implementation of transistors, becoming smaller, requiring less power and having better functionality. The first 4-transistor AM radio product followed shortly thereafter. Much of today's effort since 1978 has been driven by the telecommunications industry that has succeeded in reducing cell phone size while simultaneously increasing functionality. Just as in the 1950's, hearing aid technology continues to be at the forefront when it comes to miniaturization. The hearing aid business has always had the need to use extremely small electronic packaging. The first completely in the canal (CIC) hearing aids were produced in 1993 and required all electronic components to be small enough that they fit entirely inside the ear canal. The introduction of wireless systems into hearing aids has sharply increased component count. Due to the size and shape of a multitude of types of hearing aids, flexible circuits need to be folded and bent to fit inside hearing aid cases, with essentially all available space being used. More powerful processors and more memory are enabling sophisticated algorithms that are able to greatly improve sound quality. There is also a strong market desire to add more features to hearing products while at the same time making them smaller and less visible. The latest hearing aids have succeeded in the later demand, constructed so small they are not visible and consequently are called invisible in the canal (IIC). In order to continue meeting the markets want for smaller and more features, a new packaging method needed to be developed. One such option is embedded die packaging. This paper will examine the use of embedded die packaging (or chip-in-flex) to drive significant further size reduction in custom and standard hearing instruments over what can be achieved using chip-on-flex or traditional ceramic hybrid based technologies. The historical drivers, available circuit board technologies, use of integrated passive devices, performance improvement, size reduction, device reliability, changes in supply chain, impact on wafer test, impact on device test, and challenges of working with wafers instead of die will be discussed.

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NESENENKO, P. P., and GUI HUAZHI. "PECULIARITIES OF APPLICATION OF PUBLIC AUTHORITY INSTRUMENTS FOR IMPLEMENTATION OF AGRICULTURAL POLICY OF THE PEOPLE'S REPUBLIC OF CHINA AT DIFFERENT STAGES." Economic innovations 23, no. 4(81) (December 20, 2021): 96–107. http://dx.doi.org/10.31520/ei.2021.23.4(81).96-107.

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Topicality. The urgency of the problem of using the positive foreign experience of economic transformations and opportunities for its application in the domestic practice of reform and public administration based on the use of public authorities to implement the agricultural policy of the People's Republic of China is currently very important. Aim and tasks. The aim of the article is to develop theoretical and methodological provisions for the application of public authorities for the implementation of agricultural policy of the People's Republic of China at different stages of its development. Research results. In the Chinese economy, the agricultural sector continues to play a significant role, remaining the world's leading producer and exporter of agricultural products, although it owns only 10% of the world's arable land. China's agriculture was focused on meeting the country's domestic grain needs on its own, but in recent years they have been covered by imports. Thus, the reduction of land available for crops, made it more profitable to import crops such as wheat and rice, which allowed to save China's resources for growing more valuable products (fruits, nuts or vegetables). To support the country's independence in the field of cereals and maintain the quality of food, the Chinese government is stepping up policies aimed at cultivating more profitable crops. The main directions of modernization of the commodity economy with the purpose of revival of economic activity on transition of mainly traditional (consumer) agriculture to market (commodity) type are substantiated, where the main main direction of the accelerated development of agriculture became deep structural reorganization, refusal of monoculture of grain in agriculture and transition to diversification. farms. It is determined that in the differentiation of Chinese markets, their main common feature is the regulated nature. This is what ensured the stability of the reform movement, and the practice gave the economic process the appearance of permanent compromises in the formation of flexible economic policy. Conclusions. The agrarian policy of the state, largely due to an effective system of public administration, must ensure its food security, which is an important component of national security, which guarantees the political independence of the country, its economic integrity and stable social security. Agriculture plays a significant role in the country's economy, thanks to which the country occupies a leading position in the world in terms of agricultural production and exports. The structure of agricultural production is dominated by crop production, although the country's livestock industry has been actively developing in recent years, but has very low productivity. Increasing attention to the countryside implies a significant increase in investment in this sector, especially foreign ones. The reform of China has gone through five stages, each of which had its own specific purpose, timing, detailed testing by previous field experiments with a clear definition of future actions on the results of the positive results, which were mounted in the new programs. In the agrarian sphere, this manifested itself in the introduction of the family contract system in the agrarian sphere, the reform of the sphere of circulation, the introduction of various forms of trade, the development of hired labor, and so on. This allowed us to test new forms of market recovery and regulation, which a few years after the beginning of the reforms in the countryside were adopted in industry.

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Sha, Baolin, Xiaozhou Lü, and La Jiang. "High Sensitivity and Wide Range Biomimetic Tactile-Pressure Sensor Based on 2D Graphene Film and 3D Graphene Foam." Micromachines 13, no. 7 (July 21, 2022): 1150. http://dx.doi.org/10.3390/mi13071150.

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Bionic electronic skin is a system that simulates human skin and has multiple perceptions. For pressure sensors, high measurement accuracy and wide measurement range restrict each other, and it is difficult to achieve high measurement accuracy and wide measurement range simultaneously. Therefore, the research and application of bionic tactile-pressure sensors are limited due to the mutual constraints of measurement accuracy and range. In this work, a flexible graphene piezoresistive tactile sensor based on a biomimetic structure that utilizes the piezoresistive properties of graphene was reported. The novel tactile-pressure sensor consists of a 2D graphene film tactile sensor and a 3D graphene foam pressure sensor that could achieve high accuracy and a wide-range measurement simultaneously. The testing results show that the measurement range of this sensor was in two intervals of 0–2 N and 2–40 N. For the 0–2 N measurement range, the sensitivity was 472.2 Ω/kPa, the force resolution was 0.01 N, and the response time was less than 40 ms. For the 2–40 N measurement range, the sensitivity was 5.05 kΩ/kPa, the force resolution was 1 N, and the response time was less than 20 ms. The new sensor can realize high-precision and large-scale force measurements and shows great application value in the field of medical instruments and artificial limbs.

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Döbereiner, Luc. "Between the Abstract and the Concrete: A Constraint-Based Approach to Navigating Instrumental Space." Computer Music Journal 43, no. 1 (January 2020): 8–20. http://dx.doi.org/10.1162/comj_a_00497.

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This article deals with a way that algorithmic composition systems can be informed by material realities of musical performance. After a general discussion of the relation of abstract algorithms to concrete materiality, the article focuses on the idea of an instrument's space of possibilities. It briefly discusses a number of compositional approaches that seek to derive musical structure from bodily movements and from the physical properties of instruments. The last part describes a new open-source JavaScript library called OboeJS and a Web application based on this library. The system is an experimental exploration of the idea of instrumental space and an attempt to bring together abstract algorithmic processing and the concrete possibilities of a musical instrument. The system implements a flexible constraint-based search algorithm for the generation of oboe fingering sequences. This tool is presented as part of a wider approach to algorithmic composition that aims not to map data output of generative procedures to “sound generators” (e.g., performers, instruments, sound synthesis processes). Instead, I propose to derive structure from the space of possibilities of the instrument itself, which in this case is the oboe.

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45

Bommarito, Marco, and Mark Meyer. "Large Multisite Clinical Field Study Characterizing Contamination Levels in Patient Used Endoscopes After Manual Cleaning." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s11—s12. http://dx.doi.org/10.1017/ice.2020.483.

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Background: Multiple outbreaks multidrug-resistant organisms (MDROs) have been associated with flexible endoscopes resulting in unacceptable patient mortality and morbidity. Evidence highlights the importance of effective cleaning to achieve effective high-level disinfection (HLD). This study presents an analysis of >700,000 measurements of adenosine-triphosphate (ATP) contamination levels found in flexible endoscopes after manual cleaning. Method: This 2018–2019 study consists of 702,768 measurements of ATP levels found in the suction/biopsy channel of instruments used on patients after manual cleaning: gastroscopes (267,533 measurements from 223 sites), duodenoscopes (123,697 measurements from 161 sites), colonoscopes (252,249 measurements from 229 sites), and bronchoscopes (59,289 measurements from 107 sites). Sites were located across the United States and employed protocols that included routine cleaning verification performed by the reprocessing technicians using a handheld luminometer and the associated ATP water test (3M Clean-Trace). Results: Figure 1 shows a boxplot analysis of the ATP levels by endoscope type. Upper gastrointestinal (GI) endoscopes (gastroscopes and duodenoscopes) show a significantly (P < .005) greater level of ATP contamination after manual cleaning. The pairwise mean differences are all significant (P < .005) except for colonoscopes when compared to bronchoscopes (P = .203). Also shown on Fig. 1 is a literature supported adequate cleanliness value of 200 RLUs [=2.3log(RLUs)] (MJ Alfa et al.; Am J Infec Control 2013;41:245–253 and ANSI/AAMI ST91; 2015). A 95% confidence interval analysis performed against this literature value (Table 1) showed that a high number of gastroscopes (12%) and duodenoscopes (10%) are not adequately clean. Figure 2 shows a box-plot analysis of the data set by endoscope type and by site. There is significant (P < .005) site-to-site variability for all endoscope types as demonstrated by variation in mean values, box size, and many outliers. Conclusions: This study highlights the importance of using a quantitative cleaning verification method to better understand process capability and to provide more robust quality assurance for manual cleaning. Significant differences were detected in the level of cleanliness between upper GI scopes and lower GI scopes and bronchoscopes. When compared to a literature-supported level for adequate cleanliness, upper GI scopes exhibited failure rates in excess of 10%. Furthermore, significant site-to-site variability occurred, and many outliers fell well beyond the normal process envelope, representing significant cleaning lapses. Root causes to these concerning findings could range from inadequate execution of the cleaning protocol, to device design, to age and existing damage that could prevent achieving adequate cleaning and possibly impair the effectiveness of HLD.Funding: NoneDisclosures: Marco Bommarito, 3M (salary)

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Smaglyuk, L. V., A. M. Belous, and A. E. Karasyunok. "Features of postgraduate distance learning in «Orthodontics» specialty." PROBLEMS OF UNINTERRUPTED MEDICAL TRAINING AND SCIENCE 41, no. 1 (April 2021): 29–32. http://dx.doi.org/10.31071/promedosvity2021.01.029.

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Distance learning is the process of acquiring knowledge, abilities, skills and methods of human cognitive activity, it occurs mainly through the indirect interaction of participants in the educational process distant from each other in a specialized environment, it functions on the basis of modern psychological, pedagogical and information and communication technologies. In today’s world, distance learning is a must. This was shown by the existing COVID-19 pandemic. The purpose of our work was to present teaching methods at the Department of Orthodontics of the Ukrainian Medical Dental Academy and to determine the advantages and disadvantages of distance education. To present theoretical and practically oriented content, organize independent work and control knowledge during quarantine, the possibilities of distance learning were used using the Google Classroom web service and using the ZOOM platform, Google-meet, which made it possible to use video, photographic materials, tables, control and diagnostic models, panoramic and other images, orthodontic appliances, orthodontic instruments. Distance learning technology is flexible than traditional. This is its advantage. It is aimed at those who study, creates a comfortable environment for the applicant for higher education to master the material 24 hours a day, 7 days a week. Distance learning allows you to move away from the traditional system of teaching educational material. However, this teaching methodology requires a high level of teacher training. The teacher must have modern pedagogical and information technologies and be psychologically ready to work with applicants for education in a new educational and cognitive environment. The distance form of education must correspond to the methods of teaching in higher medical school. So, the material and technical clinical base of the Department of Orthodontics of the UMCA allows you to provide high-quality online training. But the spread of COVID-19 leads to day-to-day changes in all spheres of life, including healthcare, and the education system.

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Yue, Wenchao, Ruijie Tang, Joei Simin Wong, and Hongliang Ren. "Deployable Tubular Mechanisms Integrated with Magnetic Anchoring and Guidance System." Actuators 11, no. 5 (April 28, 2022): 124. http://dx.doi.org/10.3390/act11050124.

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Deployable mechanism has received more attention in the medical field due to its simple structure, dexterity, and flexibility. Meanwhile, the advantages of the Magnetic Anchoring and Guidance System (MAGS) are further highlighted by the fact that the operators can remotely control the corresponding active and passive magnetic parts in vivo. Additionally, MAGS allows the untethered manipulation of intracorporeal devices. However, the conventional instruments in MAGS are normally rigid, compact, and less flexible. Therefore, to solve this problem, four novel deployable tubular mechanisms, Design 1 (Omega-shape mechanism), Design 2 (Fulcrum-shape mechanism), Design 3 (Archway-shape mechanism), and Design 4 (Scissor-shape mechanism) in this paper, are proposed integrated with MAGS to realize the laser steering capability. Firstly, this paper introduces the motion mechanism of the four designs and analyzes the motion characterization of each structure through simulation studies. Further, the prototypes of four designs are fabricated using tubular structures with embedded magnets. The actuation success rate, the workspace characterization, the force generation and the load capability of four mechanisms are tested and analyzed based on experiments. Then, the demonstration of direct laser steering via macro setup shows that the four mechanisms can realize the laser steering capability within the error of 0.6 cm. Finally, the feasibility of indirect laser steering via a macro-mini setup is proven. Therefore, such exploration demonstrates that the application of the deployable tubular mechanisms integrated with MAGS towards in vivo treatment is promising.

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Ditommaso, Giacomuzzi, Cipriani, Zaccaria, Cavallo, Boggio, Albera, and Zotti. "Using Microbiological Sampling to Evaluate the Efficacy of Nasofibroscope Disinfection: The Tristel Trio Wipes System in Ear–Nose–Throat (ENT) Endoscopy." International Journal of Environmental Research and Public Health 16, no. 22 (November 19, 2019): 4583. http://dx.doi.org/10.3390/ijerph16224583.

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Disinfection and sterilization are needed for guaranteeing that medical and surgical instruments do not spread contagious microorganisms to patients. The aim of this study was to evaluate the efficacy of a simple manual technique of high-level disinfection (HLD) of flexible fiberoptic nasofibroscopes (FFNs) with wipes impregnated with a chlorine dioxide solution (Tristel Trio Wipes System—TTW) against a conventional automated washer machine (Soluscope ENT, Cimrex 12—AW). FFNs used in 62 patients undergoing endoscopy at an ENT clinic were sampled according to an aseptic procedure. For each nasoendoscopy, microbiological samples were taken at two times: (1) after a patient’s nasoendoscopy and (2) immediately after high-level disinfection. Ten microliters of each prepared sample were inoculated onto specific culture media for the detection of nasopharyngeal flora microorganisms. The microbiological results obtained from 62 post-disinfection samples revealed bacterial growth on two FFNs disinfected with AW, and five FFNs disinfected with TTW, but this difference is not statistically significant. None of the isolates were pathogenic bacteria. Our results are different than the results obtained by two previously published studies on the TTW system. In both studies, sampling was carried out by swabbing the tip and the handle surface of FFNs. This sampling method was the least effective method means of detecting bacteria on a surface. It can be concluded that the two disinfection systems allow providers to obtain a reduction of the saprophytic and pathogenic microbial load.

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Bilal, Ökkeş, Mustafa Kınaş, Ahmet Güney, and Fatih Doğar. "Cruciate Ligament Repair with Nitinol Wire Synthetic Allograft." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0019. http://dx.doi.org/10.1177/2325967114s00198.

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Objectives: To present two cases who underwent cruciate ligament repair by nitinol wire synthetic allograft and to discuss outcomes. Methods: Although definitive incidence of anterior cruciate ligament injuries is unknown, it is estimated that annual 200.000 rupture occurs with 100.000 reconstructions in United States [1]. Therapeutic options include medical treatment, isolated or augmented anterior cruciate ligament repair and reconstruction with autograft, allograft and synthetic grafts. Debates on the treatment of such injury focus on selection of graft rather than need for surgery. Once anterior cruciate ligament reconstruction was decided, surgeon should have to select a graft. In general, an autograft is preferred. There are also allograft and synthetic grafts. Autograft have advantages of low risk for cross-inflammatory response and lack of risk for disease transmission. Nitinol is a material produced from nickel and titanium. It is more often used in vascular stents, orthodontic wires, implants used in mandible surgery and some orthopedic implants [2]. We presented 2 patients who underwent reconstruction with synthetic grafts produced from flexible nitinol wire. Results: Case 1: A 31-year old man presented to our clinic with pain at right knee. The patient underwent cruciate ligament surgery 10 years ago at another facility. His right knee was sprained again 12 months ago; thus, he was re-operated ad anterior cruciate reconstruction was performed in a facility. The patient had pain after surgery. On the physical examination, there was limitation in knee flexion by 100 degree and in knee extension by 10 degree at the right. It was seen that there was painful knee movements. It was found that there was tenderness at medial joint space and patellofemoral grind test was positive while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. The patient accepted removal of graft when he was informed. Thus, we removed flexible nitinol wire synthetic graft and interference screw. In the arthroscopic examination, it was seen that there was grade 4 cartilage defect in patellofemoral joint with occasional fracture in flexible nitinol wire synthetic graft. Endo-button was localized at suprapatellar pouch and removed via artrhroscopy. Micro-fracture procedure was performed for cartilage defect. The patient was scheduled for physical therapy after surgery. After 3 months, it was seen that complaints were resolved and he had almost full range of motion without instability signs. Case 2: A 23-year old man presented to our clinic with pain at right knee. He reported that his knee was injured during sports 9 months ago and he underwent anterior cruciate ligament reconstruction in another facility. However, he had persistent pain. On the physical examination, it was seen that there was full range of motion at knee but diffuse knee pain in hyperflexion. It was seen that medial McMurray test was positive and there was tenderness at medial joint space while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. Revision surgery was recommended but the patient didn’t attend control visit. Conclusion: Orthopedic surgeons tend to have appreciation against novel instruments; however, novel techniques should be adopted by meticulously considering outcomes without fascinating. It is clear that use of synthetic grafts without sufficient experimental and biomechanical in vivo and in vitro studies will result in some complications.

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Kamundi, Shadrack. "Student Retention in secondary schools of Seventh-day Adventist Church in East Kenya Union Conference." African Journal of Empirical Research 2, no. 2 (April 10, 2021): 1–12. http://dx.doi.org/10.51867/ajer.v2i2.19.

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The study assessed students’ retention in secondary schools of the SDA Church in EKUC. It employed a concurrent mixed methods research design and adopted an exploratory approach using a descriptive survey. The subjects of the study included students, principals, the Conferences/Field Education Directors and the Board of Management (BoM) chairpersons. Based on expectancy theory of motivation, the study adopted the concurrent mixed methods research design. The target population was the twenty Seventh-day Adventist Church maintained Secondary Schools in EKUC. The unit of analysis was eleven secondary school principals, five education directors and, eleven chairpersons of the school boards of management (BOM) and 335 students. Cluster sampling technique was used to get the samples. The target population was divided into five clusters (principals, students, education directors and, board chairpersons). Samples were obtained from each of these clusters. The instruments used for data collection were questionnaires for students. Interview schedules were organized for education directors, the school BoM chairpersons and the principals for triangulation. Observation schedule was also organized. This targeted the school infrastructure and generally all what goes on in the school. The school learning facilities and the behavior of teachers in school was also captured here. The other instrument used was the tool for document analysis to collect data for 8 years. Students (335) were required to fill the provided questionnaire, but the eleven principals, five education directions and eleven BoM chairpersons were subjected to interviews. Documentary analysis method was used to get information on KCSE performance for the same period of eight years. The data collected was analyzed using descriptive statistics such as frequencies, percentages, means and standard deviations. Documentary analysis was done on records about teacher retention. Content analysis was done on responses from interviews and in open-ended questions. The findings show that there were high numbers of students in Form 2 and 3 who dropped within the year and those who joined. Students were being replaced as they dropped out in some of the years. All in all, there were high annual turnover rates. This could affect the learning processes as well as students’ academic performance. The study recommends the need for schools to put in place strategies for ensuring that students learning facilities were available. Students should also be motivated to remain in school. Bursaries and sponsorships for students from poor backgrounds should be availed. Spiritual guidance, work programs and flexible fees payment mechanisms should also be instituted so as to support children from poor background to remain in school.

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