The practice of modern craniomaxillofacial surgery has been defined by emergent technologies allowing for the acquisition, storage, utilization, and transfer of massive amounts of sensitive and identifiable patient data. This alone has thrust providers into an unlikely and unprecedented role as the stewards of vast databases of digital information. This data powers the potent surgical tool of virtual surgical planning, a method by which craniomaxillofacial surgeons plan and simulate procedural outcomes in a digital environment. Further complicating (...) this new terrain is the involvement of third‐party contractors—a necessary presence in bringing raw data to bear in the office, virtual space, and operating room. The individual privileges and responsibilities of patients, providers, and vendors towards data are situated within the most recent U.S. court rulings and regulations. This paper offers guidance for overseeing the safe and responsible transfer to third‐party contractors, and provides suggestions for negotiating the trinary relationship between physicians, their patients, and the vendors offering this transformative technology. (shrink)

This paper considers the available documentation on the Virtual Colombo Plan, launched by the World Bank and the Australian Government in 2001. The Plan is one of the World Bank’s key projects for encouraging greater use of information and communications technologies in developing countries, with a focus on the using ICTs for education, as well as for economic benefits.

Successful innovative ‘leaps’ in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical (...) innovation especially resistant to classification as ‘research’, with all of the attendant methodological and ethical obligations—of planning, regulation, monitoring, reporting, and publication—associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical ‘research’, where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients. (shrink)

The National Health Service (NHS) in the UK is currently facing a significant waiting list backlog following the disruption of the COVID-19 pandemic, with millions of patients waiting for elective surgical procedures. Effective treatment prioritisation has been identified as a key element of addressing this backlog, with NHS England's delivery plan highlighting the importance of ensuring that those with ‘the clinically most urgent conditions are diagnosed and treated most rapidly’. Indeed, we describe how the current clinical guidance on prioritisation (...) issued by The Federation of Surgical Specialty Associations serves this aim. However, whilst there are strong reasons to prioritise elective surgery in accordance with clinical need, we argue that it would be a mistake to assume that prioritisation in accordance with clinical need requires only a clinical or scientific judgement. The understanding of clinical need that we choose to employ in a prioritisation system will be grounded by some key ethical judgements. Moreover, we may also have to make trade-offs between addressing clinical need, safeguarding equality, and achieving other benefits. As the UK faces up to the backlog, it is important that surgical prioritisation guidelines enshrine a broad range of values that we believe ought to determine access to care in non-emergency circumstances. Our analysis suggests that the current approach to prioritisation is not a sufficiently nuanced way of balancing the different moral values that are operative in this context. (shrink)

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from (...) relevant literature, and from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

Multiple studies have been performed to identify the most common ethical dilemmas encountered by ethics consultation services. However, limited data exists comparing the content of ethics consultations requested by specific hospital specialties. It remains unclear whether the scope of ethical dilemmas prompting an ethics consultation differ between specialties and if there are types of ethics consultations that are more or less frequently called based on the specialty initiating the ethics consult. This study retrospectively assessed the incidence and content of ethics (...) consultations called by surgical vs. non-surgical specialties between January 1, 2013 to December 31, 2018 using our RedCap Database and information collected through the EMR via our Clinical and Translational Science Center. 548 total ethics consultations were analyzed. Our results demonstrate that more surgical consults originated from the ICU, as opposed to lower acuity units, and surgical patients were more likely to have a DNR in place. Surgical specialties were more likely to call about issues relating to withholding/withdrawing life-sustaining treatment, while non-surgical specialties were more likely to call about issues related to discharge planning. There appear to be morally relevant differences between consults classified as the “same” that are not entirely captured by the usual ethics consultations classification system. In conclusion, this study highlights the unique ethical issues experienced by surgical vs. non-surgical specialties. Ultimately, our data can help ethics consultation services determine how best to educate various hospital specialties to approach ethical issues commonly experienced within their field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A New Look at Animal-to-Human Organ TransplantationCharles R. McCarthy (bio)The acute shortage of organs available for transplantation into human beings combined with a new scientific understanding of the immune systems of both humans and animals make it probable that animal-to-human solid organ transplants (xenografts) may soon be attempted at a frequency rate unknown in the past. 1 Optimism about successful animal-to-human organ transplantation is greater than at any previous (...) time. The creation of a reliable supply of animal organs appears to be technically feasible. At least five major transplant centers in the United States are currently considering plans to pursue xenotransplantation. Although, at the time of this writing, no federal guidelines prohibit animal-to-human organ transplantation, the institutions considering such programs are awaiting deliberations on the subject by the Institute of Medicine (IOM), the Food and Drug Administration (FDA), and the Department of Health and Human Services (DHHS).The demand for organs suitable for transplantation into human beings greatly exceeds the supply. According to the United Network for Organ Sharing (UNOS 1996a), approximately 44,000 patients in the United states awaited organ transplantation at the end of 1995. In 1994, more than 3,000 patients died while on the transplant waiting list, and the demand for transplantable organs increases annually (UNOS 1996b). The figures do not include the hundreds or perhaps thousands of patients who could profit from a transplant, but who do not meet the requirements of the UNOS waiting list. Even if efforts to persuade persons to donate organs are redoubled, and even if the consent to donate organs should become a legal presumption, there is little prospect of developing a sufficient supply of transplantable human organs to meet the growing demand.As technical and biological barriers to successful animal-to-human xenografts are lowered, the prospect of raising dedicated colonies of animals, genetically altered to reduce the chances that human hosts will reject organs derived from them, is being seriously discussed. 2 Such colonies do not exist at the present time. [End Page 183] However, if new techniques for animal-to-human transplantation prove successful, it is likely that animal colonies will be established to provide a ready and predictable supply of organs for transplantation to humans. Some believe that commercial investment in colonies of purpose-bred animals to serve as a source of transplantable organs is close at hand (Leventhal 1994).New drugs and new combinations of existing drugs have improved the chances of successful medical outcomes for patients who receive solid organ transplants. It is now recognized that serial application of immunosuppressive drugs can reduce the likelihood of both short- and long-term organ rejection (Makowka 1994). Improved understanding of both human and animal immune systems, insights into histocompatibility, new agents to control graft-versus-host disease, animal breeding programs for the production of transgenic animals, and improved surgical techniques have opened, as never before, the possibility of successful transfer of organs from animals to humans. Some rate the chances of good patient outcomes (usually measured in terms of time of patient survival) as high, others make more conservative predictions, but virtually all experts believe that the chances for successful human patient outcomes resulting from xenotransplantation are improved. Because many patients face immanent death unless their organs can be replaced, there can be little doubt that many humans will readily consent to xenotransplantation.History Suggests CautionDespite the advances in immunosuppression, the frequency of failure in past animal-to-human xenograft attempts should temper the optimism of the transplant community. To date, all efforts to prolong human life by implanting solid organs from animals into human recipients have failed. The first attempts at animal-to-human xenotransplantation early in the twentieth century resulted in the early death of all recipients (Neuhof 1923). More sophisticated efforts at xenotransplantation occurred in the late 1960s and early 1970s, a period when anti-rejection drugs began to make allografts more feasible. Although one human recipient of a xenograft survived for nine months (with poor quality of life), most patients died within a matter of minutes, hours, or a few days following the transplantation of organs from chimpanzees or baboons (Starzl... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Virtual GalleryJessica Evett-Miller (bio) Click for larger view View full resolutionImage 1. Click for larger view View full resolutionImage 2. Click for larger view View full resolutionImage 3. Click for larger view View full resolutionImage 4. Click for larger view View full resolutionImage 5. Click for larger view View full resolutionImage 6. Click for larger view View full resolutionImage 7. Click for larger view View full resolutionImage 8. (...) Click for larger view View full resolutionImage 9. Click for larger view View full resolutionImage 10. Click for larger view View full resolutionImage 11. Click for larger view View full resolutionImage 12. Click for larger view View full resolutionImage 13. Click for larger view View full resolutionImage 14. Click for larger view View full resolutionImage 15. Click for larger view View full resolutionImage 16.Jessica Evett-Miller Jessica Evett-Miller took these photographs during a trip to Italy and Sicily and assembled them for her senior project at the Alternative Community School in Ithaca’ New York. Now a freshman at Cornell University, she is planning to design an independent major in visual studies. She would like to dedicate thesephotographs toherfather, John Miller, and to thank him for his inspiration.She paired the front and back cover images (the first and the last) to create an interplay between the two. They function together rather than separately.Copyright © 1996 The Johns Hopkins University Press... (shrink)

This text intends to show a kind of aprproach and introduction to Deleuze's work. Based on the problem of the non-existence of consensus in the world of life, we feel the need to start thinking and formulating the concept of virtual multiplicity. Then we present a kind of guide to do so. The solution to the problem of plurality and difference is the concept of forms of life formulated and thought in acordance with Deleuze.O texto pretende mostrar um tipo (...) de abordagem e de entrada no texto deleuziano. A partir do problema do fato da não existência de consenso no mundo da vida sentiu-se a necessidade de começar a pensar e formular um conceito de formas de vida. Escolheu-se, para isto, a idéia de plano de imanência e o conceito de multiplicidade virtual de Deleuze. Apresentamos, então, uma espécie de roteiro desse percurso. É o conceito de formas de vida, articulado e pensado a partir de Deleuze, a resposta ao problema da pluralidade e da diferença. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extra Ear:Ear on the Arm BlenderStelarc Click for larger view View full resolutionFigure 1.Blender. Teknikunst—Meat Market, Melbourne 2005. Photograph: Stelarc. Collaborator Nina Sellars stands with the Blender during an installation photograph. Text credit: K. Conden and A. Douglas. Click for larger view View full resolutionFigure 2.Blender (3D Model). Teknikunst—Meat Market, Melbourne 2005. Image: Adam Fiannaca. The installation itself stands at just over 1.6 meters high and is anthropomorphic in (...) scale and structure. Text credit: K. Conden and A. Douglas. Click for larger view View full resolutionFigure 3.Blender. Teknikunst—Meat Market, Melbourne 2005. Photograph: Stelarc. Every few minutes the Blender automatically circulates or "blends" its contents via a system of compressed air pumps and a pneumatic actuator. Text credit: K. Conden and A. Douglas.[End Page 117] Click for larger view View full resolutionFigure 4.Ear Scaffold. Los Angeles, Melbourne 2006. Photographer: Nina Sellars. The preoperative scaffolding that was surgically placed below the skin's surface of performance artist Stelarc. Text credit: R. Ferro. Click for larger view View full resolutionFigure 5.Blender (Biomaterial). Teknikunst—Meat Market, Melbourne 2005. Photograph: Cameron Jones. Both artists, Stelarc and Nina Sellars, undertook liposuction operations specifically for the purpose of this new work and have succeeded in securing the sanitized isolation and, most importantly, the legal ownership of the remnants of the procedures. Text credit: K. Conden and A. Douglas. Click for larger view View full resolutionFigure 6.Hole Hooks Forceps. As a guest at Cornell University's conference "Digital Bodies" in 2001, Stelarc spoke of his desire to implant an ear that could pick up sound. His plans become a reality in the photograph taken during surgery. Text credit: R. Ferro. Click for larger view View full resolutionFigure 7.Extra Ear: Ear on the Arm. Los Angeles, Melbourne 2006. Photographer: Nina Sellars. Stelarc's future plans are to implant Bluetooth technology into the Ear on the Arm in a subsequent surgery so that the ear will pick up sound which will be transmitted via the Internet. Text credit: R. Ferro. Click for larger view View full resolutionFigure 8.Blender (Sterile Hood). Teknikunst—Meat Market, Melbourne 2005. Photograph: Stelarc. The biomaterials are now housed within the Blender's industrial casing, on exhibition at the Meat Market Gallery B in North Melbourne until August 18. Text credit: K. Conden and A. Douglas.[End Page 118]Stelarc- Biographical NotesStelarc is an Australian artist who has performed extensively in Japan, Europe, and the USA—including new music, dance festivals, and experimental theater. He has used medical instruments, prosthetics, robotics, Virtual Reality systems, and the Internet to explore alternate, intimate, and involuntary interfaces with the body. He has performed with a THIRD HAND, a VIRTUAL ARM, a VIRTUAL BODY and a STOMACH SCULPTURE. He has acoustically and visually probed the body—having amplified brainwaves, blood-flow and muscle signals and filmed the inside of his lungs, stomach, and colon, approximately two meters of internal space. He has done twenty-five body SUSPENSIONS with insertions into the skin, in different positions and varying situations in private gallery spaces and in remote locations.For FRACTAL FLESH, as part of Telepolis in 1995, he developed a touch-screen interfaced Muscle Stimulation System, enabling remote access, actuation, and choreography of the body. Performances such as PING BODY and PARASITE (1996, 1997) probe notions of telematic scaling and the engineering of external, extended, and virtual nervous systems for the body using the Internet. In 1998 for Kampnagel, he completed EXOSKELETON—a pneumatically powered six-legged walking machine actuated by arm gestures. During 2000, he completed an EXTENDED ARM—a manipulator with eleven degrees-of-freedom that extends his arm to primate proportions and a MOTION PROSTHESIS—an intelligent, compliant servo-mechanism that enables the performance of precise, repetitive, and accelerated prompting or programming of the arms in real time. In 2002, with the collaboration of the Evolutionary and Adaptive Systems Group, COGs, University of Sussex, and TNTU, the HEXAPOD robot prototype was developed. The six-legged MUSCLE MACHINE was constructed with the assistance of The Nottingham Trent University Engineering team, using fluidic rubber muscle actuators. The PROSTHETIC... (shrink)

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four (...) main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture. (shrink)

Many researchers are currently showing interest in researching consumers who are purchasing the products with the help of new tools, and new kinds of markets are emerging rapidly. M-commerce is a prevalent mode of marketing and is famous among young people of Pakistan. Current research is planned to check the status of consumer purchase intentions (PIs) using perceived influence, virtual interactivity, brand image, and brand expected value among customers who purchase their products with the help of m-commerce. Data was (...) collected from customers who were engaged in buying with the help of m-commerce by using the convenience sampling technique and 227 complete questionnaires were used in final analysis. This research examines the direct impact of perceived influence, virtual interactivity, brand image, and brand expected value on PIs and finds the indirect effect of brand image and brand expected value on the relationships of perceived influence and virtual interactivity with PIs. Results indicate that all the hypotheses of direct relationships are accepted except the hypothesis for the relation of virtual interactivity with consumer PIs. Virtual interactivity has an insignificant positive impact on consumer PIs. Brand expected value has a strong positive effect on consumer PIs among all. The current study proposed four mediational hypotheses. All the proposed mediational hypotheses are accepted. (shrink)

Individuals vary in the way they navigate through space. Some take novel shortcuts, while others rely on known routes to find their way around. We wondered how and why there is so much variation in the population. To address this, we first compared the trajectories of 368 human subjects navigating a virtual maze with simulated trajectories. The simulated trajectories were generated by strategy-based path planning algorithms from robotics. Based on the similarities between human trajectories and different strategy-based simulated (...) trajectories, we found that there is a variation in the type of strategy individuals apply to navigate space, as well as variation within individuals on a trial-by-trial basis. Moreover, we observed variation within a trial when subjects occasionally switched the navigation strategies halfway through a trajectory. In these cases, subjects started with a route strategy, in which they followed a familiar path, and then switched to a survey strategy, in which they took shortcuts by considering the layout of the environment. Then we simulated a second set of trajectories using five different but comparable artificial maps. These trajectories produced the similar pattern of strategy variation within and between trials. Furthermore, we varied the relative cost, that is, the assumed mental effort or required timesteps to choose a learned route over alternative paths. When the learned route was relatively costly, the simulated agents tended to take shortcuts. Conversely, when the learned route was less costly, the simulated agents showed preference toward a route strategy. We suggest that cost or assumed mental effort may be the reason why in previous studies, subjects used survey knowledge when instructed to take the shortest path. We suggest that this variation we observe in humans may be beneficial for robotic swarms or collections of autonomous agents during information gathering. (shrink)

Individuals vary in the way they navigate through space. Some take novel shortcuts, while others rely on known routes to find their way around. We wondered how and why there is so much variation in the population. To address this, we first compared the trajectories of 368 human subjects navigating a virtual maze with simulated trajectories. The simulated trajectories were generated by strategy-based path planning algorithms from robotics. Based on the similarities between human trajectories and different strategy-based simulated (...) trajectories, we found that there is a variation in the type of strategy individuals apply to navigate space, as well as variation within individuals on a trial-by-trial basis. Moreover, we observed variation within a trial when subjects occasionally switched the navigation strategies halfway through a trajectory. In these cases, subjects started with a route strategy, in which they followed a familiar path, and then switched to a survey strategy, in which they took shortcuts by considering the layout of the environment. Then we simulated a second set of trajectories using five different but comparable artificial maps. These trajectories produced the similar pattern of strategy variation within and between trials. Furthermore, we varied the relative cost, that is, the assumed mental effort or required timesteps to choose a learned route over alternative paths. When the learned route was relatively costly, the simulated agents tended to take shortcuts. Conversely, when the learned route was less costly, the simulated agents showed preference toward a route strategy. We suggest that cost or assumed mental effort may be the reason why in previous studies, subjects used survey knowledge when instructed to take the shortest path. We suggest that this variation we observe in humans may be beneficial for robotic swarms or collections of autonomous agents during information gathering. (shrink)

The main aims of the project are twofold: the first one is to get insight into scope, structure, everyday life, opinions and plans of our people who live abroad as the fourth and fifth generations of emigrants, specially those who left the country during 90s. The second is checking and recording their preparedness for "return" to mother-country through complex set of activities and arrangements: return, capital investments, know-how and skills investments, preservation and strengthening cultural identity of our people abroad and (...) development their links with the ethnic/cultural background and inheritance. Glavni ciljevi realizacije ove teme su dvojaki. Prvi cilj je sticanje uvida u obim, strukturu, karakteristike svakodnevnog zivota, stavove i planove nasih ljudi koji zive u inostranstvu kao pripadnici cetvrte i pete generacije emigranata. Drugi cilj je utvrdjivanje njihove spremnosti za povratak u zemlju maticu, kroz slozen sindrom fizickog povratka ili "virtuelnog" povratka, kroz kapitalne investicije, investiranje stecenog "intelektualnog kapitala" u drustveni razvoj zemlje, ali i osnazenja drustvenog i kulturnog identiteta nasih ljudi u rasejanju i jacanja njihovih veza sa etnokulturnim zaledjem i nasledjem. (shrink)

This study aims to describe the learning motivation of students using virtual media when they are learning mathematics in grade 5. The research design applied in this research is classroom action research. The research is conducted in two phases which involve planning, action and observation and reflection. The results of the study revealed that intrinsic motivation to learn is most prevalent in the form of fun to learn mathematics with virtual media. Other forms of intrinsic motivation include (...) curiosity, need and interests, and satisfaction. Extrinsic motivation in the form of awarded and clarity of learning objectives. The most enjoyable learning experience for students was when they feel like they're learning more than they actually are. This level of enthusiasm increases with the level of learning complexity. The students are more active and motivated to learn. This can be evidenced by the increase in motivation to learn after the first phase. Unfortunately, the lack of bandwidth and time allocated for conducting experiments are some of the obstacles in the way of learning through virtual media. This study revealed that the use of virtual media could improve student's motivation for learning. (shrink)

Major events such as the COVID-19 pandemic, Olympic Games, and G20 Summit bring about supplier disruption risks and challenges to supply chain management. To help deal with these risks, a virtual dual-sourcing production-inventory system can be deployed. In this paper, we study such a system which consists of a raw material supplier, a manufacturer, and a virtual dual-sourcing contingency supplier. The manufacturer needs to determine the production, procurement, and inventory plan of raw materials. When its supplier is interrupted, (...) the manufacturer may need to adjust the production and inventory plan and work with the contingency supplier. We develop a system dynamics method to simulate the operations in this production-inventory system to identify the approximately optimal order-up-to-level inventory policies. We find that the virtual dual production-inventory strategy can be the optimal contingency policy to deal with supplier dynamic disruption risks. Furthermore, for disruption risk with low frequency and long duration, the manufacturer should increase the safety inventory level before the disruption. Otherwise, it should increase the safety inventory level in every cycle. (shrink)

Human contact is a key issue in social interactions for autonomous systems since robots are increasingly appearing everywhere, which has led to a higher risk of conflict. Particularly in the real world, collisions between humans and machines may result in catastrophic accidents or damaged goods. In this paper, a novel stop strategy related to autonomous systems is proposed. This control method can eliminate the vibrations produced by a system’s movement by analysing the poles and zeros in the model of autonomous (...) vehicles and goods. Using the pole placement technique, the motion of a system is guaranteed to be more stable, more flexible and smoother. Moreover, several control profiles are employed in the switching mechanism to choose the proper vibration-free effect. The main contributions of this paper are the recommendation of an active stopping planner using different smooth generators from a modelling study, the validation of their physical characteristics and the launching of a switching algorithm based on the socially aware navigation framework of a robot. This theoretical work is based on the virtual environment of MATLAB, and the experiment is implemented in the practical platform of an automated guided vehicle. From these results, it can be seen that the proposed approach is robust, effective and feasible for applications in storehouse management, public transportation or factory manufacturing. (shrink)

This paper focuses on invasive therapeutic procedures, defined as procedures requiring the introduction of hands, instruments, or devices into the body via incisions or punctures of the skin or mucous membranes performed with the intent of changing the natural history of a human disease or condition for the better. Ethical and methodological concerns have been expressed about studies designed to evaluate the effects of invasive therapeutic procedures. Can such studies meet the same standards demanded of those, for example, evaluating pharmaceutical (...) agents? This paper describes a research project aimed at examining the interplay and sometimes apparent conflict between ethical standards for human research and standards for methodological rigor in trials of invasive procedures. The paper discusses how the authors plan to develop a set of consensus standards that, if met, would result in substantial and much-needed improvements in the methodological and ethical quality of such trials. (shrink)

Environmental landscaping is known to build, plan, and manage landscapes that consider the ecology of a site and produce gardens that benefit both people and the rest of the ecosystem. Landscaping and the environment are combined in landscape design planning to provide holistic answers to complex issues. Seeding native species and eradicating alien species are just a few ways humans influence the region’s ecosystem. Landscape architecture is the design of landscapes, urban areas, or gardens and their modification. It comprises (...) the construction of urban and rural landscapes via coordinating the creation and management of open spaces and economics, finding a job, and working within a confined project budget. There was a lot of discussion about global warming and water shortages. There is a lot of hope to be found even in the face of seemingly insurmountable obstacles. AI is becoming more significant in many urban landscape planning and design elements with the advent of web 4.0 and Human-Centred computing. It created a virtual reality-based landscape to create deep neural networks (DNNs) to make deep learning (DL) more user-friendly and efficient. Users may only manipulate physical items in this environment to manually construct neural networks. These setups are automatically converted into a model, and the real-time testing set is reported and aware of the DNN models that users are producing. This research presents a novel strategy for combining DL-DNN with landscape architecture, providing a long-term solution to the problem of environmental pollution. Carbon dioxide levels are constantly checked when green plants are in and around the house. Plants, on either hand, remove toxins from the air, making it easier to maintain a healthy environment. Human-centered Artificial Intelligence-based web 4.0 may be used to assess and evaluate the data model. The study findings can be sent back into the design process for further modification and optimization. (shrink)

Collision-free autonomous path planning under a dynamic and uncertainty vineyard environment is the most important issue which needs to be resolved firstly in the process of improving robotic harvesting manipulator intelligence. We present and apply energy optimal and artificial potential field to develop a path planning method for six degree of freedom serial harvesting robot under dynamic uncertain environment. Firstly, the kinematical model of Six-DOF serial manipulator was constructed by using the Denavit-Hartenberg method. The model of obstacles was (...) defined by axis-aligned bounding box, and then the configuration space of harvesting robot was described by combining the obstacles and arm space of robot. Secondly, the harvesting sequence in path planning was computed by energy optimal method, and the anticollision path points were automatically generated based on the artificial potential field and sampling searching method. Finally, to verify and test the proposed path planning algorithm, a virtual test system based on virtual reality was developed. After obtaining the space coordinates of grape picking point and anticollision bounding volume, the path points were drew out by the proposed method. 10 times picking tests for grape anticollision path planning were implemented on the developed simulation system, and the success rate was up to 90%. The results showed that the proposed path planning method can be used to the harvesting robot. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Consenting for Novel and Dangerous Surgical Procedures with Minimal Supporting EvidenceMichelle J. ClarkeFrank1 was a 19–year–old man referred to me after a workup for back pain led to the discovery of a large, aggressive tumor in his sacrum. The tumor wrapped around the nerves controlling bowel, bladder, and leg function. We performed a needle biopsy and learned that the tumor was an angiosarcoma, an extremely aggressive and usually (...) deadly form of cancer. However, the tumor was unique in that it theoretically could be cured if removed in one piece. But, to do so would necessitate sacrificing the nerves, leaving the patient irreversibly incontinent, lacking sexual function, and confined to a wheelchair.Once we knew the diagnosis, Frank came to the office with his family to discuss treatment options. He appeared terrified and was almost silent through the appointment, deferring most questions to his parents. Due to the speed of tumor growth, we discussed palliative therapy, conventional treatment, and the one–piece or “en bloc” surgery, which was new and unproven for his disease. Based on the remarkable tumor growth we noted during the work–up, with palliative treatment the patient would likely survive for less than six months. Conventional treatment, in which surgery is done to remove part of the tumor while sparing the nerves to bowel and bladder function, was known to have a high rate of recurrence and death. Further, this tumor didn’t respond well to radiation and chemotherapy, so chance of survival was limited, although his life might have been extended for a short period. Thus our conversation turned to the novel “en bloc” procedure.The en bloc procedure offered a hope of long–term survival unlike the other options. However, this came with an enormous cost. The surgery itself would be planned to occur over three days with five separate surgical teams and a very real chance of major complications or death. Nerves to bowel and bladder would be cut, irreversibly leaving the patient without sexual function, and completely incontinent with a urinary catheter and colostomy. Walking was expected to be disrupted or potentially impossible due to the nerve resection. We went to great lengths over the course of many visits to describe the impact of the surgery on the patient’s function, and the impact on his quality of life. To make matters more challenging, as this procedure was so new and the tumor so rare, research did not yet exist to quantify his likelihood of long–term survival.Personally I was very uncomfortable with the situation. From a medical standpoint, the surgery offered was the best distillation of research and professional experience. En bloc surgery offered the best—if not the only—chance for survival in [End Page 5] this young man. Additionally, having treated many spine–injured patients I was aware that many patients with similar deficits led happy and productive lives following an emotional and physical adjustment period. However the surgery was also extreme. I worried that we would not be able to accomplish the goal of a one–piece resection and would accidentally spill some of the tumor, creating all of the deficits but no survival benefit. Frankly, I thought there was a 25% chance that would happen, which was explained to the family preoperatively. Were we overreaching our abilities and making a dying patient’s life worse by proceeding?Second, I was uneasy about the social situation. The patient’s family was very supportive, traveling with him to all appointments and assisting with his care. The patient himself usually deferred all scheduling to his mother, which wasn’t entirely unusual for such a young man. However it was difficult to grasp how much the patient understood of his disease or supported the plan. We attempted to delve more deeply into his thoughts, including without his parents present, but got only short answers, which revealed little. While the family appeared to have accepted the diagnosis and wanted to get to the business of treatment, the patient seemed to me to still carry the shock of his recent cancer diagnosis. Pushed by the rapid tumor growth, we were limited in how long we could wait for... (shrink)

In January 2016, a long-delayed Medicare change took effect. The Medicare program will now reimburse doctors for time they spend talking with patients about end-of-life care. This is the move that Sarah Palin and other Affordable Care Act critics said would authorize government “death panels” to decide whether older Americans should live or die. Today virtually no one buys into Palin's death panel rhetoric. But many people do think the Medicare change is a big deal. Representative Earl Blumenauer, a Democrat (...) from Oregon who sponsored the original ACA reimbursement proposal, lauded the Medicare provision as “a turning point in end-of-life care.” Others are not so sure about that. After all, laws promoting advance care planning have existed for decades. The federal Patient Self-Determination Act of 1990 and the many court decisions and state laws supporting advance care planning have had relatively little impact. Similarly, legal recognition of physician orders for life-sustaining treatment as advance planning instruments have not produced the improvements that were predicted. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients. (shrink)

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through (...) our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without ‘clear and convincing evidence’ of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail t... (shrink)

This paper addresses the problem of human–computer interactions when the computer can interpret and express a kind of human-like behavior, offering natural communication. A conceptual framework for incorporating emotions with rationality is proposed. A model of affective social interactions is described. The model utilizes the SAIBA framework, which distinguishes among several stages of processing of information. The SAIBA framework is extended, and a model is realized in human behavior detection, human behavior interpretation, intention planning, attention tracking behavior planning, (...) and behavior realization components. Two models of incorporating emotions with rationality into a virtual artifact are presented. The first one uses an implicit implementation of emotions. The second one has an explicit realization of a three-layered model of emotions, which is highly interconnected with other components of the system. Details of the model with implicit implementation of emotional behavior are shown as well as evaluation methodology and results. Discussions about the extended model of an agent are given in the final part of the paper. (shrink)

Social judgment is a social inference process whereby an agent singles out individuals to blame or credit for multi-agent activities. Such inferences are a key aspect of social intelligence that underlie social planning, social learning, natural language pragmatics and computational models of emotion. With the advance of multi-agent interactive systems and the need of designing socially aware systems and interfaces to interact with people, it is increasingly important to model this human-centric form of social inference. Based on psychological attribution (...) theory, this paper presents a general computational framework to automate social inference based on an agent’s causal knowledge and observations of interaction. (shrink)

Artificial intelligence (AI)-based virtual influencers are now frequently used by brands in various categories to engage customers. However, little is known about who the followers of these AI-based virtual influencers are and more importantly, what drives the followers to use AI-based virtual influencers. The results from a survey support the notion that compensatory mechanisms and the need to belong play important roles in affecting usage intentions of AI-based virtual influencers. Specifically, the study finds that usage intentions (...) are mediated and moderated by compensatory mechanisms that arise from the perception of AI-based virtual influencers’ functional benefits and existential threats to human identity. Furthermore, the need for belonging moderates the effects of the following status (following versus non-following) on perceived personalization benefits of AI-based virtual influencers and behavioral intentions to use AI-based virtual influencers. This study provides important implications for academia delving into the social, cultural, and philosophical implications of AI-based virtual influencers for human societies as well as for brands that plan to use AI-based virtual influencers and gain a better understanding of their customers in AI-driven digital marketing. (shrink)

Purpose:Human navigation skills are essential for everyday life and rely on several cognitive abilities, among which visual-spatial competences that are impaired in subjects with cerebral palsy. In this work, we proposed navigation tasks in immersive virtual reality to 15 children with CP and 13 typically developing peers in order to assess the individual navigation strategies and their modifiability in a situation resembling real life.Methods:We developed and adapted to IVR an application based on a 5-way maze in a playground that (...) was to be navigated to find a reward. The learning process, navigation strategies, and adaptation to changes were compared between participants with CP and their TD peers and correlated with visual-spatial abilities and cognitive competences.Results:Most participants with CP needed more attempts than TD participants to become proficient in navigation. Furthermore, the learning phase was correlated to visual-spatial memory but not with cognitive competences. Interestingly, navigation skills were comparable between groups after stabilization. While TD participants mainly relied on allocentric strategies based on environmental cues, egocentric strategies based on body motion prevailed in participants with CP. Furthermore, participants with CP had more difficulties in modifying their navigation strategies, caused by difficulties in executive processes beyond the visual-perceptual impairment, with an inefficient shift between implicit and explicit competences.Conclusions:The navigation abilities in participants with CP seem to be different from their TD peers in terms of learning and adaptation to new conditions; this could deeply affect their everyday life and ultimately participation and inclusion. A regular assessing and focused rehabilitative plans could help to better navigate the environment and affect self-perception. (shrink)

The article examines the impact of the virtual public sphere on how urban spaces are experienced and conceived in our data-driven society. It places particular emphasis on urban scale digital twins, which are virtual replicas of cities that are used to simulate environments and develop scenarios in response to policy problems. The article also investigates the shift from the technical to the socio-technical perspective within the field of smart cities. Despite the aspirations of urban scale digital twins to (...) enhance the participation of citizens in the decision-making processes relayed to urban planning strategies, the fact that they are based on a limited set of variables and processes makes them problematic. The article aims to shed light on the tension between the real and the ideal at stake during this process of abstracting sets of variables and processes in the case of urban scale digital twins. (shrink)

Esports, including virtual football, are a worldwide phenomenon. Yet, little is known about the physical activity levels of individuals engaged in virtual football game play. Therefore, we aimed to perform a preliminary evaluation of the levels of physical activity, sedentarism, and habits of physical training of adults engaged with virtual football in Portugal. This was a cross-sectional investigation based on a structured online survey using the International Physical Activity Questionnaire and a set of questions regarding habits of (...) physical training. The participants reported spending a median of 5,625 MET-min⋅week−1 being physically active. Still, the participants spent 320 min/day sitting, and 150 min/day practicing virtual football. According to the IPAQ scores, high physical activity levels were reported by 84.5% of the participants, and 87.1% were considered physically active considering the WHO guidelines on physical activity and sedentary behavior. Overall, 60.0% of the participants reported planning their own physical training. Maintaining or improving overall physical health was one of the main reasons for doing physical training, with only 6.1% responding being active to improve virtual football performance. Overall, the results showed that virtual football players accomplished the standard recommendations for physical activity, with high levels of physical activity, and encompassing regular physical training focused mostly on health promotion, rather than improved virtual football performance. (shrink)

Background Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse’s involvement in the passive euthanasia decision-making process is insufficient and lower than expected. Objectives To explore factors associated with nurses’ intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework. Design A cross-sectional study utilizing a random sample. Participants and research context The study was conducted (...) in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019. Method A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline. Ethical considerations The study was approved by the hospital’s Helsinki Committee (#20.11.2017). Findings A paired sample t test revealed that nurses’ involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses’ position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses’ intention to be involved in the care of patients requesting euthanasia. Conclusions According to the TPB, nurses’ attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses’ willingness to participate in NTD decision-making regarding euthanasia. (shrink)

In this paper, we set out a basic approach to the modeling of narrative in interactive virtual worlds. This approach adopts a bipartite model taken from narrative theory, in which narrative is composed ofstoryanddiscourse. In our approach, story elements — plot and character — are defined in terms of plans that drive the dynamics of a virtual environment. Discourse elements — the narrative’s communicative actions — are defined in terms of discourse plans whose communicative goals include conveying the (...) story world plan’s structure. To ground the model in computational terms, we provide examples from research under way in the Liquid Narrative Group involving the design of the Mimesis system, an architecture for intelligent interactive narrative incorporating concepts from artificial intelligence, narrative theory, cognitive psychology and computational linguistics. (shrink)

In this paper, we set out a basic approach to the modeling of narrative in interactive virtual worlds. This approach adopts a bipartite model taken from narrative theory, in which narrative is composed ofstoryanddiscourse. In our approach, story elements — plot and character — are defined in terms of plans that drive the dynamics of a virtual environment. Discourse elements — the narrative’s communicative actions — are defined in terms of discourse plans whose communicative goals include conveying the (...) story world plan’s structure. To ground the model in computational terms, we provide examples from research under way in the Liquid Narrative Group involving the design of the Mimesis system, an architecture for intelligent interactive narrative incorporating concepts from artificial intelligence, narrative theory, cognitive psychology and computational linguistics. (shrink)

This study explored the effect of kinesthetic motor imagery training on reaching-to-grasp movement supplemented by a virtual environment in a patient with congenital bilateral transverse upper-limb deficiency. Based on a theoretical assumption, it is possible to conduct such training in this patient. The aim of this study was to evaluate whether cortical activity related to motor imagery of reaching and motor imagery of grasping of the right upper limb was changed by computer-aided imagery training in a patient who was (...) born without upper limbs compared to a healthy control subject, as characterized by multi-channel electroencephalography signals recorded before and 4, 8, and 12 weeks after CAIT. The main task during CAIT was to kinesthetically imagine the execution of reaching-to-grasp movements without any muscle activation, supplemented by computer visualization of movements provided by a special headset. Our experiment showed that CAIT can be conducted in the patient with higher vividness of imagery for reaching than grasping tasks. Our results confirm that CAIT can change brain activation patterns in areas related to motor planning and the execution of reaching and grasping movements, and that the effect was more pronounced in the patient than in the healthy control subject. The results show that CAIT has a different effect on the cortical activity related to the motor imagery of a reaching task than on the cortical activity related to the motor imagery of a grasping task. The change observed in the activation patterns could indicate CAIT-induced neuroplasticity, which could potentially be useful in rehabilitation or brain-computer interface purposes for such patients, especially before and after transplantation. This study was part of a registered experiment. (shrink)

This book presents a lively and accessible way to use the ancient figure of Socrates to teach modern psychology that avoids the didactic lecture and sterile textbook. In the online age, is a living teacher even needed? What can college students learn face-to-face from a teacher they cannot learn anywhere else? The answer is what most teachers already seek to do: help students think critically, clearly define concepts, logically reason from premises to conclusions, engage in thoughtful and persuasive communication, and (...) actively engage the franchise of democratic citizenship. But achieving these outcomes requires an intimate, interpersonal learning community. This book presents a plan for using the ancient figure of Socrates and his Method to realize humane learning outcomes in the context of psychology. (shrink)

Conversation is a time-pressured environment. Recognizing a social action (the ‘‘speech act,’’ such as a question requesting information) early is crucial in conversation to quickly understand the intended message and plan a timely response. Fast turns between interlocutors are especially relevant for responses to questions since a long gap may be meaningful by itself. Human language is multimodal, involving speech as well as visual signals from the body, including the face. But little is known about how conversational facial signals contribute (...) to the communication of social actions. Some of the most prominent facial signals in conversation are eyebrow movements. Previous studies found links between eyebrow movements and questions, suggesting that these facial signals could contribute to the rapid recognition of questions. Therefore, we aimed to investigate whether early eyebrow movements (eyebrow frown or raise vs. no eyebrow movement) facilitate question identification. Participants were instructed to view videos of avatars where the presence of eyebrow movements accompanying questions was manipulated. Their task was to indicate whether the utterance was a question or a statement as accurately and quickly as possible. Data were collected using the online testing platform Gorilla. Results showed higher accuracies and faster response times for questions with eyebrow frowns, suggesting a facilitative role of eyebrow frowns for question identification. This means that facial signals can critically contribute to the communication of social actions in conversation by signaling social action-specific visual information and providing visual cues to speakers’ intentions. (shrink)

Se analiza el debate actual sobre el concepto de Escuela de Salamanca. Se muestran las nuevas propuestas de los estudiosos: su carácter global (no solo Salamanca); su alcance interdisciplinar (no solo teológico, también jurídico, económico, sociopolítico, etc); la cuestión de los miembros también experimenta una ampliación, aunque siempre se señala un cierto cordón umbilical con los Maestros salmantinos; todo ello dentro de un marco temporal que se extiende durante el siglo XVI y primera mitad del XVII. Estas nuevas perspectivas no (...) excluyen los elementos tradicionales, sino que amplían y desarrollan el concepto primitivo, pero con carácter inclusivo. Por último, se aborda el tema de las condiciones de posibilidad de la Escuela, que se contextualiza en un ámbito histórico que la hace posible. Al término del estudio se ofrece un posible nuevo concepto de la Escuela, todavía _in fieri_. (shrink)

La psiquiatría nace con el siglo XIX, la fenomenología con el XX. Desde el advenimiento de la segunda ha querido la primera ver en ella una vía para la superación del positivismo que la atenazaba desde su mismo origen. Uno de sus intentos más logrados fue el del psiquiatra Ludwig Binswanger a lo largo de los años veinte del pasado siglo. Recorrió en ese tiempo las Investigaciones lógicas de Husserl y ensayó su acercamiento a la psicología estructural. Proponemos que una (...) deficiente lectura de las posibilidades de la fenomenología ―comprensible en su prematuridad, desgraciada en su ímpetu anti-(neo)kantiano― impidió que reconociera su horizonte trascendental y así pudiera entrever caminos de acceso al mundo, a la persona y a su concreto sufrimiento. Para concluir presentamos el intento que supone el proyecto La mirada filosófica como mirada médica por recuperar aquella problematicidad y ahondar en una aproximación respetuosa al padecer, tal como aparece, sin violentarlo por el concepto. (shrink)

Colour information not only helps sustain the survival of animal species by guiding sexual selection and foraging behaviour but also is an important factor in the cultural and technological development of our own species. This is illustrated by examples from the visual arts and from state-of-the-art imaging technology, where the strategic use of colour has become a powerful tool for guiding the planning and execution of interventional procedures. The functional role of colour information in terms of its potential benefits (...) to behavioural success across the species is addressed in the introduction here to clarify why colour perception may have evolved to generate behavioural success. It is argued that evolutionary and environmental pressures influence not only colour trait production in the different species but also their ability to process and exploit colour information for goal-specific purposes. We then leap straight to the human primate with insight from current research on the facilitating role of colour cues on performance training with precision technology for image-guided surgical planning and intervention. It is shown that local colour cues in two-dimensional images generated by a surgical fisheye camera help individuals become more precise rapidly across a limited number of trial sets in simulator training for specific manual gestures with a tool. This facilitating effect of a local colour cue on performance evolution in a video-controlled simulator (pick-and-place) task can be explained in terms of colour-based figure-ground segregation facilitating attention to local image parts when more than two layers of subjective surface depth are present, as in all natural and surgical images. (shrink)

There is a growing demand for information and computational technology for surgeons help with surgical planning as well as prosthetics design. The two-dimensional images are registered to the three-dimensional (3D) model for high efficiency. To reconstruct the 3D model of knee joint including bone structure and main soft tissue structure, the evaluation and analysis of sports injury and rehabilitation treatment are detailed in this study. Mimics 10.0 was used to reconstruct the bone structure, ligament, and meniscus according to (...) the pulse diffusion-weighted imaging sequence (PDWI) and stir sequences of magnetic resonance imaging (MRI). Excluding congenital malformations and diseases of the skeletal muscle system, MRI scanning was performed on bilateral knee joints. Proton weighted sequence (PDWI sequence) and stir pulse sequence were selected for MRI. The models were imported into Geomagic Studio 11 software for refinement and modification, and 3D registration of bone structure and main soft tissue structure was performed to construct a digital model of knee joint bone structure and accessory cartilage and ligament structure. The 3D knee joint model including bone, meniscus, and collateral ligament was established. Reconstruction and image registration based on mimics and Geomagic Studio can build a 3D model of knee joint with satisfactory morphology, which can meet the requirements of teaching, motion simulation, and biomechanical analysis. (shrink)