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  1. Article ; Online: Open fractures of the upper limb - do the BOAST guidelines need an update?

    Lancaster, Patrick / Eves, Timothy / Tennent, Duncan / Trompeter, Alex

    Injury

    2023  

    Abstract: Aims: This scoping review aims to explore the published literature on the current management strategies and outcomes of open upper limb injuries using the BOAST 4 guidelines as a structure.: Materials and methods: A comprehensive search of the ... ...

    Abstract Aims: This scoping review aims to explore the published literature on the current management strategies and outcomes of open upper limb injuries using the BOAST 4 guidelines as a structure.
    Materials and methods: A comprehensive search of the MEDLINE, EMBASE, Cochrane and OrthoSearch computerised literature databases (from January 2012 through April 2022) was performed. The medical subject headings used were "open fracture"/ "Gustilo Anderson" and "forearm" or "radius" or "ulna" or "elbow" or "humerus" or "clavicle" or "shoulder" or "scapula". Abstract titles were reviewed for relevance. If the article was deemed eligible, the article was retrieved and reviewed in full.
    Results: The literature reveals lower rates of infection for upper limb injuries compared to their lower limb counterparts. Early antibiotic administration remains a key component of their management. Those without significant soft tissue injury (Gustilo Anderson 1) can often be treated as per their closed counterparts and timing to definitive fixation can be safely delayed in selected cases.
    Discussion: There is limited high quality evidence available on the management of open upper limb injuries with guidelines built on borrowed principles from the more studied open tibia fractures. What the available evidence does show is that with lower infection rates and a more forgiving soft tissue envelope it may be safe to diverge from the current BOAST guidelines in certain cases. This has relevance in complex fracture patterns requiring specialist input where it is not possible to achieve definitive fixation in 72 h and when there are other life threatening injuries to manage. Despite this early antibiotic administration and debridement within 24 h remains a key component of the early management.
    Language English
    Publishing date 2023-04-15
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2023.04.029
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  2. Book ; Online: MoDem-V2

    Lancaster, Patrick / Hansen, Nicklas / Rajeswaran, Aravind / Kumar, Vikash

    Visuo-Motor World Models for Real-World Robot Manipulation

    2023  

    Abstract: Robotic systems that aspire to operate in uninstrumented real-world environments must perceive the world directly via onboard sensing. Vision-based learning systems aim to eliminate the need for environment instrumentation by building an implicit ... ...

    Abstract Robotic systems that aspire to operate in uninstrumented real-world environments must perceive the world directly via onboard sensing. Vision-based learning systems aim to eliminate the need for environment instrumentation by building an implicit understanding of the world based on raw pixels, but navigating the contact-rich high-dimensional search space from solely sparse visual reward signals significantly exacerbates the challenge of exploration. The applicability of such systems is thus typically restricted to simulated or heavily engineered environments since agent exploration in the real-world without the guidance of explicit state estimation and dense rewards can lead to unsafe behavior and safety faults that are catastrophic. In this study, we isolate the root causes behind these limitations to develop a system, called MoDem-V2, capable of learning contact-rich manipulation directly in the uninstrumented real world. Building on the latest algorithmic advancements in model-based reinforcement learning (MBRL), demo-bootstrapping, and effective exploration, MoDem-V2 can acquire contact-rich dexterous manipulation skills directly in the real world. We identify key ingredients for leveraging demonstrations in model learning while respecting real-world safety considerations -- exploration centering, agency handover, and actor-critic ensembles. We empirically demonstrate the contribution of these ingredients in four complex visuo-motor manipulation problems in both simulation and the real world. To the best of our knowledge, our work presents the first successful system for demonstration-augmented visual MBRL trained directly in the real world. Visit https://sites.google.com/view/modem-v2 for videos and more details.

    Comment: 9 pages, 8 figures
    Keywords Computer Science - Robotics ; Computer Science - Artificial Intelligence ; Computer Science - Computer Vision and Pattern Recognition ; Computer Science - Machine Learning
    Subject code 501 ; 629
    Publishing date 2023-09-25
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Ultrasound-Guided Ganglionectomy of a Flexor Hallucis Longus Ganglion Cyst Using Coablation Technology: A Case Report.

    Lancaster, Patrick Justin / Colberg, Ricardo E

    PM & R : the journal of injury, function, and rehabilitation

    2019  Volume 11, Issue 7, Page(s) 779–782

    Abstract: A 44-year-old woman with a history of an open ganglionectomy 2 years prior presented with a recurrent ganglion cyst. The ganglion cyst, extending from the flexor hallucis longus tendon sheath, was confirmed with magnetic resonance imaging. The patient ... ...

    Abstract A 44-year-old woman with a history of an open ganglionectomy 2 years prior presented with a recurrent ganglion cyst. The ganglion cyst, extending from the flexor hallucis longus tendon sheath, was confirmed with magnetic resonance imaging. The patient declined another surgical incision. An experimental procedure was performed: ultrasound-guided ganglionectomy using a coablation wand. She achieved full symptom resolution, with no recurrence 1 year afterwards. To our knowledge, this is the first case report in the literature describing the use of this instrument for treating a ganglion cyst.
    MeSH term(s) Adult ; Catheter Ablation/methods ; Female ; Ganglion Cysts/diagnosis ; Ganglion Cysts/surgery ; Ganglionectomy/methods ; Humans ; Surgery, Computer-Assisted/methods ; Tendons/diagnostic imaging ; Tendons/surgery ; Ultrasonography/methods
    Language English
    Publishing date 2019-04-03
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2608988-9
    ISSN 1934-1563 ; 1934-1482
    ISSN (online) 1934-1563
    ISSN 1934-1482
    DOI 10.1002/pmrj.12084
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    Zs.A 6951: Show issues Location:
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  4. Book ; Online: Electrostatic Brakes Enable Individual Joint Control of Underactuated, Highly Articulated Robots

    Lancaster, Patrick / Mavrogiannis, Christoforos / Srinivasa, Siddhartha / Smith, Joshua

    2022  

    Abstract: Highly articulated organisms serve as blueprints for incredibly dexterous mechanisms, but building similarly capable robotic counterparts has been hindered by the difficulties of developing electromechanical actuators with both the high strength and ... ...

    Abstract Highly articulated organisms serve as blueprints for incredibly dexterous mechanisms, but building similarly capable robotic counterparts has been hindered by the difficulties of developing electromechanical actuators with both the high strength and compactness of biological muscle. We develop a stackable electrostatic brake that has comparable specific tension and weight to that of muscles and integrate it into a robotic joint. Compared to electromechanical motors, our brake-equipped joint is four times lighter and one thousand times more power efficient while exerting similar holding torques. Our joint design enables a ten degree-of-freedom robot equipped with only one motor to manipulate multiple objects simultaneously. We also show that the use of brakes allows a two-fingered robot to perform in-hand re-positioning of an object 45% more quickly and with 53% lower positioning error than without brakes. Relative to fully actuated robots, our findings suggest that robots equipped with such electrostatic brakes will have lower weight, volume, and power consumption yet retain the ability to reach arbitrary joint configurations.

    Comment: 18 pages, 17 figures
    Keywords Computer Science - Robotics
    Subject code 629
    Publishing date 2022-04-05
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Book ; Online: Improved Object Pose Estimation via Deep Pre-touch Sensing

    Lancaster, Patrick / Yang, Boling / Smith, Joshua R.

    2022  

    Abstract: For certain manipulation tasks, object pose estimation from head-mounted cameras may not be sufficiently accurate. This is at least in part due to our inability to perfectly calibrate the coordinate frames of today's high degree of freedom robot arms ... ...

    Abstract For certain manipulation tasks, object pose estimation from head-mounted cameras may not be sufficiently accurate. This is at least in part due to our inability to perfectly calibrate the coordinate frames of today's high degree of freedom robot arms that link the head to the end-effectors. We present a novel framework combining pre-touch sensing and deep learning to more accurately estimate pose in an efficient manner. The use of pre-touch sensing allows our method to localize the object directly with respect to the robot's end effector, thereby avoiding error caused by miscalibration of the arms. Instead of requiring the robot to scan the entire object with its pre-touch sensor, we use a deep neural network to detect object regions that contain distinctive geometric features. By focusing pre-touch sensing on these regions, the robot can more efficiently gather the information necessary to adjust its original pose estimate. Our region detection network was trained using a new dataset containing objects of widely varying geometries and has been labeled in a scalable fashion that is free from human bias. This dataset is applicable to any task that involves a pre-touch sensor gathering geometric information, and has been made publicly available. We evaluate our framework by having the robot re-estimate the pose of a number of objects of varying geometries. Compared to two simpler region proposal methods, we find that our deep neural network performs significantly better. In addition, we find that after a sequence of scans, objects can typically be localized to within 0.5 cm of their true position. We also observe that the original pose estimate can often be significantly improved after collecting a single quick scan.

    Comment: 8 pages, 6 figures
    Keywords Computer Science - Robotics
    Subject code 629
    Publishing date 2022-04-08
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article: Soft tissue extensor mechanism tendon ruptures of the knee.

    Rhind, John-Henry / Lancaster, Patrick / Ahmed, Usman / Carmont, Michael

    British journal of hospital medicine (London, England : 2005)

    2021  Volume 82, Issue 9, Page(s) 1–9

    Abstract: Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps ... ...

    Abstract Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.
    MeSH term(s) Adult ; Humans ; Knee Joint ; Quadriceps Muscle ; Soft Tissue Injuries ; Tendon Injuries/diagnosis ; Tendon Injuries/surgery ; Tendons
    Language English
    Publishing date 2021-09-29
    Publishing country England
    Document type Journal Article
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2021.0139
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  7. Article ; Online: Establishment Of Virtual Fracture Clinic In Princess Royal Hospital Telford: Experience And Recommendations During The First 9 Months.

    Khaleeq, Tahir / Lancaster, Patrick / Fakoya, Keji / Black, Martin / Littlehales, Julie / Ferreira, Pedro / Ahmed, Usman

    Journal of Ayub Medical College, Abbottabad : JAMC

    2022  Volume 34, Issue 2, Page(s) 341–344

    Abstract: Background: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact ... ...

    Abstract Background: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety.
    Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes.
    Results: In total 2489 patients were referred to VFC from internal and external sources. Seven hundred and thirty-four patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. Eighty-seven patients were triaged into subspecialty clinics. Thirty-seven patients were felt to have been referred inappropriately.
    Discussion: British Orthopaedic Association guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review; the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.
    MeSH term(s) Ambulatory Care Facilities ; COVID-19 ; Fractures, Bone/therapy ; Hospitals ; Humans ; Pandemics
    Language English
    Publishing date 2022-05-01
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2192473-9
    ISSN 1819-2718 ; 1025-9589
    ISSN (online) 1819-2718
    ISSN 1025-9589
    DOI 10.55519/JAMC-02-9891
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    Zs.A 6109: Show issues Location:
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  8. Article ; Online: Open lower limb fractures in the elderly.

    Lancaster, Patrick / Kocialkowski, Cezary / Pearce, Oliver / Khan, Umraz / Riddick, Andrew / Kelly, Michael

    Injury

    2022  Volume 53, Issue 6, Page(s) 2268–2273

    Abstract: Objective: The aim of this study was to assess the outcomes of open lower limb fractures in patients aged 65 and over. The primary outcome was mortality at 30 days, and the secondary outcome was reoperation.: Methods: This study retrospectively ... ...

    Abstract Objective: The aim of this study was to assess the outcomes of open lower limb fractures in patients aged 65 and over. The primary outcome was mortality at 30 days, and the secondary outcome was reoperation.
    Methods: This study retrospectively identified patients aged 65 and over, presenting with an open tibia or ankle fracture, over a two-year period. Patient demographics, injury characteristics and surgical interventions were documented. The 30-day and one-year mortality was recorded, as well as any complications encountered.
    Results: There were 88 patients included in the study, with a mean age of 78 years and 66% of patients were female. Of this cohort, 67 patients (76%) had low energy injuries and 64 patients (73%) had Gustillo-Anderson type IIIB injuries. Treatment consisted of a one-stage surgical procedure in 49 patients (56%) and a two-stage procedure in 37 patients (42%), with two patients dying before definitive treatment. Primary wound closure was performed in 23 patients (26%), four patients (5%) had a split skin graft alone, 35 patients (40%) had local flaps, 21 patients (24%) were managed with free flaps and three patients (3%) had primary below knee amputations. The 30-day mortality rate was 10%, the one-year mortality rate was 19% and the reoperation rate was 8%.
    Conclusion: Open lower limb fractures in the elderly are a life and limb threatening injury, with a similar demographic and mortality profile to hip fracture. This study demonstrates that limb salvage can be achieved in 93% of cases, with treatment performed as a one-stage procedure in 56% of cases.
    MeSH term(s) Aged ; Female ; Fractures, Open/complications ; Fractures, Open/surgery ; Free Tissue Flaps ; Humans ; Lower Extremity/injuries ; Lower Extremity/surgery ; Male ; Retrospective Studies ; Surgical Wound Infection/therapy ; Tibial Fractures/complications ; Tibial Fractures/surgery ; Treatment Outcome
    Language English
    Publishing date 2022-03-16
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2022.03.029
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    Zs.A 778: Show issues Location:
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    Zs.MO 10: Show issues

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  9. Book ; Online: Optical Proximity Sensing for Pose Estimation During In-Hand Manipulation

    Lancaster, Patrick / Gyawali, Pratik / Mavrogiannis, Christoforos / Srinivasa, Siddhartha S. / Smith, Joshua R.

    2022  

    Abstract: During in-hand manipulation, robots must be able to continuously estimate the pose of the object in order to generate appropriate control actions. The performance of algorithms for pose estimation hinges on the robot's sensors being able to detect ... ...

    Abstract During in-hand manipulation, robots must be able to continuously estimate the pose of the object in order to generate appropriate control actions. The performance of algorithms for pose estimation hinges on the robot's sensors being able to detect discriminative geometric object features, but previous sensing modalities are unable to make such measurements robustly. The robot's fingers can occlude the view of environment- or robot-mounted image sensors, and tactile sensors can only measure at the local areas of contact. Motivated by fingertip-embedded proximity sensors' robustness to occlusion and ability to measure beyond the local areas of contact, we present the first evaluation of proximity sensor based pose estimation for in-hand manipulation. We develop a novel two-fingered hand with fingertip-embedded optical time-of-flight proximity sensors as a testbed for pose estimation during planar in-hand manipulation. Here, the in-hand manipulation task consists of the robot moving a cylindrical object from one end of its workspace to the other. We demonstrate, with statistical significance, that proximity-sensor based pose estimation via particle filtering during in-hand manipulation: a) exhibits 50% lower average pose error than a tactile-sensor based baseline; b) empowers a model predictive controller to achieve 30% lower final positioning error compared to when using tactile-sensor based pose estimates.

    Comment: 8 pages, 6 figures
    Keywords Computer Science - Robotics
    Subject code 629 ; 004
    Publishing date 2022-04-05
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Encouraging reflection: good doctor or bad doctor?

    Brand, Sarah / Lancaster, Patrick / Gafson, Irene / Nolan, Helen

    Medical education

    2017  Volume 51, Issue 11, Page(s) 1173–1174

    MeSH term(s) Education, Medical ; Focus Groups ; Humans ; Interpersonal Relations ; Physician-Patient Relations ; Physicians/psychology ; Physicians/standards ; Students, Medical/psychology
    Language English
    Publishing date 2017
    Publishing country England
    Document type Journal Article
    ZDB-ID 195274-2
    ISSN 1365-2923 ; 0308-0110
    ISSN (online) 1365-2923
    ISSN 0308-0110
    DOI 10.1111/medu.13449
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