Coordinating Human-Robot Teams with Dynamic and Stochastic Task Proficiencies

As robots become ubiquitous in the workforce, it is essential that human-robot collaboration be both intuitive and adaptive. A robot’s ability to coordinate team activities improves based on its ability to infer and reason about the dynamic (i.e., the “learning curve”) and stochastic task performance of its human counterparts. We introduce a novel resource coordination algorithm that enables robots to schedule team activities by (1) actively characterizing the task performance of their human teammates and (2) ensuring the schedule is robust to temporal constraints given this characterization. We first validate our modeling assumptions via user study. From this user study, we create a data-driven prior distribution over human task performance for our virtual and physical evaluations of human-robot teaming. Second, we show that our methods are scalable and produce high-quality schedules. Third, we conduct a between-subjects experiment (n = 90) to assess the effects on a human-robot team of a robot scheduler actively exploring the humans’ task proficiency. Our results indicate that human-robot working alliance ( p\lt 0.001 ) and human performance ( p=0.00359 ) are maximized when the robot dedicates more time to exploring the capabilities of human teammates.

Must Clinics Replace 2D by 3D Environments for an Efficient Training of Laparoscopic Novices? A Critical Analysis of the Learning Curve for Basic Skills

Background and AimsPublished studies repeatedly demonstrate an advantage of three-dimensional (3D) laparoscopic surgery over two-dimensional (2D) systems but with quite heterogeneous results. This raises the question whether clinics must replace 2D technologies to ensure effective training of future surgeons.MethodsWe recruited 45 students with no experience in laparoscopic surgery and comparable characteristics in terms of vision and frequency of video game usage. The students were randomly allocated to 3D (n = 23) or 2D (n = 22) groups and performed 10 runs of a laparoscopic “peg transfer” task in the Luebeck Toolbox. A repeated-measures ANOVA for operation times and a generalized linear mixed model for error rates were calculated. The main effects of laparoscopic condition and run, as well as the interaction term between the two, were examined.ResultsNo statistically significant differences in operation times and error rates were observed between 2D and 3D groups (p = 0.10 and p = 0.72, respectively). The learning curve showed a significant reduction in operation time and error rates (both p's < 0.001). No significant interactions between group and run were detected (operation time: p = 0.342, error rates: p = 0.83). With respect to both endpoints studied, the learning curves reached their plateau at the 7th run.ConclusionThe result of our study with laparoscopic novices revealed no significant difference between 2D and 3D technology with respect to performance time and the error rate in a simple standardized test. In the future, surgeons may thus still be trained in both techniques.

The learning curve for ultrasound-guided peripheral intravenous cannulation in adults: a multicenter study

Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a hands-on training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first proce-dure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.

Connecting the Dots: Multistage Fracturing in Horizontal Wells with Multilayered Reservoirs - Lessons Learned

Efficient multistage hydraulic fracturing in horizontal wells in tight-gas formations with multilayered and laminated reservoirs is a very challenging subject matter; due to formation structure, required well trajectory, and the ability to establish a conductive and permanent connection between all the layers. BP Oman had initiated the technical journey to deliver an effective horizontal well multistage frac design through learnings obtained during three key pilot horizontal wells. Since these initial wells, additional candidates have been drilled and stimulated, resulting in further advancement of the learning curve. Many aspects will be covered in this paper, that will describe how to facilitate the most effective hydraulic fracture placement and production performance, under these laminated conditions. These approaches will include the completion and perforation selection, fracture initiation zone selection, fracture height consideration, frac fluid type and design. The paper will go on to describe a range of different surveillance options, including clean-up and performance surveillance as well as number of other factors. The experiences that have been gained provide valuable insight and learning about how to approach a multistage fracturing horizontal well program in this kind of depositional environment. Additionally, how these lessons can potentially be subsequently adapted and applied to access resources in the more challenging and higher risk areas of the field. For example, this paper will present direct comparison of over and under-displaced stages; differences in execution and production for cased hole and open hole completions; and many other variables that always under discussion for hydraulic fracturing in horizontal wells. This paper describes in detail the results of many multistage fracturing trials by BP Oman in horizontal wells drilled in challenging multilayered and laminated tight-gas reservoirs. These findings may help to cut short learning curve in similar reservoirs in the Middle East Region and elsewhere.

Increased failure rates after the introduction of the TFNA proximal femoral nail for trochanteric fractures: implant related or learning curve effect?

Background and purpose — Trochanteric fractures are often treated using intramedullary fixation. In our institution, the TFN-Advanced Proximal Femoral Nailing System (TFNA) was introduced as replacement for the Gamma Trochanteric Nail (GTN3) for the treatment of these fractures as a result of a hospital-driven change of trauma implant supplier. We compared trochanteric fracture fixation failure rate between these 2 intramedullary nails. Patients and methods — All trochanteric fractures treated surgically from 2011 to 2019 were retrospectively reviewed for fixation failure. From 2016 only the TFNA was used. Fixation failure was defined as implant cut-out, implant breakage, non-union, malpositioning of the screw/blade requiring reoperation, new fracture around the nail, or miscellaneous. Propensity score matching was used to balance distribution of covariates and to compare failure rates between TFNA and GTN3 groups. Learning curve analyseswere performed. Results — After exclusion, 797 GTN3s (779 patients) and 542 (536 patients) TFNAs were available for analysis. A higher risk of fixation failure was found in the TFNA group (14%) compared with the GTN3 group (7.0%) (hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.2–3.5). This was mainly attributed to a higher risk of cut-out (HR 2.2; CI 0.9–5.7), malpositioning (HR 4.7; CI 0.7–34), and new fracturearound the nail (HR 4.0; CI 1.0–16). Learning curve analyses indicated no clear learning curve effect. Interpretation — Failure of fixation increased after a switch from the GTN3 to the TFNA proximal femoral nail for the treatment of trochanteric fractures. Cut-out and malpositioning of the calcar screw or blade appeared to be the most dominant failure mechanisms. Modifications in implant design may have played a role in this increased risk of failure of fixation. In our institution a new implant device was introduced without solid clinical evidence behind it. This study may help to underline the need for medical doctors with acritical and scientific background to be involved in implant choices.

QUALITY CONTROL IN ECHOCARDIOGRAPHY REPORTING (PART A)

For cardiac evaluation echocardiography is of immense importance. Easy availability, low cost, and portability lands it in the hands of novices at times. It has a learning curve and expertise must be obtained to keep the standard of reports high and reliable. The referring physician must be fully conversant with the indications of echocardiography. The echocardiographic machine should deliver images of high resolution and fully equipped with all the basic modalities. Availability of 3D (3-dimensional) imaging, tissue synchronization imaging and strain analysis are added advantages. Preliminary data of patient must be collected and the study should be recorded for off-line analysis. Finally, the findings should be narrated on a proforma in the form of a standardized report showing all the relevant features, especially directed to the query of referring physician, thus completing the loop.

Training to proficiency in surgery using simulation: is there a moral obligation?

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.