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CiteScore 4.4
Frontiers in Robotics
and AI
Biomedical Robotics
Robotics, Autonomous Systems and AI for Nonurgent/Nonemergent Healthcare Delivery During and After the COVID-19 Pandemic View all 34 Articles
Elena De Momi
Politecnico di Milano, Italy
Riccardo Muradore
University of Verona, Italy
Selene Tognarelli
Sant'Anna School of Advanced Studies, Italy
Francesca Cordella
Campus Bio-Medico University, Italy
Robotics-Assisted Surgery
Tele-Examination of Patients
Tele-Training of Surgeons
Discussion and Conclusion
PERSPECTIVE article
Front. Robot. AI, 14 April 2021 | https://doi.org/10.3389/frobt.2021.610677
Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision
Navid Feizi1, Mahdi Tavakoli2, Rajni V. Patel1,3,4 and S. Farokh Atashzar5,6*
1Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, and School of Biomedical Engineering, University of Western Ontario, London, ON, Canada
2Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
3Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada
4Department of Surgery, University of Western Ontario, London, ON, Canada
5Department of Electrical and Computer Engineering, New York University, New York, NY, United States
6Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.
The novel coronavirus has been declared a public health emergency of international concern by WHO in Jan 2020 (WHO, 2020). By the time of writing this paper, all countries are affected by the pandemic. The unprecedented shock wave of the virus spread has impacted regular health care service delivery. The extreme pressure on healthcare systems has exceeded capacity, and managing the pandemic has become a global issue that has drastically influenced most aspects of the healthcare system. The performance of surgeries (most of which are categorized as elective surgeries), training for surgery, and assessments for surgery are aspects that have been significantly impacted.
Due to the chance of false negatives in the pre-surgery COVID-19 testing of patients, all patients have to be treated as suspect cases. Dealing with infected or suspected patients requires precautions such as consideration for anesthesiologists (Willer et al., 2020), limitation of staff exposure to patients, and wearing PPE, which poses difficulties to operating theatre (Kumar et al., 2020). However, these procedures cannot guarantee the safety of staff and patients. Moreover, since hospital staff is in contact with several people each day, cross-infection through staff should also be considered.
New regulations have recommended a moratorium on elective surgery to avoid virus spread in hospitals by minimizing personal interactions and expenditure of medical resources for infected patients who need intensive care. Deferring elective surgeries is based on opinions and has secondary consequences. Progression of the disease continues when the patient is waiting for surgery. This has a substantial impact on the life quality of patients (Fu et al., 2020), results in higher treatment costs (Reyes et al., 2019), and may cause unexpected death (Zafar, 2020). On the other hand, elective surgeries are not optional and must be performed eventually. Thus, there may be a need for performing a deferred surgery during the COVID-19 time frame. Moreover, catching up with the 2 million backlogged elective surgeries worldwide each week will impose a huge burden on the healthcare system when elective surgeries resume (Szklarski, 2020).
This unprecedented scenario not only has affected surgeries, but has also influenced surgery-related activities profoundly. Surgical education has been affected adversely by the pandemic. There has been a gradual reopening of activities, including schools, but with the anticipated rise in the rate of infection it is anticipated that there will be some levels of shut down again in this sector. Trainees are banished from wards, and residents have lost their access to practical OR training (Ferrario et al., 2020; Ferrel and Ryan, 2020). In addition, emergency and non-deferable surgeries are being done by senior surgeons without the presence of trainees to reduce operation time and risk of complications, and mitigate the risk of residents' exposure to COVID-19 (Bernardi et al., 2020). This situation has imposed mental anxiety and has slowed down the learning curve of residents and medical students, who will be needed in catching-up with deferred surgeries in the future (Ahmed et al., 2020).
Moreover, going into hospitals for pre- and post-surgery assessments is also a safety concern during the pandemic. There is always an infection risk for any minute that a non-COVID patient spends in a hospital. Consequently, hospitals try to discharge patients as soon as possible to reduce the risk of infection. Besides, the closure of medical offices has disturbed pre- and post-surgery assessments (Scaravonati et al., 2020).
Since there is no widely approved or sufficiently tested vaccine, there is a possible chance of second and third global waves in the Fall and Winter, and continuing lockdown regulations imposes an intolerable burden on the healthcare system. Several countries are therefore planning for a reopening guideline to resume safe delivery of surgical services (Dattani et al., 2020). However, it is not clear how the reopening phase will affect the quality of healthcare delivery and how the above-mentioned tasks should be performed safely while there is a lack of a clinically approved therapy for COVID-19. This perspective paper proposes robotics and artificial intelligence (AI) as a solution for the three above-mentioned tasks and investigates potential opportunities in the area to address the mentioned problems.
Minimally invasive surgery (MIS) has demonstrated superiority over open surgery. Less amount of blood loss, and shorter recovery and hospital stay are the main reasons for the preference of MIS when it is possible. Meanwhile, robotics-assisted MIS (RAMIS) has evolved and shown superhuman capabilities for teleoperation and has found its place in MIS. Teleoperation offers surgeons an ergonomically operating posture (Ballantyne, 2002), provides them with more dexterity than conventional laparoscopy (Moorthy et al., 2004), enhances the accuracy of motion beyond surgeons' natural ability, etc. Besides these benefits, the main virtue that distinguishes teleoperation in the COVID-19 era is providing the ability to separate the surgeon's console (leader robot) from the patient robot (follower robot) while keeping them connected through a communication interface (Challacombe et al., 2003).
Telesurgery affords physical separation of the surgeon from the patient, in a separate room avoiding bilateral infection transfer, which can be life-threatening. In addition, the number of bedside staff in RAMIS is less than in open surgery (Kimmig et al., 2020). This provides the safety of the patient and operating room by reducing inter-personal contacts to the lowest level possible. This performance has been shown experimentally. In the United States, a CorPath robotic intervention arm has been used in coronary intervention on a COVID patient to provide safety of the personnel (Tabaza et al., 2020).
Dealing with an infected or suspected patient requires a maximal level of protection (Liang, 2020). The physical disturbance caused by this level of protection has a negative influence on surgical performance. On the other hand, the COVID-19 situation increases the surgeon's mental stress, which critically affects the surgeon's performance. Elevated stress levels could likely be due to the fear of contracting the virus or spreading it to patients and the surgeon's family (Tan et al., 2020). Studies have shown that depression, anxiety, insomnia, and stress have increased, especially among front-line healthcare providers during the pandemic (Lin et al., 2020). High stress levels may result in inappropriate responses, such as poor decision making and impaired psychomotor performance (Wetzel et al., 2006; Arora et al., 2010). The elevated psychological stress levels among healthcare providers may sustain even one year after the outbreak as it happened in 2004 with SARS (Lee et al., 2007). Not only telesurgery reduces surgeon's stress by providing better ergonomics during surgery (Berguer and Smith, 2006), but also, during the COVID era, robotics-assisted surgery significantly reduces stress levels by providing higher infection protection through physical distancing between the patient and the surgeon; also, it reduces the number of needed medical staff to be present in close proximity to the patient and each other during prolonged surgeries (which can increase the possibility of infection transfer between a patient and staff and between staff members). It should be highlighted that robotics assisted surgery does not make the aforementioned interactions zero as there is always the need for some format of interaction between a patient and staff. However, it reduces the duration and the number of interactions.
Recently, the concept of semi-autonomous and autonomous surgery has attracted a great deal of interest thanks to advancements in the area of machine intelligence especially when combined with computer vision (Moawad et al., 2020). When compared with teleoperated robotic surgery, AI-based autonomous and semi-autonomous robotic systems has not been fully exploited in the literature as these are newer topics of the field. In the language of surgery project, it has been shown that combining AI with teleoperation can provide a semi-automated system that can recognize and perform tasks automatically when there is a pre-trained model for the recognized task, allowing for faster and high accuracy procedures (Bohren et al., 2011). Semi-autonomous robots have been used for orthopedic surgery, such as MAKOplasty, when preoperative images are fused with intraoperative information to provide surgeons with an augmented sensorimotor capability through production of dynamic virtual fixture in time and space. More recently, fully-autonomous robotic surgery has been discussed in medical robotic communities and preliminary experiments on ex-vivo tissue have shown promising results. The performance and accuracy of semi-autonomous surgical robots have been proved clinically (Hampp et al., 2019). For example, the MAKO (Stryker, 2020) and NAVIO (Smith and Nephew, 2020) robots guide the surgeon in joint arthroplasty semi-autonomously and prevent excessive bone loss. This guarantees proper bone preparation and precise implantation. However, autonomous surgical robots, despite their great accuracy in comparison to manual procedures (Shademan et al., 2016), are still in the non-clinical development phase. In the context of remote operation, the use of autonomous robots can provide a higher degree of separation while providing some additional accuracy through processing of multimodal intraoperative information. However, this is a technologically challenging field which should be investigated to provide more autonomy regarding management of surgery during a crisis such as COVID-19.
The other benefit of RAMIS in the COVID-19 era is that it increases the availability of intensive care unit (ICU) beds. The smaller incision for RAMIS shortens patient's recovery time and hospital stay. This allows hospitals to dedicate more ICU beds to critically ill cases while handling surgeries. There is however a shortcoming in terms of the OR time usage for RAMIS as a result of the extra setting-up time and longer procedure times (Heemskerk et al., 2007; Cho et al., 2016; Lindfors et al., 2018). Nonetheless, a shorter post-surgery hospital stay is of paramount importance and outweighs the longer OR time, notably in the COVID-19 era. Moreover, deploying AI in robotic surgery has been shown to decrease soft tissue damage and consequently decrease recovery time (Wall and Krummel, 2020).
Due to abdominal pressure in laparoscopic surgery, there are some concerns about the possibility of aerosolization of viral particles and contamination through surgery smoke in laparoscopic surgery (Schwarz and Tuech, 2020; Van den Eynde et al., 2020). Although these methods of infection are not completely proved for COVID-19 yet, safety regulations should be considered to prevent possible infections. It should be noted that surgical smoke is also released in open surgeries; however, in RAMIS, it is easier to handle the smoke trapped in the patient's body. Safety precautions to prevent these issues are 1) lowering the electrocautery power to reduce the amount of smoke production (Mottrie, 2020); 2) smoke evacuation and abdominal deflation through ultra-low penetrating air (ULPA) filter (Kimmig et al., 2020); and 3) reducing abdominal pressure to the lowest possible. RAMIS surgeries are feasible to perform with lower abdominal pressure than conventional laparoscopic surgery (Kimmig et al., 2020). To summarize, RAMIS is safer than MIS and open surgery in terms of contamination through aerosolization of viral particles for bedside staff.
Telerobotic surgical systems have solved several issues associated with conventional MIS and also provided the surgeon with new capabilities. These features are 1) depth perception; 2) dexterity enhancement; 3) improved accuracy; 4) better hand-eye coordination; and 5) and multiple tools delivery through a single incision (Atashzar and Patel, 2018). Moreover, in teleoperation, information and operation data can be saved and used for training purposes both for AI supervision and training of novice surgeons (Zemmar et al., 2020). The problem of degraded haptic feedback in conventional laparoscopy has not been solved yet. Better tracking accuracy and improved surgical performances have been achieved using the haptic feedback in RAMIS (Talasaz et al., 2014), (Currie et al., 2017). Related to this, the lack of haptic feedback increases the risk of tissue damage due to large unintentional forces. Other modalities of feedback such as visual force feedback of the tool (Tavakoli et al., 2006), a tactile sensor and tactile ultrasound (tactUS) instrument for palpation and tumor localization (Trejos et al., 2009; Naidu et al., 2017a; Naidu et al., 2017b), and skin stretch feedback (Schorr et al., 2013) are influential in robotic surgery, but none of them can completely make up for the absence of haptic feedback. Thus, enabling telerobotic surgical systems with force sensing and force reflecting modules is of high importance, which increases the quality of teleoperated surgery (Talasaz and Patel, 2013; Talasaz et al., 2017). A machine learning algorithm has been deployed to estimate the elongation of suture from knot type, initial suture length, and surgical thread type data, and visual feedback has been used to warn the surgeon of the risk of suture breakage (Dai et al., 2019). In particular, considering a larger number of surgeries that can benefit from teleoperated procedures using robots, during the era of COVID, addressing this challenge should be accelerated. This topic has seen ongoing research, and unfortunately, the current trend does not show a promise of an upcoming solution. With improving technology for haptic feedback, this can result in a major advance in the performance of teleoperated surgeries on a larger scale and can enlarge the domain of surgeries, which can be conducted teleoperatively, helping with the management of the current concerns regarding infection transfer during surgery in the time of COVID.
There are two characteristics associated with a good haptic teleoperation system: transparency and stability. In the last three decades, a significant amount of research has been done on developing a transparent control architecture. Four-Channel Lawrence (FCL) was proposed as the first transparent teleoperation system (Lawrence, 1993). It was modified to simpler architectures (Hashtrudi-Zaad and Salcudean, 2001), (Hashtrudi-zaad and Salcudean, 2002). Atashzar et al. proposed a simplified two-channel modified-ELFC (M-ELFC) architecture that provides a high degree of transparency (Atashzar et al., 2012). To deal with the stability issue, three categories of passivity-based controllers have been proposed: 1) the Wave Variable approach (Aziminejad et al., 2008); 2) Time Domain Passivity Approach (TDPA) (Ryu et al., 2010); and 3) Small-gain approach (Atashzar et al., 2017a). Both techniques stabilize the system; however, stabilization comes at the cost of compromising transparency. Considerable research has been done to improve the performance of teleoperation (Artigas et al., 2010; Chawda and Omalley, 2015; Atashzar et al., 2017b; Panzirsch et al., 2019; Singh et al., 2019), but the proposed stabilization methods are still far from ideal. The discussion above clarifies some of the technical challenges creating obstacles to realizing high-fidelity haptics-enabled teleoperated surgery. The potential of RAMIS in resolving the surgical issues caused by COVID-19 is calling for an accelerated trend of research and development, extending the performance of teleoperated surgical robotic systems for allowing more benefit of this technology in reducing the burden on the healthcare system during the pandemic and similar crises in the future.
Remark: AI has been extensively developed in the last decade and has revolutionized many industries. However, the application of AI in surgical procedures requires a significant amount of adaptation and consideration. Robotic surgery can take advantage of AI in the COVID era from three aspects; 1) increasing accuracy and reducing the risk of failure by providing shared and full autonomy in simple tasks (Rabinovich et al., 2020; Wall and Krummel, 2020); 2) allowing physical distancing by changing the surgeon's role from executive and continuous control to supervisory and intermittent control; and 3) increasing the average number of surgical procedures, which will be required to address the backlogged surgeries caused by the shutdown of elective surgeries over a long period of time, thereby reducing the load on surgeons and allowing after-hour surgeries (Zemmar et al., 2020).
Preoperative examination for surgery preplanning and post-operative patient examination in the recovery time is another matter of concern in the COVID-19 era. In-person visits increase the risk of virus contraction for the patient and the surgeon. Keeping personal interactions as low as possible is the key factor in dealing with the pandemic.
Post-operative examinations may include patient's assessment at home and ICU. Telepresence robots that are made for telehealthcare purposes allow physicians to interact with patients, and monitor patients' vital signs without the physical presence of the surgeon in the ICU (Laniel et al., 2017). These systems have been used in Italy at COVID-19 patients' bedside in the ICU (Bogue, 2020; Pullella, 2020). A similar robot has been used in Israel to communicate with quarantined patients (Marks, 2020). In terms of home healthcare, messages, phone, and video calls have been used for post-operative examination. It has been shown that telepresence robots could provide a stronger feeling of a person to person interaction for both users, in comparison to video and phone calls, and both physicians and patients have expressed satisfaction (Tavakoli et al., 2020), (Becevic et al., 2015).
Preoperative examinations have also been done with AI- and robotics-enabled telehealth, but applications are limited due to the lack of physical exams and the need for clinical imaging. However, it has been shown that for some specific conditions, diagnosis via telemedicine could be as accurate as an in-person diagnosis when examination through telemedicine is feasible subject to limitations (Asiri et al., 2018). For example, AI can be used for digital triage to direct patients to the most appropriate medical center based on the resources and their condition before they show up in emergency rooms (Lai et al., 2020). As another example, it has been shown that blood draw and injections can be done with portable robots using AI more accurately and faster than a manual procedure (Zemmar et al., 2020). Another example is the telerobotic system that has been used in China to perform cardiac and lung ultrasound on a COVID patient (Wang et al., 2020). These systems can help safeguard patients and staff by reducing the need for patient referral to hospital and physical distancing.
Robotics and AI have taken a step in the development of tele-examination of patients during pre- and post-operative phases. However, there is still room for adding new capabilities to tele-healthcare robots in order to lower the need for in-person examinations or patient referrals to hospital. Besides robots, focusing on smartphone-based or computer-based tele-examination systems would be useful because of their widespread use.
The outbreak of COVID-19 has severely affected surgical training procedures. The most significant components of surgical training are comprised of theoretical, pre-clinical, and hands-on clinical training, but the lockdown caused by the pandemic has severely limited the opportunities for students and residents to acquire surgical training (Puliatti et al., 2020), (Bernardi et al., 2020). High-quality and intense healthcare support, which would be needed during and after COVID-19, requires precise training. Although some schools are in a gradual reopening phase, there would be some level of shut down again with the next wave of the pandemic.
In such extraordinary conditions, online learning, teleconferences, and webinars can be of benefit with regard to surgical education and fill the gap with regard to theoretical training issues (Dedeilia et al., 2020). The benefits of these online learning technologies have been shown prior to the COVID-19 pandemic.
On the other hand, robotics and AI could improve the quality of pre-clinical training. Pre-clinical training is conventionally performed through dry or wet lab practices. The use of robotic simulators based on virtual reality (VR) systems has shown a significant improvement in novice surgeons' skills (Tergas et al., 2013). Hands-on-Surgical Training (HoST) provided by augmented reality (AR), and dual-user teleoperated system with virtual fixtures are more advanced simulators that help the novice surgeon to navigate using haptics-enabled cues outside the OR (Shahbazi et al., 2013; Kumar et al., 2015). Xperience Team Trainer developed by Mimic Simulations allows teamwork training in the OR at the pre-clinical stage (Mimics, 2020). This technology provides simultaneous training for the novice surgeon and the bedside assistant to improve coordination between the surgeon and assistant.
The preservation of acquired skills is another important issue in the COVID time. Surgical skills including motor and cognitive skills decay when a surgeon goes through a long period of time without using the acquired skills (Perez et al., 2013). Simulation-based medical education may fill the gap in surgical practice and prevent the loss of surgical skills during a lockdown (Higgins et al., 2020). In addition, AI can be employed to interpret the data collected from simulations for surgeons' skill evaluation (Winkler-Schwartz et al., 2019).
Because the above-mentioned technologies provide high-quality training while keeping social distancing, they could be part of the solution for the educational gap in the COVID-19 era. An active line of research and development that can be accelerated would be to design and develop small, inexpensive, and portable sensorized robotic modules connected to cloud-based virtual reality surgical environments. A large number of trainee surgeons could then continue their hands-on practice/training when access to training facilities is significantly restricted. This is critical because sensorimotor learning is a continual process in the human brain, and a long pause before getting to the agency level can drastically result in fading of sensorimotor skills.
Theoretical and pre-clinical training may guide students to pass the cognitive phase of learning; however, the integration phase, which gives them appropriate motor skills to perform surgery, requires performing surgery under the supervision of an expert in the OR (Choi et al., 2020). Residents would have very limited access to this form of training due to cancelation of elective surgery (Imielski, 2020) or requirements of social distancing. For telesurgery which is more challenging for residents to perform than open surgery and requires specific training, a viable solution that can be achieved using existing systems can be developed using hand-over-hand haptic-enabled tele-training (realized by multilateral teleoperation systems). This would not only allow novice surgeons to perform surgery from a safe distance, but also give them the opportunity to be supervised by an expert at the same time (Shahbazi et al., 2018a; Shahbazi et al., 2018b). The dual console teleoperation system format shares the control of the operation between the expert and the trainee. Incorporating haptics-enabled feedback would then provide the trainee with real-time force feedback. This format of telesurgery training gives the resident experience through supervised surgery without jeopardizing the safety of the patient or the resident during the constraints imposed by COVID-19. Furthermore, these multilateral tele-training systems could also be set up to evaluate the motor skills of trainees based on their performance.
The novel coronavirus has challenged the healthcare system across the globe. Social distancing has become a new normal and may remain for a significant length of time especially as a result of the lack of vaccine and treatment for a critical period of time. This has deeply impacted surgeries and surgically related activities which may revolutionize how future healthcare systems function. Canceling elective surgeries was an efficient policy to curb the spread of the virus; nevertheless, keeping to this plan could have a detrimental effect on the health of patients and the healthcare system. Currently, governments are working on reopening guidelines. In this unprecedented situation, robotics and AI could play an important role in the safe delivery of surgical services through the use of telesurgery, tele-examination, and tele-training environments. A summary of the existing technologies and required features is given in Table 1.
TABLE 1. Existing technologies and required features in telesurgery, tele-examination, and tele-training.
Regarding teleoperated robotic surgery, it should be noted that although there is a wide range of benefit for both patients and the surgeons, there still exist a spectrum of challenges which are open topics for research and development. Regarding benefits, in the context of laparoscopic surgery, it can be mentioned that besides reduced operation time, reduced blood loss, increased accuracy, and reduced recovery time, there are additional benefits that are more pronounced during the pandemic, including reduced time and frequency of interpersonal interaction between surgical staff, reduced number of staff, reduced interaction between patients and staff, all to reduce the risk of infection transfer and increase the safety of surgical procedures (Kimmig et al., 2020; Tavakoli et al., 2020). It should be noted that the current state of telesurgery and robotics-assisted surgery are advanced for abdominal surgery; however, for some categories such as orthopedic surgery, teleoperation has not been considered as a robust option. During the pandemic, any technology that reduces the duration of surgery directly or indirectly (for example, by increasing the accuracy which reduces the need for readjustments) can significantly reduce the chances of infection transmission. This is critical since, in general, surgeons operate on many patients in a short time, which can increase the risk of infection even between patients indirectly through their surgeon.
However, it should be noted that there is a wide range of challenges which have not been addressed yet, especially in the context of teleoperated surgery, and these for the future direction of research. One of the major challenges is the stability and transparency of force-feedback teleoperated robotic systems (Aziminejad et al., 2008; Ryu et al., 2010; Atashzar et al., 2017a). Due to the concerns of safety the existing commercialized telerobotic surgical systems, such as the da Vinci surgical system, do not enable force reflection, even though it is known that force reflection can significantly increase the quality of surgery by providing a much higher situational awareness for surgeons. Although a number of stabilizers and control algorithms have been reported in the literature, the existing algorithms result in deviation of motion tracking and force reflection, which reduces the accuracy of surgery and is often not acceptable (Artigas et al., 2010; Chawda and Omalley, 2015; Atashzar et al., 2017b; Panzirsch et al., 2019; Singh et al., 2019). Besides stability, instrumentation is another challenge. Attaching inexpensive, disposable, biocompatible, and miniaturizable force sensors to surgical tools for measuring multidimensional forces for reflection through a teleoperation medium is a major instrumentation challenge and an open line of research (Atashzar and Patel, 2018). Technologies such as optical force sensors are promising options and are the front line of research in this regard.
In addition, the introduction of AI in telesurgery is a new field of research and development which has attracted a great deal of interest in order to enable parts of surgical tasks to be automated, thereby reducing some cognitive and physical burden for the surgical team with the potential for reducing the operation time, increasing accuracy and reducing the number of needed staff in the operating room. The accuracy resulting from using AI in industrial applications has been shown; however, more research is required to prove its performance and build up confidence in the medical area (Wall and Krummel, 2020). Dealing with soft tissue is the main challenge when involving AI in the context of robotic and telerobotic surgery.
Regarding tele-examination, telepresence robots have been effective in improving post-operative patient-surgeon interactions and monitoring patient's vital signs, mostly in ICUs. However, due to limitations, effective solutions for detailed pre- and post-operative tele-examination of patients have not been proposed in the literature. One of the main challenges in this area is the development of portable sensorized robots for detailed remote monitoring of patient's signs. On the other hand, AI would be particularly useful in automating tele-examination devices to reduce the need for in-person pre- and post-operative examinations.
As for tele-training, simulation-based training systems using AR and HoST have provided a context for pre-clinical training while ensuring the safety of trainees and experts. In addition, simulation-based training can be effective in ensuring skill levels of surgeons in the presence of long periods of surgical inactivity. However, there are open areas for research in this field. Hand-over-hand training using multilateral teleoperation is one of the future research areas that can profoundly improve the quality of clinical surgical tele-training. The stability of delayed multilateral teleoperation and effective methods for sharing control between an expert and a trainee are directions for future researches (Shahbazi et al., 2018a; Shahbazi et al., 2018b). Besides hand-over-hand training, employment of AI for surgical skill training and assessment are open research areas.
In this perspective article, we have provided our opinions on some existing technologies which can be adopted rapidly to help with the current unprecedented situation and have given a perspective of the technologies required in hospitals. The intention in writing this article has been to initiate discussions between researchers, policymakers, and stakeholders to further investigate the use of robotic, telerobotic and AI-based solutions in a framework for enhancing the performance of surgery, surgical training, post-operative treatment, and monitoring under the severe restrictions imposed by COVID-19. The vision and opinions presented in this article are based on an extensive review of the literature concerning approaches through which Robotics and AI can play a significant role.
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.
The four authors (NF, MT, RP, SA) collaborated on the conceptualization of this article, conduction of the literature review, technical and technological analysis, and writing and editing the paper.
The work of NF and RP was funded by the Natural Sciences and Engineering Research Council (NSERC) of Canada under grant #RGPIN-1345 (awarded to RP) and the Tier-1 Canada Research Chairs Program (RP). The work of SA is supported, by the National Science Foundation (Award Number:2031594).
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Keywords: COVID-19, robotics, surgery, teleoperation, tele-examination, tele-training
Citation: Feizi N, Tavakoli M, Patel RV and Atashzar SF (2021) Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision. Front. Robot. AI 8:610677. doi: 10.3389/frobt.2021.610677
Received: 26 September 2020; Accepted: 18 January 2021;
Published: 14 April 2021.
Elena De Momi, Politecnico di Milano, Italy
Selene Tognarelli, Sant'Anna School of Advanced Studies, Italy
Riccardo Muradore, University of Verona, Italy
Francesca Cordella, Campus Bio-Medico University, Italy
Copyright © 2021 Feizi, Tavakoli, Patel and Atashzar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: S. Farokh Atashzar, f.atashzar@nyu.edu


text:
Sister of death in custody victim Sheku Bayoh urges Scots to protest George Floyd killing virtually
Nurse Kadijartu Johnson urged #BlackLivesMatter protesters not to put themselves at risk amid the coronavirus pandemic in a statement.
Daniel Harkins
Nicholas KeydenAssistant Live News Editor
Sheku Bayoh died in custody after he was restrained by up to nine police officers in 2015 (Image: PA)
The sister of death in custody victim Sheku Bayoh has issued a plea to those planning to demonstrate over the police killing of George Floyd in Scotland to do so virtually.
Nurse Kadijartu Johnson urged protesters not to put themselves at risk amid the coronavirus pandemic in a statement alongside lawyer and campaigner Aamer Anwar, Justice Secretary Humza Yousaf and Labour MSP Anas Sarwar.
Her brother Sheku died in 2015 aged 32 after being restrained by officers responding to a call in Kirkcaldy, Fife.
His family believes race played a part in his death and a public inquiry was announced by Yousaf in November last year, with which Police Scotland pledged to "engage fully".
Mr Anwar has previously drawn comparisons to the case with that of Mr Floyd, who died in police custody after a white officer held him down by pressing a knee into his neck in Minneapolis, Minnesota, on May 25.
Sheku Bayoh's sister Kadijartu Johnson (Image: PA)
His death has sparked protests across the US and recent rallies in the UK, including Edinburgh.
The joint statement highlights UK Government statistics showing BAME lives have been disproportionately impacted by Covid-19.
"We are united in our abhorrence at the scenes of racial injustice in the US and stand in complete solidarity with the Black Lives Matter Movement and those demanding justice for George Floyd," it says.
"Like so many we want to stand in unity with millions across our planet to show solidarity with those protesting against racial injustice in the USA but also to support those challenging racial injustice and discrimination in Scotland."
It adds progress on easing out of lockdown in Scotland is "fragile".
"The rules in place are there to protect people's health and ultimately people's lives," it says.
"Therefore, as long-term anti-racist campaigners we are still urging people to protest but to use the many other methods available at this time, including digital protests.
"We hope people will understand our position and explore other methods of demonstrating practical solidarity with #BlackLivesMatter."
Speaking separately from the statement, Ms Johnson said she will not be attending protests planned for Sunday.
"In as much as my family would like to be part of the demonstrations taking place on Sunday for Black Lives Matter, I believe that danger of the spread of coronavirus is still too great," she said.
"As a staff nurse I know the deadly impact of the virus and I would worry about social distancing on the day and the lives of my family and other lives being put at risk.
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"Sadly we cannot attend, nor will we encourage others to go because we believe a virtual protest would be far more effective and involve those unable to attend because of the risk.
"I hope that you will join our campaign, we have fought for five years for justice for my dead brother Sheku and believe Black Lives Matter is as relevant in Scotland."
In a separate plea for people not to attend protests, Mr Yousaf said: "I fully understand and feel the anger and the sadness that leads people to want to gather together and to show solidarity and community at this time.
George Floyd is pinned down by a police officer kneeling on his neck before died (Image: Facebook/Darnella Frazier/AFP vi)
"Unfortunately, the threat of Covid-19 is still with us and I must urge people not to attend mass gatherings, which pose a clear risk to public health, even with social distancing in place.
"The Scottish Government advice is still that no more than eight people should meet at any one time, and for those people to be from no more than two households."
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He added: "I would encourage people to explore alternative ways to make their voices heard on this vital issue, including for example through social media and by engaging friends, families and work colleagues.
"I hope we will soon be able to gather together to show our solidarity.
"But until then we must continue to do what is necessary to protect the health of everyone, following the guidelines."
CourtsDrug addict brutally murdered mother then tried to cover up killingCassandra Scott, aged 36, savagely murdered her own mother 'in cold blood'.
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redpajama_set_name: RedPajamaCommonCrawl


text:
William George Wayne "Bill" Peabody
Obituary of William George Wayne Peabody
William George Wayne Peabody, age 77, beloved husband of Gail A. Peck Peabody of Bethany, died peacefully, surrounded by his family on December 5, 2022 at Griffin Hospital, Derby. Born in Lebanon, New Hampshire on October 23, 1945, he was the son of the late George Wayne and Gladys Follensbee Peabody. Mr. Peabody was raised in Lebanon, NH, graduated from Lebanon High School and earned a bachelor's degree from the University of New Hampshire. Mr. Peabody enjoyed a long career owning and working in various industries. He was the Executive Director of the New Haven location of the Olin Corporation for 15 years. He then became the National Sales Manager of Shelter Logic Corporation for over 10 years, until the time of his retirement in 2012. Mr. Peabody was an avid golfer and played courses all over New England. A voracious reader, he read a book a day for years. He was an avid UCONN Girls Basketball fan and never missed a game, recording very accurate statistics. He took great pride in maintaining his property in Bethany. In his earlier years, Mr. Peabody enjoyed traveling and scuba diving and boating, especially in the Caribbean. In addition to his wife of 42 years, he is survived by his devoted daughters, Amy Ceriana and her husband, Umberto of Tuscany, Italy and Kate LeGault and her husband, Mark of Colchester; a sister, Cynthia Hall of VT; one niece and two nephews; cherished grandchildren, Francesca and Clelia Ceriana of Italy and Anna LeGault of Colchester. A future memorial service will be announced by the Wakelee Memorial Funeral Home, 167 Wakelee Avenue, Ansonia. Memorial contributions may be made to Christ Episcopal Church, 526 Amity Road, Bethany, CT 06824 or to the Clark Memorial Library, 538 Amity Road, Bethany, CT 06824. Online condolences may be made at www.wakeleememorial.com.
Memorial contributions may be made to Christ Episcopal Church, 526 Amity Road, Bethany, CT 06824 or to the Clark Memorial Library, 538 Amity Road, Bethany, CT 06824.


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WORTH THE HYPE VOLUMIZING & LENGTHENING MASCARA is rated 4.4 out of 5 by 3048.
Rated 1 out of 5 by Karlibby from Not a very good one! I've been used this mascara for a week and of course you notice if works or not since the first time. The first one didn't but I thought it was because I applied a primer from L'Oréal and that ruined the result. Well, I was wrong. Second time I used it by itself without the primer and it was exactly same finish. I think it's kind of heavy that makes my lashes go down instead of up like we all want. They start all up and with volume but as the time goes by they end up being all down and like if I was not wearing mascara. A very disappointed product since I've read all the reviews and seemed like it was gonna be a boom for my eyes.
Rated 4 out of 5 by MTTH from Affordable! I think this was a great and affordable mascara that would work with a lot different eye shapes. It's wand features a tapered bristle brush that's densely packed. While being a more dense brush aids to it's volume and lengthening, it doesn't offers much in terms of separating. The formula is more wet and so there is a dry-down time, however it is buildable and doesn't clump up the lashes. This mascara does not flake, but I did find it since it isn't waterproof it does smudge after a full day of wear (8 hours) and that's my biggest concern with it. However, I do it find it worth the price and I think it's a good mascara (not amazing).
Rated 5 out of 5 by Lola K from NYX has done it again! Seriously, this mascara is magic. I already posted a review about the Boudoir waterproof, but this one is a dream! As someone who has short, straight lashes, this product does amazing things. I look like I'm wearing falsies, and it actually does stand up to a little water. This mascara is a total game changer, and for the price you can't beat it.
Rated 5 out of 5 by Jjohn from You want long lashes this is for you!! Im so happy that i got the chance to try the NYX Worth the Hype Volumizing & Lengthening Mascara free thanks to Topbox Circle. I love the look of this mascara on! It didn't clump like other leading mascara so this looked natural!! It so easy to apply, just one coat leave my lashes looking perfect. The brush curls as it glides and has little bristles at the end to coat the tiny inner corner lashes. I also really appreciate that its easy to take off! No scrubbing or losing my lashes. For the price, i totally recommend it! I wore this mascara all day.. (even slept with it on and it looked great the next day too!! Thanks so much for this chance!


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US President Donald Trump 0canceled his delegation's trip to the World Economic Forum in Davos, Switzerland, next week due to the partial US government shutdown. Photo: Reuters
Home World International
Jan 18, 2019 8:37am
Trump cancels WEF trip, denies Pelosi use of military plane
US President Donald Trump has canceled his delegation's trip to the World Economic Forum in Davos, Switzerland, next week due to the partial US government shutdown, Reuters reports, citing a statement released by Press Secretary Sarah Sanders.
Trump's decision came shortly after he denied House Speaker Nancy Pelosi use of military aircraft for an overseas trip in apparent retaliation for her suggestion that he delay the annual State of the Union address.
The rising tension between Trump and the Democrats suggested that the shutdown, on its 27th day on Thursday, remains far from being resolved.
In the meantime, the Trump administration continued to try to mitigate the shutdown's impact. The State Department said it would call its furloughed employees back to work next week for national security reasons.
Pelosi had been scheduled to travel on a military aircraft as part of a congressional delegation to Belgium, where NATO is based, and Afghanistan to visit American troops stationed there.
Trump, who attended last year's Davos event, had planned to go again this year but pulled out last week as he grapples with Democrats in Congress over funding for a wall on the border with Mexico that has led to a partial shutdown of the government.
Treasury Secretary Steven Mnuchin and Secretary of State Mike Pompeo were expected to lead the US delegation in Trump's place, two senior administration officials said this week.
"Out of consideration for the 800,000 great American workers not receiving pay and to ensure his team can assist as needed, President Trump has canceled his delegation's trip to the World Economic Forum in Davos, Switzerland," Sanders's statement said on Thursday.
Mnuchin and Pompeo had planned to speak jointly to the opening session of the forum on Jan. 22. They were also expected to jointly host a dinner of the Group of Seven foreign and finance ministers to discuss national security and economic issues.
Commerce Secretary Wilbur Ross and US Trade Representative Robert Lighthizer also planned to be part of the delegation.
Pelosi trip an 'excursion'
In a letter to Pelosi denying her delegation the use of a plane, the Republican president called the trip an "excursion" but the Democrat's spokesman said the trip to the Afghanistan war zone was for security and intelligence briefings.
"In light of the 800,000 great American workers not receiving pay, I am sure you would agree that postponing this public relations event is totally appropriate," Trump wrote.
He told Pelosi she could make the trip by flying commercial.
Trump's intervention stopped the trip just as Pelosi and other lawmakers were about to travel.
Sanders said that in forcing Pelosi not to travel on a US government jet, Trump had acted within his authority as commander in chief.
"He postponed her ability to use military air, which must be approved" by the Department of Defense, Sanders said.
A spokesman for Pelosi, Drew Hammill, said the trip to Brussels was intended "to affirm the United States' ironclad commitment to the NATO alliance".
The Afghanistan leg of the trip would have obtained "critical national security and intelligence briefings from those on the front lines", Hammill said.
A US defense official, speaking on condition of anonymity, said Pelosi had requested and been granted Defense Department support for overseas travel, although the president has the authority to cancel Pelosi's travel.
The cancellation appeared to be a response to a letter Pelosi sent to Trump on Tuesday, suggesting he delay the annual State of the Union address to Congress, scheduled for Jan. 29, to some point after the government reopens.
Pelosi cited concerns over the capacity of the Department of Homeland Security and the Secret Service to safeguard the Capitol during the event. The agency later said it was capable of securing the venue.
Trump's action drew criticism from one of his Republican allies in the Senate. "One sophomoric response does not deserve another," Republican Senator Lindsey Graham wrote on Twitter.
He criticized Pelosi's move on the State of the Union as "blatantly political" but said, "President Trump denying Speaker Pelosi military travel to visit our troops in Afghanistan, our allies in Egypt and NATO is also inappropriate".
About a quarter of federal agencies have been shuttered since Dec. 22, with Democratic lawmakers refusing to accede to Trump's demands to pay for a wall along the US border with Mexico.
Trump is holding out for US$5.7 billion for a border wall. Democrats, who took over the US House of Representatives this month, have rejected his demands, saying there are cheaper, more effective ways of enhancing border security.


I'm still getting my head around Solutions and what best practice is going to be out there in the real world. I want to leverage the rollback ability of managed solutions and want to enforce proper release process with changes migrating from DEV through to TEST and PROD. And I can see we will build up a library of solutions over time that we will want to pick and choose from for each customer.
You could potentially customise away in the default solution on your DEV server and ignore Solutions initially.
You will now have components back in your DEV environment that sit under the default solution and under your new solution. They actually exist only once and any changes are reflected under each Solution. The Solutions are just 2 different groups that the single set of components are attached to.
If you make changes to one of these components and then re-export the Solution you created(having first manually incremented its version # to 1.1) and then import that into the same destination environment as before, the import process will detect that this is an update to an existing solution.
You will get asked about how to handle any additional changes that might have been made in the destination environment to the components involved. You can keep those changes and ignore any conflicting changes coming in the import. Or you can indicate the import should win. I'm not sure whether that second option specifically delete all changes made or only when there is a conflict.
Unmanaged solutions can be deleted but the delete just removes the solution wrapper, the components remain.
Managed solutions can be deleted and in this case the delete will remove the components of the solution. Not sure what this means if the solution included changes to an existing entity, I assume those changes are undone.
If several versions of a managed solution are imported in the delete process removes all. It is more like an 'add remove programs' action then a 'rollback last service pack' action.
If we build up a library of corporate assets and store these as solutions how would these then fit into these deployment models? I guess they would be imported into the DEV environment and then get added to the outbound solution that you will deploy. This might mean your DEV environment has 10 little imported solutions and your TEST and PROD have a single managed solution. It feels a little unnatural to have a Solution architecture in DEV that differs from TEST and PROD, but I guess that's always been the way of custom development where you have source code and then compiled code, perhaps CRM is moving closer to that analogy? Or more likely, I haven't quite got my head around this quite right yet!
This entry was posted in Uncategorized and tagged 2011, crm, solutions on November 6, 2010 by Gareth Tucker.


RUTSHURU, Congo, Nov. 3 -- On Saturday morning, Congolese rebels drove through the muddy streets of this provincial town in eastern Congo, telling war-weary residents it was time they showed appreciation for their new leaders, the National Congress for the Defense of the People. It was unclear whether the rebels were offering much choice.
By noon, a raggedy parade of a few hundred people -- most of whom had fled the fighting here last week and only just returned home -- were shuffling behind a brass band blaring a rebel anthem. Children held up signs, most made from the same paper, with the same handwriting and the same slogan: "We are happy with CNDP," the rebel group's French initials.
"The soldiers came and announced for civilians to march," said one grim-faced man who declined to give his name. "People here are still afraid."
Having seized vast new swaths of eastern Congo, rebel leader Laurent Nkunda is embarking on a new phase of his campaign to "liberate" this mineral-rich central African nation the size of Western Europe. U.N. officials, aid workers and others here say he is forcing tens of thousands of displaced people to return to their homes behind rebel lines, where a kind of indoctrination is now underway as Nkunda seeks to expand his political base.
Massive camps that used to house thousands near here have been emptied and burned to the ground, according to U.N. officials who have described the humanitarian situation as "catastrophic."
The escalating tensions between the government and Nkunda, who has close ties to Rwanda, have drawn the attention of U.S. and European officials. On Monday, U.N. Secretary General Ban Ki-moon said he would meet with Congolese President Joseph Kabila and Rwandan President Paul Kagame as early as this weekend.
Ban said Monday that Kabila had indicated a willingness to heed Nkunda's request for direct talks. Nkunda has rejected a January peace deal that Western diplomats are still pushing as the basis for a resolution to the crisis.
Meanwhile, Nkunda is trying to exploit the lack of security he helped to create, urging people to return to areas now under his control.
"As you can see, this place is just peaceful," said Oscar Balinda, who described himself as a deputy foreign relations official in Nkunda's movement. He was sitting comfortably in an office that once belonged to provincial officials.
"The people of Rutshuru, they are grateful for the peace we've brought here," he said, adding that the rebels want aid groups to help people restart their lives, but not in camps. "We want to stabilize people in their places."
The parade here Saturday ended at a half-wrecked stadium, where tribal, political and military leaders who had recently joined Nkunda's movement gave speeches and sang the CNDP anthem to the crowd, who did not join in.
"Clap hands! Clap hands!" the emcee said, and after a pause, people began clapping.


A5 Does Your Mama Know About Me?
Orange label Hollywood first pressing.
"From Chicago, legendary birthplace of the urban blues style which became the sound of the Fifties and Sixties, the 21st Century arrives letting us know how tomorrow sounds today. The children of the Seventies have seen more of civilization and life than any previous generation. A song heard here by the 21st Century describes growing up with "a man on the moon and hippie communes" echoing the frustrations of young people who see themselves being handled a world they did not create; yet all the while their music speaks loudly with the joy of youth. Surrounded since birth by a sophisticated musical tradition, they have learned to sing with intensity and feeling about today and tomorrow. Listen ... and welcome to the 21st Century!"


Take a trip aboard the ISS with Neil deGrasse Tyson, Scott Kelly, Sasheer Zamata, Terry Virts, Jennifer Fogarty, and Bill Nye the Science Guy.
Chuck and Gary explore the ever-expanding world of data-driven analytics in the world of professional soccer, with Dan Altman and Howard Hamilton.
All you need to know about meteorites & meteorite hunting from host/astrobiologist David Grinspoon, co-host Chuck Nice & meteorite hunter Geoff Notkin.
Re-visit the past, present & future of NASA with Neil, Chuck & Ellen Stofan. Extended with Neil, Chuck & Dr. Sheyna Gifford talking interstellar exploration.
Gary O'Reilly and Chuck Nice go ultra as we explore ultra-running and ultramarathons with runner Ann Trason and Shawn Bearden a.k.a Dr. Ultra.
Dark matter, dark energy, and the mysteries of our universe – explore the darkness with Natalia Reagan, Andrea Jones-Rooy, and Astro Katie Mack!
Surf's up! Neil deGrasse Tyson, Kelly Slater, Chuck Nice, William Finnegan, Travis Schramek, Adam Fincham, and Bill Nye uncover the science of surfing.
Preview the epic match between Tiger Woods and Phil Mickelson with Chuck Nice, Gary O'Reilly, neuroscientist Heather Berlin and physicist John Eric Goff.
Find out how to communicate climate change with host and astrobiologist David Grinspoon, co-host Chuck Nice, and climate scientist Kate Marvel.
What Does the Future of Humanity Look Like? Find out Friday from Neil deGrasse Tyson and Sir Martin Rees.
What does the future hold? Neil Tyson, Maeve Higgins, and Sir Martin Rees explore where humanity is going, and how science will help us get there.
Gary O'Reilly and Chuck Nice take to the skies with Jim Clash, Jim Reed, and Kirby Chambliss as we explore the extreme flights of Red Bull Air Racing.
Go far, far away as we explore interstellar travel with Natalia Reagan, Harrison Greenbaum, Jana Grcevich, Ronke Olabisi, Kate Greene, and Jay Van Bavel.


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"Postcard sent from Adolf Kafka in Prague, Bohemia-Moravia, to the Litz"
Front: Red printed postcard lines and border. Includes black and purple stamps, and black handwritten addresses.Back: Message handwritten in black ink. Includes several underlined portions.
Information Provided by Michael D. Bulmash: At the time that this inquiry was sent, April 28, 1942, Litzmannstadt ghetto residents were forbidden to send mail to outsiders in an effort to prevent any news about the deportations to the extermination camp Chelmno (Kulmhof in German) from reaching the outside world. From mid-January to mid-May of 1942, 66 transports carried almost 55,000 Jews from this ghetto to Chelmno. Here they were gassed to death. The hand stamp on the left shows that this postcard was received at Hans Biebow's ghetto administration on May 1, 1942. Paul Kafka perished during the Shoah, as did Franz Kafka's sisters, and other members of the Kafka family.
"Postcard sent from Adolf Kafka in Prague, Bohemia-Moravia, to the Litzmannstadt Ghetto Mayor inquiring about a Dr. Paul Adolf Kafka" (1942). Bulmash Family Holocaust Collection. 2014.1.134.


text:
OPINION: Al Baghdadi and the Doctrine Behind the Name
By Farhang Jahanpour
When Ibrahim al-Badri al-Samarrai adopted the name of Abu-Bakr al-Baghdadi al-Husseini al-Quraishi and revealed himself to the world as the Amir al-Mu'minin (the Commander of the Faithful) Caliph Ibrahim of the self-proclaimed Islamic State, the whole world had to sit up and take notice of him.
Fears Rise of 'Taliban-Style' Justice in Syria
By Shelly Kittleson
Concerns are rising that courts run by Islamic clerics in many of Syria's rebel-held areas may serve as a prelude to Taliban-style justice in what was long a violently repressive but secular state.
Islamist Vigilantes Begin to Police Egypt
By Cam McGrath
As Egyptians debate how deeply Sharia should influence the new constitution, and in the face of clashes that left five dead on Wednesday, some extremists have taken to the streets to enforce their own interpretation of "God's law". In recent months, these self-appointed guardians of public probity have accosted Muslims and minority Christians they accuse of violating the provisions of Islamic law.
Adultery Laws Unfairly Target Women, U.N. Says
By Thalif Deen
When one of the Asian countries embraced Islamic Sharia law back in the 1990s, the rigidly conservative government threatened to enforce a provision that called for convicted adulterers to be stoned to death.


Joel Del Rosario | The Official "jDR" Page! | News : Awesome review from singer & show host Cres O'Neal!
Awesome review from singer & show host Cres O'Neal!
It's been an awesome week full of fantastic radio interviews and meeting new people. I'd like to thank all of you that have been so supportive of my latest release "Coast to Coast". It really has been exciting and yet humbling to hear all your fantastic comments! Thank You! I'd like to share a special CD review from my friend, singer, and radio host Cres O'Neal!
Joel's music is truly a gift from heaven. His powerful compositions coupled with his extraordinary playing ability sets his listeners up for an emotionally spiritual experience they will never forget. Yes folks, he goes there. His new CD Coast to Coast is sure to rock your world.
His previous CDs, All Him, and Calming the Storm, are still enjoyed by audiences all over the world. And, Coast to Coast is gaining full momentum in becoming another great hit for this musical genus from San Diego.
"Joel's music is truly a gift from heaven. His powerful compositions coupled with his extraordinary playing ability sets his listeners up for an emotionally spiritual experience they will never forget. Yes folks, he goes there. His new CD Coast to Coast is sure to rock your world.
His previous CDs, All Him, and Calming the Storm, are still enjoyed by audiences all over the world. And, Coast to Coast is gaining full momentum in becoming another great hit for this musical genius from San Francisco.
So, jump on board, and let Joel take you on a deep soulful journey with tunes such as Been Good to Me, Hey It's the Weekend, and of course his title song Coast to Coast."


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You are here: Home / News / Global Sustainable Development Report 2019: NINA Background Report on Biodiversity and Health
Global Sustainable Development Report 2019: NINA Background Report on Biodiversity and Health
Biodiversity and Human Health
During recent years, novel research has shown the wide spectrum of connections between biodiversity and human health: from mental to physical health, from microbial to the landscape level, from rural to urban contexts, from children and young adults throughout the lifespan into old age, and from individuals to groups of people – indeed, to humanity as a whole.
Recognized as a broad and well established research network with high-quality, societally relevant biodiversity research, ALTER-Net was invited by the UN Independent Group of Scientists to produce a Global Sustainable Development (SDG) background report on the state of the art on biodiversity-human health relationships. This report was spearhead by NINA, the Norwegian Institute for Nature Research.
This background report discusses the direct and indirect linkages and focuses the scattered knowledge through concrete cases where the biodiversity-health link has shown its power.
The key findings and key messages from the regional assessment for Europe and Central Asia of the inter-linkages between health and biodiversity are given in this background paper, as an overview of the main conclusions in this field. In addition, this paper highlights the links between biodiversity and health at various spatial and temporal scales, further elaborated upon in a diversity of cases. These cases, ranging from issues around microbiota, Asian bush mosquitos, forest and marine ecosystems, and biodiversity and health issues at a national scale, emphasise not only the diverse range of ways by which biodiversity can have an impact on health and social well-being, but also the importance of integrating the issue of biodiversity and health into our efforts to meet the Sustainable Development Goals by 2030. The first case on microbial biodiversity is directly linked to human health issues, and is also expected to have implications for the next generation.The current invasion of the Asian bush mosquito in Europe impairs physical health as the mosquito is a vector of various pathogens. Both forest and marine biodiversity are shown to affect a combination of physical and mental health, as well as social wellbeing and the'OneHealth/EcoHealth' approach is described in the national case from as a transdisciplinary effort to implement actions that promote adaptive health management across human, animal and ecosystem interfaces.
Van Dijk, J., Carss, D., Keune, H., Vikström, S., Flandroy, L., Rook, G., Haahtela, T.,Mehring, M., Birzle-Harder, B., Reuss, F., Müller, R., Luque, S. & Rodrigues, J.G. 2019.Invited background document on biodiversity and health for the Global SustainableDevelopment Report 2019 drafted by the Independent Group of Scientists. NINA Report1555. Norwegian Institute for Nature Research. ISBN: 978-82-426-3293-7
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