Muireann McMahon

Social Sustainability in Design: Moving the Discussions Forward

Abstract This paper describes a Delphi Study conducted to begin filling the definitional deficits that exist in the discussions around social sustainability in design. The results from three rounds of the study opened a rich and multi-layered debate amongst a panel of experts from across the spectrum of design and sustainability. The paper opens by establishing a contextual background for the study and then follows with the delivery of the Delphi Study rounds and outcomes produced by the productive back and forth dialogue between researcher and experts. In conclusion, the paper presents a ‘living’ construct for social sustainability in design, as well as a framework of practical competencies designers should demonstrate to move the discussion in a more pragmatic direction.

Toward a Model of Human Information Processing for Decision-Making and Skill Acquisition in Laparoscopic Colorectal Surgery

OBJECTIVE To create a human information-processing model for laparoscopic surgery based on already established literature and primary research to enhance laparoscopic surgical education in this context. DESIGN We reviewed the literature for information-processing models most relevant to laparoscopic surgery. Our review highlighted the necessity for a model that accounts for dynamic environments, perception, allocation of attention resources between the actions of both hands of an operator, and skill acquisition and retention. The results of the literature review were augmented through intraoperative observations of 7 colorectal surgical procedures, supported by laparoscopic video analysis of 12 colorectal procedures. RESULTS The Wickens human information-processing model was selected as the most relevant theoretical model to which we make adaptions for this specific application. We expanded the perception subsystem of the model to involve all aspects of perception during laparoscopic surgery. We extended the decision-making system to include dynamic decision-making to account for case/patient-specific and surgeon-specific deviations. The response subsystem now includes dual-task performance and nontechnical skills, such as intraoperative communication. The memory subsystem is expanded to include skill acquisition and retention. CONCLUSIONS Surgical decision-making during laparoscopic surgery is the result of a highly complex series of processes influenced not only by the operators knowledge, but also patient anatomy and interaction with the surgical team. Newer developments in simulation-based education must focus on the theoretically supported elements and events that underpin skill acquisition and affect the cognitive abilities of novice surgeons. The proposed human information-processing model builds on established literature regarding information processing, accounting for a dynamic environment of laparoscopic surgery. This revised model may be used as a foundation for a model describing robotic surgery.

Health futures lab : transdisciplinary development of T shaped professionals through 'wicked problem' challenges

It is clear that differences in approach and enquiry are apparent between the established disciplines of Design, Engineering, Business and Health Sciences. The attempt to tackle Wicked Problems (Rittel and Webber 1973) is a challenge for universities and policy makers yet we are only beginning to appreciate the potential of transdisciplinary collaboration. This paper outlines a case study in a transdisciplinary education model which addressed some of the wicked problems of health and wellbeing of urban citizens, using Limerick city, Ireland as a test bed. The Health Futures Lab [HFL] was a pilot initiative that brought recent graduates of Interactive Media, Engineering, Product Design, Architecture, Economics, Marketing and Health Sciences together to apply their professional skills in a transdisciplinary manner. The lab ran for a five week period in the summer of 2014 and was situated in the city core. Facilitation and expert mentoring was given by university faculty, and a range of community advocates. This case study examines the benefits and challenges of transdisciplinary labs as a method for addressing complex social problems and provides an example of how graduates can use their specialist knowledge whilst collaborating across disciplines for maximum effect.

Retreating for Interdisciplinarity: The Case of the Health Research Futures Lab, Limerick

The need to develop interdisciplinary approaches to complex problems and societal challenges is evident across current and emerging policy within the EU. However, while interdisciplinarity is an important goal, the full potential of such an approach has yet to be realised. This chapter documents one approach to address the challenges of interdisciplinary working between researchers across AHSS and STEM, by charting one response to the dearth of work looking explicitly at the process of interdisciplinary working. It describes the design and implementation of the Health Research Futures Lab held in Limerick over 4 days in March/April 2016, which was based on a model of interdisciplinary research developed at the University of Limerick by an interdisciplinary group from the faculties of science, technology, engineering and mathematics (STEM), the Kemmy Business School and the Irish World Academy of Music and Dance (AHSS). In this chapter the design principles of the HRFL will be explained and explored in terms of their contribution to knowledge in the field of interdisciplinary research and the support they can bring. Key dimensions will be elaborated upon, including the use of design tools to enable researchers to identify and explore research ideas together; the retreat dimension, which meant that researchers worked over 2×48 h time frames researching, eating and socialising together as a means to develop community; and finally, the use of experiential exercises throughout the early stages of the workshop, which aimed to enable trust and build social ties.

Mechanical characterisation of porcine non-intestinal colorectal tissues for innovation in surgical instrument design

This article presents an investigation into the mechanical properties of porcine mesocolon, small intestinal mesentery, fascia, and peritoneum tissues to generate a preliminary database of the mechanical characteristics of these tissues as surrogates for human tissue. No study has mechanically characterised porcine tissue correlates of the mesentery and associated structures. The samples were tested to determine the strength, stretch at failure, and stiffness of each tissue. The results indicated that porcine mesenteric and associated tissues visually resembled corresponding human tissues and had similar tactile characteristics, according to an expert colorectal surgeon. Stiffness values ranged from 0.088 MPa to 6.858 MPa across all tissues, with fascia being the weakest, and mesentery and peritoneum being the strongest. Failure stress values ranged from 0.336 MPa to 6.517 MPa, and failure stretch values ranged from 1.766 to 3.176, across all tissues. These mechanical data can serve as reference baseline data upon which future work can expand.

3D modelling of non-intestinal colorectal anatomy

AbstractPurposeThere is a paucity of methods to model soft anatomical tissues. Accurate modelling of these tissues can be difficult with current medical imaging technology. MethodsThe aim of this research was to develop a methodology to model non-intestinal colorectal tissues that are not readily identifiable radiologically to enhance contextual understanding of these tissues and inform medical device design. The models created were used to inform the design of a novel medical device to separate the mesocolon from the retroperitoneum during resection of the colon. We modelled the peritoneum and the mesentery. The mesentery was used to indicate the location of Toldt’s fascia.ResultsWe generated a point cloud dataset using cryosection images as the target anatomy is more visible than in CT or MRI images. The thickness of the mesentery could not be accurately determined as point cloud data do not have thickness. A denser point cloud detailing the mesenteric boundaries could be used to address this.ConclusionsExpert anatomical and surgical insight and point cloud data modelling methods can be used to model soft tissues. This research enhances the overall understanding of the mesentery and Toldt’s fascia in the human specimen which is necessary for medical device innovations for colorectal surgical procedures.

A study of laparoscopic instrument use during colorectal surgery

The aim of this study was to quantify laparoscopic instrument use and actions of both limbs during a sample of common colorectal surgical procedures. A method was devised using Observer XT software to code video recordings. Anonymised HD video recordings of nine laparoscopic colorectal procedures performed by a single surgeon were analysed. We determined the percentage and frequency of instrument use and limb actions throughout the total laparoscopic surgical duration, as well as the duration of instrument inactivity. Seven instruments and seven actions were studied across nine surgical procedures. Manoeuvring, blunt dissection, and tenting up tissues accounted for the longest amount of total surgical time (non-dominant hand (NDH) 29%, dominant hand (DH) 39%), followed by grasping (NDH 33%, DH 9%), and cauterising (NDH <0.2%, DH 8%). Least time was spent performing other actions such as suction/irrigation (NDH 0.01%, DH 3%) and stapling colorectal tissue (NDH 0.03%, DH 0.5%). The total duration of instrument use and hand actions by the dominant and non-dominant hands were similar overall. However, the frequency of actions performed was lower for the non-dominant hand. This indicates that the non-dominant hand spent more time holding actions than switching between actions, supporting the actions of the dominant hand. These findings highlight the lengthy durations of laparoscopic surgical procedures involved in navigating to anatomical planes and moving tissues. Further, the results detail the extent of secondary functions performed with the surgical instruments.

Assessing Instrument Usage Patterns in Multiple Long Duration Colorectal Surgical Proceduresto Categorise Decisions Made by Surgeons and Elicit Specific Design Needs

The aims of this study are twofold: firstly to apply a method of categorizing surgical instrument use during long duration laparoscopic procedures, and secondly to validate this method by applying it to multiple instances of a single procedure. Case studies were performed on several separate high definition recordings of laparoscopic sigmoid colectomy procedures to assess the actions performed by the surgeon. The Observer XT V11.0(Noldus 2011) software package was used to study specific instrument usage, the actions associated with each instrument, idle behavior time and instrument changeover times. The Observer XT V11.0 software package was an effective method of categorizing the actions during the procedure. The data from the case studies indicated that for this specific right handed operator, the right hand led the procedure, using the most instruments and separate actions. The left hand provided support through actions such as grasping and maneuvering only. The most used instrument was the suction/irrigation instrument, followed by the grasping instruments. Key operations such as stapling/dissecting occupied the least amount of time. More time was spent maneuvering the internal anatomy than mobilizing the sigmoid colon or creating an anastomosis or stoma. Once the actions of each hand during each procedure were categorized, high level statistical analyses were applied to the data. It was necessary to perform these analyses to normalize the data as each part of the laparoscopic sigmoid colectomy procedure utilized different instruments for different durations. The future applications of this work lie in the innovation of new instruments or approaches to laparoscopic surgery. In these case studies, more time was spent navigating to the surgery site than performing the mobilization of the colon. There would appear to be a previously unmet clinical need to innovate new approaches to this type of surgery to shorten the duration of the surgery while preserving or improving the clinical outcome for the patient. More case studies are needed to confirm the validity of this claim.

Creating Biofidelic Phantom Anatomies of the Colorectal Region for Innovations in Colorectal Surgery

The aim of this research was to develop a replicated colorectal region for use in laparoscopic instrument innovation.Testing of both surgical skills and laparoscopic surgical instruments takes place in a controlled lab setting. Cadaverous tissue or laparoscopic simulators are the tools of choice for skill testing.However, in the instance of colorectal surgery, porcine intestines remain the gold standard for laparoscopic testing(Lamata et al. 2004). There exists data in current literature which discuss the use of anatomical simulators (also known as simulator boxes) for both researching surgical methods, and testing laparoscopic instruments. There is little focus in the literature on the materials used to create surrogate environments which mimic those of the real world. Simulator boxes exist, and are of high fidelity, but can be quite cumbersome, with some being left in storage areas indefinitely, with some remaining inaccessible for many centers around the world. There are also many peripheral devices which need to accompany these simulators, such as laparoscopes and external monitoring equipment for recording and review. As they are highly specialized pieces of research equipment, in the majority of cases, they are not designed to be portable or readily reconfigurable. These limitations make high end laparoscopic simulators inappropriate choices for early stage HFE (Human Factors Engineering) studies.The authors propose the creation of a laparoscopic simulator which contains anatomically accurate, 3D printed colorectal sections for use in both surgical training and instrument innovation. The colon is modeled from high quality CT data in DICOM format, using the Material Mimics Innovation Suite (Materialise, 2013). By creating virtual models of the internal anatomical structure of the colorectal region, it allows for a more accurate depiction of the anatomy encountered in a surgical setting. A maximum level of realism is required for a simulator to be effective(Lamata et al. 2004).The future application of this work lies in the validation of the 3D printed anatomy which will lead to innovation of new instruments or approaches to laparoscopic surgery.