Assisted Mode Research Articles

Evaluating Force-based Haptics for Immersive Tangible Interactions with Surface Visualizations.

Haptic feedback provides an essential sensory stimulus crucial for interaction and analyzing three-dimensional spatio-temporal phenomena on surface visualizations. Given its ability to provide enhanced spatial perception and scene maneuverability, virtual reality (VR) catalyzes haptic interactions on surface visualizations. Various interaction modes, encompassing both mid-air and on-surface interactions-with or without the application of assisting force stimuli-have been explored using haptic force feedback devices. In this paper, we evaluate the use of on-surface and assisted on-surface haptic modes of interaction compared to a no-haptic interaction mode. A force-based haptic stylus is used for all three modalities; the on-surface mode uses collision based forces, whereas the assisted on-surface mode is accompanied by an additional snapping force. We conducted a within-subjects user study involving fundamental interaction tasks performed on surface visualizations. Keeping a consistent visual design across all three modes, our study incorporates tasks that require the localization of the highest, lowest, and random points on surfaces; and tasks that focus on brushing curves on surfaces with varying complexity and occlusion levels. Our findings show that participants took almost the same time to brush curves using all the interaction modes. They could draw smoother curves using the on-surface interaction modes compared to the no-haptic mode. However, the assisted on-surface mode provided better accuracy than the on-surface mode. The on-surface mode was slower in point localization, but the accuracy depended on the visual cues and occlusions associated with the tasks. Finally, we discuss participant feedback on using haptic force feedback as a tangible input modality and share takeaways to aid the design of haptics-based tangible interactions for surface visualizations.

Research on mode adjustment control strategy of upper limb rehabilitation robot based on fuzzy recognition of interaction force

In the process of robot-assisted training for upper limb rehabilitation, a passive training strategy is usually used for stroke patients with flaccid paralysis. In order to stimulate the patient's active rehabilitation willingness, the rehabilitation therapist will use the robot-assisted training strategy for patients who gradually have the ability to generate active force. This study proposed a motor function assessment technology for human upper-limb based on fuzzy recognition on interaction force and human-robot interaction control strategy based on assistance-as-needed. A passive training mode based on the calculated torque controller and an assisted training mode combined with the potential energy field were designed, and then the interactive force information collected by the three-dimensional force sensor during the training process was imported into the fuzzy inference system, the degree of active participation σ was proposed, and the corresponding assisted strategy algorithms were designed to realize the adaptive adjustment of the two modes. The significant correlation between the degree of active participation σ and the surface electromyography signals (sEMG) was found through the experiments, and the method had a shorter response time compared to a control strategy that only adjusted the mode through the magnitude of interaction force, making the robot safer during the training process.

Communal Poverty Is a Significant Risk Factor for Neonatal Seizures.

Neonatal seizures (NS) are a severe condition with significant mortality and long-term morbidity. This study aims to identify risk factors for NS in a racially or ethnically diverse population in Israel. This is a case-control study. The cases were all newborns born between 2001 and 2019 at Emek Medical Center in Israel and admitted with NS. Two healthy controls born in the same period were matched for each case. Demographic, maternal, and neonatal variables were abstracted from the electronic medical files. A total of 139 cases were matched with 278 controls. Residing in a town with lower socioeconomic status (SES), primiparity and abnormal prenatal ultrasound were significantly associated with NS. Prematurity, assisted delivery, a lower birthweight, being small for gestational age, and lower Apgar score were also associated with NS. In two different multivariable regression models, lower SES (odds ratio [OR] = 4.07) and Arab race/ethnicity (OR = 2.66) were risk factors for NS. Other significant risk factors in the multivariable regression models included an assisted mode of delivery (OR = 2.33), prematurity (OR = 2.27), and a 5-minute Apgar score below 7 (OR = 54.1). Communal poverty, as reflected by lower SES of towns of residence, was found to be a stronger risk factor than race or ethnicity, for NS. More studies should focus on social class, as a risk factor for maternal and neonatal adverse outcomes. As SES is a modifiable variable every effort should be invested in fighting communal poverty and improving the SES of impoverished towns and population.

Influence of Mechanical Ventilation Modes on the Efficacy of Nebulized Bronchodilators in the Treatment of Intubated Adult Patients with Obstructive Pulmonary Disease.

Little has been reported in terms of clinical outcomes to confirm the benefits of nebulized bronchodilators during mechanical ventilation (MV). Electrical Impedance Tomography (EIT) could be a valuable method to elucidate this gap. The purpose of this study is to evaluate the impact of nebulized bronchodilators during invasive MV with EIT by comparing three ventilation modes on the overall and regional lung ventilation and aeration in critically ill patients with obstructive pulmonary disease. A blind clinical trial in which eligible patients underwent nebulization with salbutamol sulfate (5 mg/1 mL) and ipratropium bromide (0.5 mg/2 mL) in the ventilation mode they were receiving. EIT evaluation was performed before and after the intervention. A joint and stratified analysis into ventilation mode groups was performed, with p < 0.05. Five of nineteen procedures occurred in controlled MV mode, seven in assisted mode and seven in spontaneous mode. In the intra-group analysis, the nebulization increased total ventilation in controlled (p = 0.04 and ⅆ = 2) and spontaneous (p = 0.01 and ⅆ = 1.5) MV modes. There was an increase in the dependent pulmonary region in assisted mode (p = 0.01 and ⅆ = 0.3) and in spontaneous mode (p = 0.02 and ⅆ = 1.6). There was no difference in the intergroup analysis. Nebulized bronchodilators reduce the aeration of non-dependent pulmonary regions and increase overall lung ventilation but there was no difference between the ventilation modes. As a limitation, it is important to note that the muscular effort in PSV and A/C PCV modes influences the impedance variation, and consequently the aeration and ventilation values. Thus, future studies are needed to evaluate this effort as well as the time on ventilator, time in UCI and other variables.

The influence of alcohol and automation on drivers’ visual behavior during test track driving

BackgroundDriving under the influence of alcohol severely increases crash risk. Impairment detection during driving is therefore key to improve traffic safety. However, future detection systems need to capture impairment for more reasons than alcohol intoxication and must also function in all driving modes (manual, assisted, autonomous). Driver Monitoring Systems (DMS) are promising candidates for such broader impairment detection. MethodA test track study investigated the effects of alcohol intoxication on drivers’ visual behavior both when just driving and when engaged in a non-driving related task. Twenty-six participants performed two drives: 1) sober baseline, 2) with a target blood alcohol concentration of 0.1%. The participants drove in either manual, assisted, or autonomous drive (AD) mode. ResultsIntoxication influenced glance behavior in all driving modes. It was most evident during visually demanding non-driving related tasks where it resulted in longer single and total off-path glance durations. Additionally, when just driving in manual mode, almost one third of the drivers displayed gaze concentration to the forward roadway when intoxicated. For sober driving, the difference in visual behavior between manual and assisted mode were moderate. In contrast, there was a huge shift towards longer off-path glances, lower percent road center, and lower off-path glance frequency in AD mode. ConclusionsIntoxication clearly affects drivers’ on/off road glance behavior. However, it is necessary to account for both driving mode and engagement in non-driving related tasks to reliably distinguish sober from drunk driving. Glance metrics has the potential to serve as a sub-set of indicators for a broader DMS-based detection of impaired driving, which can inform the decisions on when to activate in-vehicle countermeasures.

Autonomic heart rate modulation in patients with coronavirus disease 2019 in mechanical ventilation.

Patients with coronavirus disease 2019 on automatic mechanical ventilation have greater heart rate modulation with greater parasympathetic modulation. To analyze the autonomic modulation of heart rate in critically ill patients with coronavirus disease 2019 on invasive mechanical ventilation. A cross-section study was carried out with 36 individuals divided into two groups. The control group included patients of both genders, in orotracheal intubation with invasive mechanical ventilation under controlled assisted mode, hospitalized in the intensive care unit for another 24 h. In the non-COVID group, patients diagnosed with coronavirus disease 2019 in the same condition mentioned in the control group. There was a significant increase in heart rate variability (standard deviation of all normal RR intervals recorded at an interval of time; p=0.001; triangular interpolation histogram of RR intervals; p=0.048; and SD2; p=0.014) in the coronavirus disease group compared to the non-COVID group. Successively, the parameters that demonstrate parasympathetic modulation are shown to be higher in the group of patients with coronavirus disease 2019 (root mean square of the square of differences between adjacent normal RR intervals in an interval of time; p<0.001; pNN50; p<0.001; SD1; p=0.002; and high frequency; p=0.022). There was a greater autonomic modulation of heart rate with a greater parasympathetic modulation in patients with coronavirus disease 2019 on mechanical ventilation.

FNIRS-based brain functional response to robot-assisted training for upper-limb in stroke patients with hemiplegia.

Robot-assisted therapy (RAT) has received considerable attention in stroke motor rehabilitation. Characteristics of brain functional response associated with RAT would provide a theoretical basis for choosing the appropriate protocol for a patient. However, the cortical response induced by RAT remains to be fully elucidated due to the lack of dynamic brain functional assessment tools. To guide the implementation of clinical therapy, this study focused on the brain functional responses induced by RAT in patients with different degrees of motor impairment. A total of 32 stroke patients were classified into a low score group (severe impairment, n = 16) and a high score group (moderate impairment, n = 16) according to the motor function of the upper limb and then underwent RAT training in assistive mode with simultaneous cerebral haemodynamic measurement by functional near-infrared spectroscopy (fNIRS). Functional connectivity (FC) and the hemisphere autonomy index (HAI) were calculated based on the wavelet phase coherence among fNIRS signals covering bilateral prefrontal, motor and occipital areas. Specific cortical network response related to RAT was observed in patients with unilateral moderate-to-severe motor deficits in the subacute stage. Compared with patients with moderate dysfunction, patients with severe impairment showed a wide range of significant FC responses in the bilateral hemispheres induced by RAT with the assistive mode, especially task-related involvement of ipsilesional supplementary motor areas. Under assisted mode, RAT-related extensive cortical response in patients with severe dysfunction might contribute to brain functional organization during motor performance, which is considered the basic neural substrate of motor-related processes. In contrast, the limited cortical response related to RAT in patients with moderate dysfunction may indicate that the training intensity needs to be adjusted in time according to the brain functional state. fNIRS-based assessment of brain functional response assumes great importance for the customization of an appropriate protocol training in the clinical practice.

Hypoventilation and sleep hypercapnia in a case of congenital variant-like Rett syndrome

BackgroundBreathing disturbances are often a primary clinical concern especially during wakefulness of the classic form of Rett syndrome, but data for atypical forms are lacking.Case presentationWe report the case of a 20-month-old female affected by Rett syndrome with congenital variant-like onset, characterized by severe hypotonia and neurodevelopment impairment. She presented hypoventilation, persistent periodic breathing, and sustained desaturation during sleep, without obstructive or mixed events. Pulse oximetry and capnography during wakefulness were strictly normal. To the best of our knowledge, this is the first case of a patient affected by a congenital variant of Rett syndrome presenting sleep hypercapnia. Hypotonia may play a major role in the genesis of hypoventilation and hypoxemia in our patient. Non-invasive ventilation led to quality-of-life improvements.ConclusionsThus, we suggest screening patients with congenital-like Rett syndrome through transcutaneous bedtime carbon dioxide and oxygen monitoring. Moreover, assisted control mode was a breakthrough to achieve adequate ventilation in our case.

Financing format selection for electronic business platforms with a capital-constrained e-tailer

In today’s new stage of digitization, the rapid development of FinTech enables an increasing number of electronic business (EB) platforms to have access to providing financing services to capital-constrained e-tailers. This paper studies the EB-platform’s financing format preference for self-supported loan financing, assisted loan financing, and joint loan financing and investigates the multifaceted impacts of loan programs on the order quantity of e-tailer, the operational decisions of the EB-platform, as well as the whole supply chain performance. A multi-period game-theoretic model made up of one capital-constrained e-tailer (the follower), one bank (the sub-leader) and one EB-platform (the leader) is established wherein the EB-platform has a financing format option, and the bank determines the competitive interest rate. The analytical results indicate that if the opportunity cost of the EB-platform is greater than the one for the bank, then the EB-platform prefers to adopt either an assisted loan or a joint loan, rather than a self-supported loan for the e-tailer. Otherwise, the EB-platform provides the e-tailer with a self-supported loan or assisted loan. In particular, given the e-tailer’s relatively high procurement cost, the EB-platform may adopt an assisted loan mode. We also find that the appropriate financing format selection for the whole supply chain depends heavily on the interaction of the commission fee and the procurement cost. Further, a counter-intuitive finding is that under the assisted loan format, the EB-platform will also charge the bank a negative service fee when the unit commission fee is relatively high. In contrast, under the joint loan format, the EB-platform should not charge the service fee.

Traded and combined cooperative control of a smart wheelchair

AbstractThis article deals with a human–machine cooperative system for the control of a smart wheelchair for people with motor disabilities. The choice of a traded control mode is first argued. The paper then pursues two objectives. The first is to describe the design of the cooperative system by focusing on the dialogue and the interaction between the pilot and the robot. The second objective is to introduce a new cooperative mode. In this one, three features are proposed: two semi-autonomous features, a wall following and a doorway crossing, during which the user can intervene punctually to rectify a trajectory or a path, and an assisted mode where, conversely, the machine intervenes in a manual control to avoid obstacles. This mode of intervention of an entity, human or machine, supervising a movement controlled by the other is referred as “combined control.” Examples of scenarios exploiting the cooperative capabilities of the system are presented and discussed.

Automatic Sleep Scoring Using Intrinsic Mode Based on Interpretable Deep Neural Networks

Sleep experts manually label sleep stages via polysomnography (PSG) to diagnose sleep disorders. However, this process is time-consuming, requires a lot of labor from sleep experts, and makes the participants uncomfortable with the attachment of multiple sensors. Thus, automatic sleep scoring methods are essential for practical sleep monitoring in our daily lives. In this study, we propose an automatic sleep scoring model based on intrinsic oscillations in a single channel electroencephalogram (EEG) signal. We applied noise assisted bivariate empirical mode decomposition (NA-BEMD) to extract the intrinsic mode components and an attention mechanism in deep neural networks to provide weights to the components depending on their significance to sleep scoring. In particular, through the attention mechanism, we found an interpretable model by examining the oscillations that correspond to specific sleep stages. Therefore, we analyzed which frequency components are more weighted to a sleep stage than the others, when the model classifies sleep stages, and, as a result, confirmed that the model assigns convincing weights to the frequency components for each sleep stage. Additionally, the model consists of a one-dimensional convolutional neural network (1D-CNN) to extract features of an epoch and bidirectional long short-term memory (Bi-LSTM) to learn the sequential information of the consecutive epochs. We evaluated proposed model using Fpz-Cz, Pz-Oz, and F3-M2 channel EEG from three different public datasets (Sleep-EDF-2013, Sleep-EDF-2018, WSC) and demonstrated that our model yielded the best overall accuracy (Fpz-Cz: 86.22%-82.67%, Pz-Oz: 83.63%-80.15%, F3-M2: 84.20%) and macro F1-score (Fpz-Cz: 80.79%-76.90%, Pz-Oz: 76.89%-72.98%, F3-M2: 74.88%) compared with the state-of-the-art sleep scoring algorithms using single channel EEG. As a benchmark test, FIR bandpass filters were compared, and it was confirmed that NA-BEMD was superior to the traditional filters in all experiments, demonstrating that the proposed model is interpretable and a state-of-the-art sleep scoring algorithm.

Predictors for extubation failure in COVID-19 patients using a machine learning approach

IntroductionDetermining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19.MethodsWe used highly granular data from 3464 adult critically ill COVID patients in the multicenter Dutch Data Warehouse, including demographics, clinical observations, medications, fluid balance, laboratory values, vital signs, and data from life support devices. All intubated patients with at least one extubation attempt were eligible for analysis. Transferred patients, patients admitted for less than 24 h, and patients still admitted at the time of data extraction were excluded. Potential predictors were selected by a team of intensive care physicians. The primary and secondary outcomes were extubation without reintubation or death within the next 7 days and within 48 h, respectively. We trained and validated multiple machine learning algorithms using fivefold nested cross-validation. Predictor importance was estimated using Shapley additive explanations, while cutoff values for the relative probability of failed extubation were estimated through partial dependence plots.ResultsA total of 883 patients were included in the model derivation. The reintubation rate was 13.4% within 48 h and 18.9% at day 7, with a mortality rate of 0.6% and 1.0% respectively. The grandient-boost model performed best (area under the curve of 0.70) and was used to calculate predictor importance. Ventilatory characteristics and settings were the most important predictors. More specifically, a controlled mode duration longer than 4 days, a last fraction of inspired oxygen higher than 35%, a mean tidal volume per kg ideal body weight above 8 ml/kg in the day before extubation, and a shorter duration in assisted mode (< 2 days) compared to their median values. Additionally, a higher C-reactive protein and leukocyte count, a lower thrombocyte count, a lower Glasgow coma scale and a lower body mass index compared to their medians were associated with extubation failure.ConclusionThe most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. These predictors should therefore be routinely captured in electronic health records.

Effects of Different Levels of Variability and Pressure Support Ventilation on Lung Function in Patients With Mild–Moderate Acute Respiratory Distress Syndrome

Background: Variable pressure support ventilation (vPSV) is an assisted ventilation mode that varies the level of pressure support on a breath-by-breath basis to restore the physiological variability of breathing activity. We aimed to compare the effects of vPSV at different levels of variability and pressure support (ΔPS) in patients with acute respiratory distress syndrome (ARDS).Methods: This study was a crossover randomized clinical trial. We included patients with mild to moderate ARDS already ventilated in conventional pressure support ventilation (PSV). The study consisted of two blocks of interventions, and variability during vPSV was set as the coefficient of variation of the ΔPS level. In the first block, the effects of three levels of variability were tested at constant ΔPS: 0% (PSV0%, conventional PSV), 15% (vPSV15%), and 30% (vPSV30%). In the second block, two levels of variability (0% and variability set to achieve ±5 cmH2O variability) were tested at two ΔPS levels (baseline ΔPS and ΔPS reduced by 5 cmH2O from baseline). The following four ventilation strategies were tested in the second block: PSV with baseline ΔPS and 0% variability (PSVBL) or ±5 cmH2O variability (vPSVBL), PSV with ΔPS reduced by 5 cmH2O and 0% variability (PSV−5) or ±5 cmH2O variability (vPSV−5). Outcomes included gas exchange, respiratory mechanics, and patient-ventilator asynchronies.Results: The study enrolled 20 patients. In the first block of interventions, oxygenation and respiratory mechanics parameters did not differ between vPSV15% and vPSV30% compared with PSV0%. The variability of tidal volume (VT) was higher with vPSV15% and vPSV30% compared with PSV0%. The incidence of asynchronies and the variability of transpulmonary pressure (PL) were higher with vPSV30% compared with PSV0%. In the second block of interventions, different levels of pressure support with and without variability did not change oxygenation. The variability of VT and PL was higher with vPSV−5 compared with PSV−5, but not with vPSVBL compared with PSVBL.Conclusion: In patients with mild-moderate ARDS, the addition of variability did not improve oxygenation at different pressure support levels. Moreover, high variability levels were associated with worse patient-ventilator synchrony.Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT01683669.

Resonant-ring assisted large mode area segmented cladding fiber with high-index rings in core

This paper proposes a modified segmented cladding fiber with two-layer high-index rings in the core. The inner high-index ring helps to increase the loss ratio between the higher-order modes (HOMs) and the fundamental mode (FM) to achieve single-mode operation. The outer high-index ring is beneficial to improve the waist of the electric field distribution of the FM to enlarge the mode area. The simulation results show thanks to the joint defect of these two-layer high-index rings, the defect of the RR-SCF that cannot provide single-mode operation in all bending orientations is made up. Effective single-mode operation is achieved at a tight bending radius of 15 cm when the operating wavelength ranges from 1.06 μm to 1.58 μm. The mode area of the fiber operating at 1.06 μm is markedly enlarged to 835 μm2. This new fiber shows great potential in compact high-power fiber lasers and amplifiers.

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation.

Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation. In this ancillary study, patients were continuously monitored with a catheter measuring the electrical activity of the diaphragm. A method for automatic detection of reverse triggering using electrical activity of the diaphragm was developed in a derivation sample and validated in a subsequent sample. The authors assessed the predictive value of the software. In 39 recently intubated patients under assist-control ventilation, a 1-h recording obtained 24 h after intubation was used to determine the primary outcome of the study. The authors also compared patients' demographics, sedation depth, ventilation settings, and time to transition to assisted ventilation or extubation according to the median rate of reverse triggering. The positive and negative predictive value of the software for detecting reverse triggering were 0.74 (95% CI, 0.67 to 0.81) and 0.97 (95% CI, 0.96 to 0.98). Using a threshold of 1 μV of electrical activity to define diaphragm activation, median reverse triggering rate was 8% (range, 0.1 to 75), with 44% (17 of 39) of patients having greater than or equal to 10% of breaths with reverse triggering. Using a threshold of 3 μV, 26% (10 of 39) of patients had greater than or equal to 10% reverse triggering. Patients with more reverse triggering were more likely to progress to an assisted mode or extubation within the following 24 h (12 of 39 [68%]) vs. 7 of 20 [35%]; P = 0.039). Reverse triggering detection based on electrical activity of the diaphragm suggests that this asynchrony is highly prevalent at 24 h after intubation under assist-control ventilation. Reverse triggering seems to occur during the transition phase between deep sedation and the onset of patient triggering.

EL PERSONAL DE ENFERMERÍA EN LA APLICACIÓN DEL PROTOCOLO DE VENTILACIÓN MECÁNICA

La ventilación mecánica es un tratamiento de soporte vital, en el que se utiliza una máquina que suministra un soporte ventilatorio y oxigenatorio, facilitando el intercambio gaseoso y el trabajo respiratorio de los pacientes con insuficiencia respiratoria. Un protocolo es un documento que se desarrolla para orientar la toma de decisiones entorno a problemas específicos, ya sea como diagnosticar, tratar y cuidar a alguien con una afección específica. En este documento se describe si el personal de Enfermería aplica el Protocolo de Ventilación Mecánica propio de la unidad o del Ministerio de Salud Pública en la Unidad de Cuidados Intensivos. ). Por tal motivo resulta importante resaltar el papel que el personal de enfermería desempeña en las áreas de cuidados intensivos brindando la atención especializada e individualizada que requiere el paciente aportando a su progresiva recuperación El tipo de investigación realizada es de carácter observacional, de campo y prospectivo, Participaron en el estudio un total de 11 profesionales de enfermería del área de la Unidad de Cuidados Intensivos del Hospital Napoleón Dávila Córdova de Chone. De acuerdo con las encuestas realizadas el 100% del personal refiere que aplican el protocolo de Ventilación Mecánica del MSP, utilizando con mayor frecuencia el modo de ventilación mecánica asistida. Previo al procedimiento de ventilación mecánica el personal de enfermería aplica las debidas normas de bioseguridad. La implementación del protocolo del de VM invasiva y no invasiva al momento de realizar el procedimiento es esencial porque de esta manera se va a trabajar con una guía específica la cual evitará posibles complicaciones en la UCI.

Barriers and facilitators to implementation of serial point-of-care hearing tests using a novel iPad-based audiometry in platinum chemotherapy-treated cancer patients (pts).

223 Background: Platinum-based chemotherapy agents cause significant hearing loss in 40-80% of treated cancer pts. Lack of follow-up serial testing has created gaps in knowledge regarding hearing loss onset, progression, and possible recovery between treatment cycles. This study aims to determine barriers and facilitators to implementation of a tablet-based point-of-care hearing test, as a serial screening tool to address these knowledge gaps. Methods: From Jul 2019 to Mar 2020, 53 pts receiving high dose platinum agents were recruited from three clinics (Thoracic, head and neck, and testicular cancer) at a comprehensive cancer centre, to undergo serial audiometry testing. Baseline hearing tests, mid cycles (3,6, and 9 weeks), and post treatment tests (3,6,9,12, 19 and 24 months) were completed during the pts’ clinic appointments. Clinical research coordinators (CRCs) collected feedback from physicians, nurses, and pts to identify barriers and facilitators of implementing serial point-of-care hearing tests in these clinics. An inductive and iterative approach was used to identify themes. Implementation was tailored and mapped to the CIHR Knowledge to Action Framework (KTA). Results: Barriers: Logistical barriers included: locating quiet and accessible rooms to administer the test; pts being distracted or interrupted while completing the test; presence of family members adding to noise levels; concerns over the serial testing during treatment; length of each test; and clinic staff burden. Facilitators: User-friendly self-administered tests; increasing healthcare staff education and pt management. Adapting to the local context: Logistical barriers were resolved by CRCs designating quiet spaces for the study to occur, and meeting pts upon arrival to utilize their wait time. A ‘hearing test in progress’ sign put on exam room doors prevented interruptions. CRCs utilized the test’s ‘assisted mode’ feature to keep pts attentive and/or accelerate the process. Low noise level was emphasized to obtain accurate test results. Pt engagement in their test results facilitated retention in the study. Test length may be shortened in the future by omitting low frequency testing. Conclusions: Participants and stakeholders expressed support for in-clinic hearing tests and identified personal and systemic barriers to implementation. These findings suggest that implementation should focus on addressing concerns related to accessible rooms, pt time investment and overall clinic flow.

Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis

BackgroundPressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Whether PAV or PSV is superior for weaning remains unclear.MethodsEligible randomized controlled trials published before April 2020 were retrieved from databases. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs).ResultsSeven articles, involving 634 patients, met the selection criteria. Compared to PSV, PAV was associated with a significantly higher rate of weaning success (fixed-effect RR 1.16; 95% CI 1.07–1.26; I2 = 0.0%; trial sequential analysis-adjusted CI 1.03–1.30), and the trial sequential monitoring boundary for benefit was crossed. Compared to PSV, PAV was associated with a lower proportion of patients requiring reintubation (RR 0.49; 95% CI 0.28–0.87; I2 = 0%), a shorter ICU length of stay (MD − 1.58 (days), 95% CI − 2.68 to − 0.47; I2 = 0%), and a shorter mechanical ventilation duration (MD − 40.26 (hours); 95% CI − 66.67 to − 13.84; I2 = 0%). There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.42–1.06; I2 = 0%) or weaning duration (MD − 0.01 (hours); 95% CI − 1.30–1.28; I2 = 0%).ConclusionThe results of the meta-analysis suggest that PAV is superior to PSV in terms of weaning success, and the statistical power is confirmed using trial sequential analysis.Graphical abstract

Environmental and economic analysis of a photovoltaic assisted mixed mode solar dryer with thermal energy storage and exhaust air recirculation

Environmental and economic analysis of a photovoltaic assisted mixed mode solar dryer with thermal energy storage and exhaust air recirculation

Proportional modes of ventilation: technology to assist physiology.

Proportional modes of ventilation assist the patient by adapting to his/her effort, which contrasts with all other modes. The two proportional modes are referred to as neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation with load-adjustable gain factors (PAV+): they deliver inspiratory assist in proportion to the patient’s effort, and hence directly respond to changes in ventilatory needs. Due to their working principles, NAVA and PAV+ have the ability to provide self-adjusted lung and diaphragm-protective ventilation. As these proportional modes differ from ‘classical’ modes such as pressure support ventilation (PSV), setting the inspiratory assist level is often puzzling for clinicians at the bedside as it is not based on usual parameters such as tidal volumes and PaCO2 targets. This paper provides an in-depth overview of the working principles of NAVA and PAV+ and the physiological differences with PSV. Understanding these differences is fundamental for applying any assisted mode at the bedside. We review different methods for setting inspiratory assist during NAVA and PAV+ , and (future) indices for monitoring of patient effort. Last, differences with automated modes are mentioned.