Unit Discharge Research Articles

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report.

Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation. A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated. The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100). The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83. This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.

Optimizing active chilled beam systems in the South Korean Climate: Comparative analysis of cooling energy and thermal comfort by set-point temperature

In this study, the feasibility of implementing the active chilled beam system (ACBS) in South Korea has been analyzed, and an appropriate control strategy has been proposed. While ACBS is increasingly adopted in North America and Europe, its spread in South Korea has been slow due to different climatic characteristics and a lack of diverse understanding and analysis. Furthermore, research discussing the effects of key system parameters on ACBS is notably scarce. Therefore, this study aims to assess the impact of air handling unit discharge air temperature (AHU DAT) and ACBS entering chilled water temperature (ACBS ECWT) on ACBS and propose a control strategy suitable for the South Korean climate. The applicability of ACBS, compared with existing HVAC systems using this control strategy, has been evaluated. The study incorporates two methodologies: firstly, the impact of control variables has been assessed, and a suitable control strategy has been proposed through a sensitivity analysis of these variables. Secondly, the feasibility of applying ACBS, in comparison with conventional HVAC systems, has been evaluated from the perspectives of energy and thermal comfort. It has been found that system parameters, tailored for the South Korean climate, can maintain a level of thermal comfort like existing HVAC systems while achieving up to 18% in energy savings. Overall, this research not only demonstrates the potential applicability of ACBS in hot and humid climates like South Korea but also emphasizes the need for controlling key system parameters

First Clinical Application of Aztreonam–Avibactam in Treating Carbapenem-Resistant Enterobacterales: Insights from Therapeutic Drug Monitoring and Pharmacokinetic Simulations

Background: A novel fixed combination of aztreonam (ATM) and avibactam (AVI) offers promising potential to treat infections with carbapenem-resistant Enterobacterales (CRE) producing metallo-β-lactamases (MBL). This study aimed to assess the accuracy of population pharmacokinetic (PK) models for ATM-AVI in predicting in vivo concentrations in a critically ill patient with CRE infection during its first clinical use. Methods: A 70-year-old male with septic shock due to hospital-acquired pneumonia (HAP) caused by MBL-producing Klebsiella pneumoniae was treated with ATM-AVI. Trough and peak serum concentrations (32 samples over 7 days) were measured using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Population PK models were used to simulate complete concentration–time profiles. Bland–Altman analysis assessed model performance by comparing predicted and measured concentrations. Results: Median ATM trough concentrations (18.4 mg/L) remained above the minimum inhibitory concentration (MIC) of 1 mg/L for the pathogen. The Bland–Altman analysis demonstrated reasonable agreement between predicted and observed concentrations, with a relative bias (rBias) of −50.5% for ATM and −14.4% for AVI. ATM-AVI ratios remained stable. Clinical improvement and sterile blood cultures within 12 days led to intensive care unit (ICU) discharge. Conclusions: Population PK models for ATM-AVI accurately predicted in vivo concentrations in a severely ill patient with HAP. Therapeutic drug monitoring (TDM) with PK modeling ensured optimal antimicrobial exposure and contributed to clinical recovery.

Motor unit discharge rates and acute intermittent hypoxia: the other half of the force equation.

Motor unit discharge rates and acute intermittent hypoxia: the other half of the force equation.

Predictors for length of stay after surgical aortic valve replacement.

Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement. Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed. Upon multivariable linear regression, endocarditis [regression coefficient (β) 2.98; 95% confidence interval (CI) 1.51, 4.45; p<0.001)] and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p=0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p=0.001) as well as chronic obstructive pulmonary disease (β 1.61; 95% CI 0.66, 2.55; p=0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p=0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p=0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p=0.006). Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and chronic obstructive pulmonary disease. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

Greater motor unit discharge rate during rapid contractions in chronically strength-trained individuals.

Though similar motor unit (MU) discharge properties have been observed during slow sustained contractions between chronically strength-trained (ST) and untrained (UT) individuals, it is currently unknown if differences between these groups exist for when maximal in vivo MU discharge rate is assessed during rapid, maximal rate of force development (RFD) contractions. Therefore, we compared MU discharge characteristics and RFD during rapid contractions in chronic ST and UT individuals. The investigations were performed in two independent cohorts of chronically ST men, with trained elbow flexors (Experiment 1, n=13, 6±4 years of training experience) or knee extensors (Experiment 2, n=11, 9±4 years of experience), and compared with those of UT (n=12 and n=10, respectively). ST individuals had greater absolute elbow flexion and knee extension RFD throughout the first 150 ms of rapid contractions compared to UT, but this difference was absent for relative RFD. ST exhibited higher initial MU discharge rate in both biceps brachii (74 [68, 80] vs. 56 [50, 63] pps, p<0.0001) and vastus lateralis (102 [90, 115] vs. 76 [63, 90] pps, p=0.0025) and a greater average number of MU discharges per second in both trained muscles in the early phase of rapid contractions. We provide novel evidence for a higher maximal MU discharge rate in strength-trained individuals. Interestingly, despite the augmented output of the spinal cord, no differences in relative RFD were observed, which suggests either greater maximal force enhancement of ST compared to UT and/or slowing of the intrinsic contractile properties by prolonged strength training.

A New Type of Pre-Aeration Stepped Spillway

Aiming to increase energy dissipation and prevent the cavitation potential of a traditional stepped spillway (TSS) at large unit discharges, a kind of pre-aeration stepped spillway, called a hydraulic-jump-stepped spillway (HJSS), is introduced in this paper. Unlike a TSS, a basin added upstream of the stepped chute in the HJSS plays a vital role in the hydraulic performance owing to the formation of a hydraulic jump in the basin. This paper presents experimental research on the hydraulic performance of the HJSS in comparison to a TSS with the same chute slope (θ = 39.3°) for a wide range of unit discharges, including the flow pattern, energy dissipation, pre-aeration effect, and maximum splash height. The results showed that the HJSS corresponded to a large energy dissipation rate, the air was effectively entrained at the inlet of the stepped chute, and there was an observation of splash formation in the foregoing and downstream steps. Under large unit discharges, the HJSS maintained an energy dissipation rate exceeding 80%. Additionally, at the inlet, the air concentrations reached 4.5% on the bottom and 11.2% on the sidewall. The findings of this research could be used as a general guideline for stepped spillway design with large unit discharges.

Impact of an Acute Care Surgery Clinical Pathway on Patient Outcomes in Acute Appendicitis.

Objectives: Acute care surgery (ACS) encompasses surgical critical care, emergency general surgery, and the surgical management of trauma. Following ACS implementation at our institution, we developed a perioperative clinical pathway for acute appendicitis (AA) to improve efficiency and standardize post-operative care. The purpose of our study is to assess patient outcomes utilizing our ACS clinical pathway for patients with AA. Methods: This is a retrospective cohort study involving patients admitted to our tertiary care facility with AA who underwent appendectomy. Patients were classified by pre-implementation (January 1, 2016-July 31, 2018) and post-implementation (August 1, 2018-December 31, 2020) of our ACS clinical pathway. The primary outcome was hospital length of stay (LOS). Statistical analysis was performed using SAS with a p-value <0.05 determined as significant. Results: Of the 492 patients included, 225 were in the pre- and 267 were in the post-implementation cohorts. Hospital LOS was substantially decreased in the post-implementation cohort (31.2 vs. 50.4 h, p < 0.001). The post-implementation group had a substantial decrease in computed tomography (CT) to operating room (OR) start time (6.81 vs. 11.4 h, p < 0.001), CT to antibiotic agents' administration (2.20 vs. 3.37 h, p < 0.001), inpatient opioid utilization (125 morphine equivalents [ME] vs. 172 ME, p < 0.001), and discharge antibiotic agents' prescription rates (23.6% vs. 30.7%, p = 0.077). Recovery unit discharges (20 vs. 9%, p < 0.001) were increased in the post-implementation cohort. Conclusion: Our ACS clinical pathway for AA resulted in earlier surgical intervention, enhanced opioid and antimicrobial stewardship, and gains in surgical care efficiencies.

Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial.

Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients' short-term physical function. Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (≥65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95% CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (≥65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ≥5 versus <5), and sex (male versus female). CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830. RR1-10.2196/54451.

Growth trajectory at 24 months of preterm infants after discharge: a longitudinal study in Indonesia.

Maintaining optimal growth of preterm infants after hospital discharge remains a challenge. There has been no data on the long-term growth trajectory of preterm infants in Indonesia. We aimed to describe the growth trajectory of preterm infants up to 24 months of corrected age and its variation among gestational age groups. A longitudinal study was conducted in Cipto Mangunkusumo Hospital, Jakarta, from 2018 to 2020. All preterm infants who were discharged during the study period were included. Growth trajectory analysis used weight-for-age, length-for-ageand weight-for-length z-score of 3-month time intervals across gestational age groups using repeated measure ANOVA and generalised estimating equation regression. Length trajectory was specifically reported as a stunted proportion. Among 306 preterm infants included, most were moderate preterm (49·67 %) and low birth weight (69·93 %). Overall weight-for-age at 0 months was in the median of the curve, then decreased at 3 months but consistently increased slowly until 24 months. The weight-for-age trends were unique across gestational age groups but statistically similar (P= 0·263). The proportion of stunted gradually decreases to 13·40 % at 24 months, mostly among the moderate preterm group in the first 6 months (P< 0·001), but then becomes similar at 24 months. All subjects were in the normal range for weight-for-length but had variations in trends across gestational age groups (P< 0·001). Growth trajectory differed between weight, length and weight-for-length in the first 24 months and varied among gestational age groups. Close follow-up is crucial to ensure optimal growth after neonatal intensive care unit discharge.

NSE and S100β as serum alarmins in predicting neurological outcomes after cardiac arrest

Cardiac arrest (CA) is a serious health concern that often results in mortality or severe neurological dysfunction in the case of survival. Our aim was to explore the neurological prognostic factors in patients with CA. This retrospective observational study included adult patients with CA. We investigated serum neuron-specific enolase (NSE), S100 calcium-binding protein β (S100β), and indices and parameters at 1, 3, 5, 7 and intensive care unit (ICU) discharge days after CA. The primary study endpoint was the Cerebral Performance Category (CPC) scale score at ICU discharge, which was dichotomized as good neurological outcome (CPC 1–2: full recovery or moderate disability) and poor neurological outcome (CPC 3–5: severe disability, vegetative state, or death). Of the 191 adult patients with CA, 42 (22%) had good neurological outcomes, and 149 (78%) had poor neurological outcomes. NSE at 1,3,5,7 and ICU discharge days showed excellent predictive accuracy for neurological outcomes (area under the curve [AUC]: 0.666, 0.716, 0.870, 0.739, and 0.901, respectively). However, S100β exhibited general predictive power (AUC: 0.666, 0.573, 0.607, 0.594, 0.727). Finally, the early warning model, which combined day 1 NSE, day 1 S100β, cardiac arrest time, SOFA scores, APACHE II scores, and age, was used to screen CA patients with poor neurological prognosis at early stages and had an AUC of 0.792. Serum concentrations of NSE and S100β were significantly elevated in CA patients and could be prognostic biomarkers to predict neurological outcomes. Day 1 NSE and S100β combined with multiple indicators could be a decent early warning model for poor neurological prognosis in patients with CA.

A comparison of electromyography techniques: surface versus intramuscular recording.

This review is a comprehensive guide for electromyography (EMG) researchers, providing a comparison of skin EMG recording (surface EMG: sEMG and high-density sEMG: HD-sEMG) and intramuscular EMG recording (multi-motor unit-MMU and single motor unit electromyography-SMU). We delve into the nuances of techniques, highlighting their strengths and limitations in quantifying muscle activation during dynamic and static conditions. We first examine how EMG signals change with time, focussing on the interplay between motor unit synchronisation and signal amplitude. The review then explores the impact of electrode placement on signal quality. We further discuss the challenges of signal cancellation, crosstalk from neighbouring muscles, and motion artifacts, which can significantly affect signal integrity. Finally, we address the temporal changes in electrode impedance and its implications for data interpretation. Our analysis proposes that specific research objectives should guide the choice amongst sEMG, HD-sEMG, SMU and MMU. MMU, which records the peak counts of individual motor unit action potentials from a localised muscle area, is particularly suited for studying deep or small muscles during static and dynamic activities. Its high sensitivity to motor unit recruitment and discharge rates minimises the impact of factors such as signal cancellation and motion artefacts. Conversely, sEMG is well-suited for short-duration, isometric assessments of large, superficial muscles. HD-sEMG helps study single motor unit properties under isometric conditions. SMU is particularly suited for studying neuronal networks between stimulated sites and motor neurons. This review aims toprovideresearchers with the information to select the most appropriate EMG technique for their investigations.

Epidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.

Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes. This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis. Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001). One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients.

Spinal cord stimulation (SCS) represents an established interventional pain therapeutic; however, the SCS effects of SCS waveforms on motor neuron recruitment of the lower limbs of chronic pain patients remain largely unknown. We investigated these effects by performing isometric ankle-dorsal flexions at varying force levels under four SCS conditions: SCS Off (1week), burst SCS (40Hz), SCS Off (acute), and tonic SCS (130Hz). Muscle activity was recorded via high-density surface electromyography (64-electrode grid) on the tibialis anterior muscle. Motor unit action (MUs) potentials were analyzed for recruitment and de-recruitment thresholds, discharge rate, inter-spike interval, and common synaptic input. In this prospective study, we included nine patients (five females; four males; mean age 59years) with chronic pain treated with thoracic (Th7-Th8) epidural spinal stimulation. A total of 97 MUs were found for 15% maximal voluntary torque (MVT) and 83 for 30%MVT, an average of 10.8±3.7 for 15%MVT and 10.4±3.5 for 30%MVT. While a few subject-specific variations were observed, our study suggests that the different SCS frequencies applied do not significantly influence motor unit discharge characteristics in the TA muscle among the participants (p values at 15%MVT were 0.586 (Chi2=1.933), 0.737 (Chi2=1.267), 0.706 (Chi2=1.4) and 0.586 (Chi2=1.933), respectively. The p values of the Friedman test at 30%MVT were 0.896 (Chi2=0.6), 0.583 (Chi2=1.95), 0.896 (Chi2=0.6) and 0.256 (Chi2=4.05). No significant difference was found for the different stimulation types for the delta (0-5Hz), alpha (5-12Hz), and beta (15-30Hz) bands at both force levels. In summary, we did not observe any changes in motor unit oscillatory activity at any low and high bandwidths, indicating that SCS using different waveforms (tonic/burst) does not significantly influence motor neuron recruitment for non-motor individuals with chronic pain.

Analysis of extremely low water hammer pressures of draft tubes for double units in pumped storage power stations under successive load rejection conditions

With large-scale integration of intermittent energy into power systems, the operating conditions of pumped storage power stations (PSPSs) change frequently, thereby intensifying the risk of load rejections. For multiple units sharing a water conveyance system, when one or more units reject the load, other units also reject the load after a few seconds; this is defined as successive load rejection (SLR). During SLR conditions, pumped storage units produce extreme water hammer pressures, jeopardizing the safe operation of PSPSs. This study reveals the generation mechanism of extremely low draft tube pressure (DTP) during SLR, and clarifies the generating unit and corresponding occurrence moment characteristics of the minimum DTP. The results indicated an extremely low DTP, attributed to the sharp decline in the discharge owing to increased rotational speed in unit's S-shape region and the hydraulic interference owing to the increased discharge of the other unit. When the guide vane closing time (GVCT) was short, the minimum DTP occurred in the subsequent load rejection unit (SLRU) near the first peak of its rotational speed, with the discharge of initial load rejection unit (ILRU) in the rising stage. Conversely, for a large GVCT, the minimum DTP occurred in the ILRU near the second peak of its rotational speed, with SLRU discharge in the rising stage. Finally, engineering measures to improve the extremely low DTP were proposed. Overall, the findings underscore crucial engineering insights for ensuring the safety of PSPSs under extreme conditions.

Chronic kidney disease associated with extremely premature birth and extremely low birth weight may progress through the burden of growth.

Chronic kidney disease associated with low birth weight and/or premature birth (L/P-CKD) in infants may result from a decreased number of nephrons at birth. These infants may develop acute kidney injury due to exposure to nephrotoxic substances or other events during nephrogenesis in early infancy. Nonetheless, L/P-CKD progression remains unclear. We present three cases of L/P-CKD diagnosed after neonatal intensive care unit (NICU) discharge. Three patients were born extremely prematurely (gestational age, 24-26weeks) with extremely low birth weight (606-906g). They were admitted to the NICU (117-311days) anad received several nephrotoxic medications during the early postnatal period. They showed elevated serum creatinine levels at 4weeks after birth, which decreased to normal levels at NICU discharge. Proteinuria was first detected during adolescence (10-15years) on annual school urine screening, with a remarkable increase in their height (18 - 50.8cm), without known episodes of urinary tract infection, dehydration, lifestyle-related issues, such as excessive salt/protein intake, and extreme lack of exercise that might have caused kidney damage. Their kidneys were smaller than normal on renal ultrasonography. Open renal biopsy findings indicated glomerulomegaly and perihilar glomerulosclerosis in two of the three patients, suggesting glomerular hypertension. The remarkable differences between the body height before CKD and the timing of diagnosis of CKD could contribute to the progress of CKD. Long-term follow-up of low birth weight and extremely premature infants, from NICU discharge until adulthood, should be established.

Assessing the impact of degree of fusion and muscle fibre twitch shape variation on the accuracy of motor unit discharge time identification from ultrasound images

ObjectiveUltrasound (US) images during a muscle contraction can be decoded into individual motor unit (MU) activity, i.e., trains of neural discharges from the spinal cord. However, current decoding algorithms assume a stationary mixing matrix, i.e. equal mechanical twitches at each discharge. This study aimed to investigate the accuracy of these approaches in non-ideal conditions when the mechanical twitches in response to neural discharges vary over time and are partially fused in tetanic contractions. MethodsWe performed an in silico experiment to study the decomposition accuracy for changes in simulation parameters, including the twitch waveforms, spatial territories, and motoneuron-driven activity. Then, we explored the consistency of the in silico findings with an in vivo experiment on the tibialis anterior muscle at varying contraction forces. ResultsA large population of MU spike trains across different excitatory drives, and noise levels could be identified. The identified MUs with varying twitch waveforms resulted in varying amplitudes of the estimated sources correlated with the ground truth twitch amplitudes. The identified spike trains had a wide range of firing rates, and the later recruited MUs with larger twitch amplitudes were easier to identify than those with small amplitudes. Finally, the in silico and in vivo results were consistent, and the method could identify MU spike trains in US images at least up to 40% of the maximal voluntary contraction force. ConclusionThe decoding method was accurate irrespective of the varying twitch-like shapes or the degree of twitch fusion, indicating robustness, important for neural interfacing applications.

Is an Exclusive Human Milk Diet at the Time of Neonatal Intensive Care Unit Discharge Adequate to Maintain Growth and Neurodevelopment among Very Preterm Infants?

Background: An exclusive human milk (EHM) diet has numerous benefits. Formula supplementation may be recommended for former preterm infants at the time of neonatal intensive care unit (NICU) discharge to meet perceived metabolic demands and caloric goals. Recommendations addressing postdischarge nutrition for very preterm infants (VPTIs) are controversial, as the benefits of human milk supplementation regarding long-term growth, neurodevelopment, and chronic conditions are mixed. Objective: To compare growth and neurodevelopment of former VPTI fed an EHM diet to a supplemented/formula diet at NICU discharge. Materials and Methods: A retrospective cohort study of VPTI was followed at the Regional Neonatal Follow-up Program. Patients were categorized by diet at NICU discharge: EHM diet; mixed diet (EHM and formula); and exclusive formula diet. Growth percentile ranks at the first neonatal follow-up visit and 3 years of age were compared by diet type at NICU discharge. Neurodevelopmental outcomes as measured by the Bayley Scales of Infant Development 3rd Edition at 3 years of age were also compared. Results: Among 835 VPTIs, weight percentiles at the first neonatal follow-up visit were similar between the three NICU discharge diet types. One hundred fifty-eight subjects received neurodevelopmental evaluations at 3 years of age; anthropometrics and neurodevelopment were similar irrespective of diet at NICU discharge. Conclusion: An EHM diet at NICU discharge is appropriate to support growth in infancy as well as growth and neurodevelopment through 3 years of age. Thus, this raises the question of whether routine nutritional supplementation is necessary for VPTIs at NICU discharge.

Using augmented intelligence to improve long term outcomes.

For augmented intelligence (AI) tools to realize their potential, critical care clinicians must ensure they are designed to improve long-term outcomes. This overview is intended to align professionals with the state-of-the art of AI. Many AI tools are undergoing preliminary assessment of their ability to support the care of survivors and their caregivers at multiple time points after intensive care unit (ICU) discharge. The domains being studied include early identification of deterioration (physiological, mental), management of impaired physical functioning, pain, sleep and sexual dysfunction, improving nutrition and communication, and screening and treatment of cognitive impairment and mental health disorders.Several technologies are already being marketed and many more are in various stages of development. These technologies mostly still require clinical trials outcome testing. However, lacking a formal regulatory approval process, some are already in use. Plans for long-term management of ICU survivors must account for the development of a holistic follow-up system that incorporates AI across multiple platforms. A tiered post-ICU screening program may be established wherein AI tools managed by ICU follow-up clinics provide appropriate assistance without human intervention in cases with less pathology and refer severe cases to expert treatment.

Mental health screening for parents following surgical neonatal intensive care unit (NICU) discharge

Admission to the surgical neonatal intensive care unit (sNICU) is a stressful experience. Care is often complex, with inherent risks and potential complications. This study describes the implementation of an outpatient mental health screening process for parents of infants admitted to a sNICU. Parents of infants aged >34 weeks gestation with a congenital anomaly requiring neonatal surgery participated in this prospective observational study. Standardised measures to screen for parenting stress (Parenting Stress Index™ Fourth Edition Short Form) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) were administered at the first outpatient visit scheduled when the infant's corrected gestational age was 4 months. A triage algorithm was developed, to review the initial screening results prompting appropriate action and intervention. Positive screens were triaged as evaluate (assess within 48 h), targeted information (email contact), or escalate response (same day risk assessment). Demographic factors associated with parental stress and depressive symptoms were explored. Forty parents (response rate: 88 %) participated in screening. A high portion of parents (52.5 %) required secondary screening, for parenting stress (n = 10), depressive symptoms (n = 5) or both stress and depressive symptoms (n = 6). Socioeconomic disadvantage was positively associated with parenting stress (p = 0.02) and greater depressive symptoms with parent education levels (p = 0.01). Results indicate screening of parent mental health in the outpatient setting is feasible. Use of a triage algorithm helped prioritise parent follow-up and facilitate workflows. Parent mental health screening should be prioritised within and beyond the sNICU to support family and infant outcomes during this critical period of development.