86,221 research outputs found

    Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial

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    Background: Intraventricular haemorrhage is a subtype of intracerebral haemorrhage, with 50% mortality and serious disability for survivors. We aimed to test whether attempting to remove intraventricular haemorrhage with alteplase versus saline irrigation improved functional outcome. Methods: In this randomised, double-blinded, placebo-controlled, multiregional trial (CLEAR III), participants with a routinely placed extraventricular drain, in the intensive care unit with stable, non-traumatic intracerebral haemorrhage volume less than 30 mL, intraventricular haemorrhage obstructing the 3rd or 4th ventricles, and no underlying pathology were adaptively randomly assigned (1:1), via a web-based system to receive up to 12 doses, 8 h apart of 1 mg of alteplase or 0·9% saline via the extraventricular drain. The treating physician, clinical research staff, and participants were masked to treatment assignment. CT scans were obtained every 24 h throughout dosing. The primary efficacy outcome was good functional outcome, defined as a modified Rankin Scale score (mRS) of 3 or less at 180 days per central adjudication by blinded evaluators. This study is registered with ClinicalTrials.gov, NCT00784134. Findings: Between Sept 18, 2009, and Jan 13, 2015, 500 patients were randomised: 249 to the alteplase group and 251 to the saline group. 180-day follow-up data were available for analysis from 246 of 249 participants in the alteplase group and 245 of 251 participants in the placebo group. The primary efficacy outcome was similar in each group (good outcome in alteplase group 48% vs saline 45%; risk ratio [RR] 1·06 [95% CI 0·88–1·28; p=0·554]). A difference of 3·5% (RR 1·08 [95% CI 0·90–1·29], p=0·420) was found after adjustment for intraventricular haemorrhage size and thalamic intracerebral haemorrhage. At 180 days, the treatment group had lower case fatality (46 [18%] vs saline 73 [29%], hazard ratio 0·60 [95% CI 0·41–0·86], p=0·006), but a greater proportion with mRS 5 (42 [17%] vs 21 [9%]; RR 1·99 [95% CI 1·22–3·26], p=0·007). Ventriculitis (17 [7%] alteplase vs 31 [12%] saline; RR 0·55 [95% CI 0·31–0·97], p=0·048) and serious adverse events (114 [46%] alteplase vs 151 [60%] saline; RR 0·76 [95% CI 0·64–0·90], p=0·002) were less frequent with alteplase treatment. Symptomatic bleeding (six [2%] in the alteplase group vs five [2%] in the saline group; RR 1·21 [95% CI 0·37–3·91], p=0·771) was similar. Interpretation: In patients with intraventricular haemorrhage and a routine extraventricular drain, irrigation with alteplase did not substantially improve functional outcomes at the mRS 3 cutoff compared with irrigation with saline. Protocol-based use of alteplase with extraventricular drain seems safe. Future investigation is needed to determine whether a greater frequency of complete intraventricular haemorrhage removal via alteplase produces gains in functional status

    Parking and the visual perception of space

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    Using measured data we demonstrate that there is an amazing correspondence among the statistical properties of spacings between parked cars and the distances between birds perching on a power line. We show that this observation is easily explained by the fact that birds and human use the same mechanism of distance estimation. We give a simple mathematical model of this phenomenon and prove its validity using measured data

    Measuring working memory load effects on electrophysiological markers of attention orienting during a simulated drive

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    Intersection accidents result in a significant proportion of road fatalities, and attention allocation likely plays a role. Attention allocation may depend on (limited) working memory (WM) capacity. Driving is often combined with tasks increasing WM load, consequently impairing attention orienting. This study (n = 22) investigated WM load effects on event-related potentials (ERPs) related to attention orienting. A simulated driving environment allowed continuous lane-keeping measurement. Participants were asked to orient attention covertly towards the side indicated by an arrow, and to respond only to moving cars appearing on the attended side by pressing a button. WM load was manipulated using a concurrent memory task. ERPs showed typical attentional modulation (cue: contralateral negativity, LDAP; car: N1, P1, SN and P3) under low and high load conditions. With increased WM load, lane-keeping performance improved, while dual task performance degraded (memory task: increased error rate; orienting task: increased false alarms, smaller P3). Practitioner Summary: Intersection driver-support systems aim to improve traffic safety and flow. However, in-vehicle systems induce WM load, increasing the tendency to yield. Traffic flow reduces if drivers stop at inappropriate times, reducing the effectiveness of systems. Consequently, driver-support systems could include WM load measurement during driving in the development phase

    Ethical and Social Aspects of Self-Driving Cars

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    As an envisaged future of transportation, self-driving cars are being discussed from various perspectives, including social, economical, engineering, computer science, design, and ethics. On the one hand, self-driving cars present new engineering problems that are being gradually successfully solved. On the other hand, social and ethical problems are typically being presented in the form of an idealized unsolvable decision-making problem, the so-called trolley problem, which is grossly misleading. We argue that an applied engineering ethical approach for the development of new technology is what is needed; the approach should be applied, meaning that it should focus on the analysis of complex real-world engineering problems. Software plays a crucial role for the control of self-driving cars; therefore, software engineering solutions should seriously handle ethical and social considerations. In this paper we take a closer look at the regulative instruments, standards, design, and implementations of components, systems, and services and we present practical social and ethical challenges that have to be met, as well as novel expectations for software engineering.Comment: 11 pages, 3 figures, 2 table

    A first approach to understanding and measuring naturalness in driver-car interaction

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    With technology changing the nature of the driving task, qualitative methods can help designers understand and measure driver-car interaction naturalness. Fifteen drivers were interviewed at length in their own parked cars using ethnographically-inspired questions probing issues of interaction salience, expectation, feelings, desires and meanings. Thematic analysis and content analysis found five distinct components relating to 'rich physical' aspects of natural feeling interaction typified by richer physical, analogue, tactile styles of interaction and control. Further components relate to humanlike, intelligent, assistive, socially-aware 'perceived behaviours' of the car. The advantages and challenges of a naturalness-based approach are discussed and ten cognitive component constructs of driver-car naturalness are proposed. These may eventually be applied as a checklist in automotive interaction design.This research was fully funded by a research grant from Jaguar Land Rover, and partially funded by project n.220050/F11 granted by Research Council of Norway

    Looking away from faces: influence of high-level visual processes on saccade programming

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    Human faces capture attention more than other visual stimuli. Here we investigated whether such face-specific biases rely on automatic (involuntary) or voluntary orienting responses. To this end, we used an anti-saccade paradigm, which requires the ability to inhibit a reflexive automatic response and to generate a voluntary saccade in the opposite direction of the stimulus. To control for potential low-level confounds in the eye-movement data, we manipulated the high-level visual properties of the stimuli while normalizing their global low-level visual properties. Eye movements were recorded in 21 participants who performed either pro- or anti-saccades to a face, car, or noise pattern, randomly presented to the left or right of a fixation point. For each trial, a symbolic cue instructed the observer to generate either a pro-saccade or an anti-saccade. We report a significant increase in anti-saccade error rates for faces compared to cars and noise patterns, as well as faster pro-saccades to faces and cars in comparison to noise patterns. These results indicate that human faces induce stronger involuntary orienting responses than other visual objects, i.e., responses that are beyond the control of the observer. Importantly, this involuntary processing cannot be accounted for by global low-level visual factors
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