Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Neurophysiological correlates of producing and perceiving natural connected speech

Spoken language is an essential part of our every-day lives. Despite being one of the most prominent human behaviors, little is known about the cortical substrates supporting the perception and production of continuous, connected speech. This doctoral dissertation aimed to fill this gap through an extensive experimental paradigm consisting of both natural speech production and speech perception tasks. There was a special emphasis on speech rhythm which is tied to speaking rate. Cortical signals were measured with magnetoencephalography. Electromyographic and acoustic signals were recorded during the speech production tasks. Study I aimed to quantify speech rhythm using a multimodal spectral approach in the form of coherence between electromyographic and acoustic signals. This multimodal approach was compared to a unimodal approach, which involves spectral analysis of electromyographic and acoustic signals in isolation. As opposed to a unimodal analysis, a multimodal analysis was shown to successfully reveal the shared periodic components in the two signals. This suggests that coherence metrics are especially useful in quantifying rhythm in the inherently complex natural speech. Study II investigated the cortical correlates of natural speech production and perception. Modulations in band-limited cortical signal power were examined in response to variations in three fundamental speech-related features: the amount of linguistic content present in an utterance, speaking rate and social relevance. The resulting spatiospectral patterns revealed that the right hemisphere is markedly involved in natural speech processing and, particularly, that processing of socially relevant speech engages the right temporo-parietal junction. Notably, natural speech production and perception were found to extensively overlap in both hemispheres. Study III examined, using audio-MEG coherence, the cortical tracking of global rhythmic structure and local, transient variations in speaking rate in perceived natural, connected speech. It was found that cortical tracking of perceived natural, connected speech extends beyond the previously reported emphasis on the temporal regions and also engages higher-order cortical regions. Furthermore, the observed audio-MEG coherence patterns revealed two spatially and functionally distinct components of cortical tuning: evolutionary tuning to global rhythmic structure, and predictive tuning that is driven by local changes in speaking rate. This doctoral dissertation presents novel methodological tools for characterizing rhythm in natural speech. It also contributes to an emerging view on cortical speech processing that is not confined to traditional left-hemispheric cortical regions and offers an insight into the functional role of speech rhythm in speech comprehension

Evoked responses to transcranial and electrical stimulation during isometric and lengthening contractions of the soleus muscle

The aim of this study was to assess differences in motor control between isometric and lengthening contractions of the soleus muscle. Evoked responses to TMS (MEPs) and electrical stimulation of the peripheral nerve (H-reflexes) where recorded at rest and during isometric and lengthening contractions of the soleus muscle at 20%, 40%, 60% and 80% MVC. Torque and background EMG were averaged over a time window of 100ms prior to stimulation. MEPs were found to be significantly lower (P < 0.05) during lengthening contractions compared to isometric contractions at 40%, 60% and 80% MVC (10.95 ± 0.05 mV vs 9.93 ±0.06 mV ; 1.47 ± 0.07 mV vs 9.7 ± 0.08 mV; 11.48 ± 0.08 mV ± vs 10.14 ± 0.07 mV). The H-reflex-to-Mmax ratio was significantly lower (P < 0.05) during passive lengthening compared to the passive isometric condition (2.5 ± 1.11 mV vs 1.4 ±0.88 mV). In an active muscle, the H-reflex-to-Mmax ratio was similar between isometric and lengthening modes of contraction. Torque production during passive lengthening (1.8 ± 2.8 Nm vs 4.6 ± 3.2 Nm) and at 20% MVC lengthening (215.25 ± 68.3 Nm vs 300.8 ± 155 Nm) was higher (P < 0.05) compared to the corresponding torque produced in isometric conditions. MEPs represent the excitability of both supraspinal and spinal neurons; H-reflex, on the other hand, reflects only the excitability of the spinal MN pool. Therefore, it was concluded that the motor cortex generates a descending command of lower amplitude in the case of lengthening contractions. This, however, could not be considered as neural inhibition, since recorded torque during muscle lengthening was similar or higher compared to the torque recorded during isometric muscle actions

Google Dialogflow-based chatbot for planning a trip

Η τεχνολογία των Chatbots στις μέρες μας είναι γνωστή στο ευρύτερο κοινό ως μία σύγχρονη πτυχή της επιστήμης των υπολογιστών. Θεωρείται στενά συνδεδεμένη με την τεράστια εξέλιξη που έχει βιώσει και συνεχίζει να βιώνει ο κλάδος της Τεχνητής Νοημοσύνης τα τελευταία χρόνια. Ωστόσο, η ιδέα των Chatbots έχει ξεκινήσει να αναπτύσσεται και να υλοποείται ήδη από τα μέσα του 20ου αιώνα. Το 1950, ο Alan Turing συνδέει για πρώτη φορά την ικανότητα επικοινωνίας μεταξύ ανθρώπου και μηχανής με την έννοια της υπολογιστικής ευφυΐας. Ισχυρίζεται ότι το Turing test μπορεί να αποτελέσει κριτήριο ευφυΐας, ορίζοντας την τελευταία ως την ικανότητα ενός υπολογιστικού προγράμματος να υποδύεται τον άνθρωπο σε μία γραπτή συζήτηση αληθινού χρόνου με αυτόν. Τα επόμενα χρόνια ακολούθησε η προσπάθεια υλοποίησης αυτής της υπολογιστικής ευφυίας με το πρώτο Chatbot (Eliza) να δημιουργείται το 1966 από τον Joseph Weizenbaum. Στις μέρες μας, η τεχνολογία των Chatbots έχει αποκτήσει μεγάλη αναγνώριση σε πολλούς επιστημονικούς κλάδους. Η δυνατότητα αντίληψης της κατάστασης, της σκέψης και των αναγκών του χρήστη από τον υπολογιστή έχει αποτελέσει ένα πολύ δυνατό εργαλείο σε κλάδους όπως η ιατρική, η ψυχολογία και η ψυχαγωγία. Στη συγκεκριμένη πτυχιακή εργασία έχει υλοποιηθεί μέσω του Google Dialogflow μία εφαρμογή Chatbot, η οπία έχει ως στόχο την παροχή της κατάλληλης βοήθειας στον χρήστη για την οργάνωση ενός ταξιδιού ή την απόκτηση χρήσιμων πληροφοριών για κάποιον προορισμό.The technology of Chatbots nowadays is known as a modern aspect of computer science. It is considered to be heavily connected to the immense development that the field of Artificial Intelligence has experienced during the past years and still continues to experience. However, the idea of Chatbots started spreading and being realised since the middle of the 20th century. In 1950, Alan Turing connects the ability of communication between humans and machines with the concept of computing intelligence for the first time. He claims that the ‘Turing test’ can be a measure of intelligence, defining the latter as the ability of a computer program to act as a human in a written real-time conversation with him. The following years the effort of materializing this computing intelligence continued with the first Chatbot (Eliza) being developed in 1966 by Joseph Weizenbaum. Nowadays, the technology of Chatbots has received wide recognition in several scientific fields. The ability of the computer to understand situations, the thoughts and the needs of the user has become a powerful tool in fields such as Medicine, Psychology and even entertainment. In this thesis a Chatbot application has been created through Google Dialogflow with the objective of providing appropriate help to the user in planning a trip or acquiring useful information for a certain destinatio

Cortical tracking of global and local variations of speech rhythm during connected natural speech perception

During natural speech perception, listeners must track the global speaking rate, that is, the overall rate of incoming linguistic information, as well as transient, local speaking rate variations occurring within the global speaking rate. Here, we address the hypothesis that this tracking mechanism is achieved through coupling of cortical signals to the amplitude envelope of the perceived acoustic speech signals. Cortical signals were recorded with magnetoencephalography (MEG) while participants perceived spontaneously produced speech stimuli at three global speaking rates (slow, normal/ habitual, and fast). Inherently to spontaneously produced speech, these stimuli also featured local variations in speaking rate. The coupling between cortical and acoustic speech signals was evaluated using audio–MEG coherence. Modulations in audio–MEG coherence spatially dif- ferentiated between tracking of global speaking rate, highlighting the temporal cortex bilaterally and the right parietal cortex, and sensitivity to local speaking rate variations, emphasizing the left parietal cortex. Cortical tuning to the temporal structure of natural connected speech thus seems to require the joint contribution of both auditory and parietal regions. These findings suggest that cortical tuning to speech rhythm operates on two functionally distinct levels: one encoding the global rhythmic structure of speech and the other associated with online, rapidly evolving temporal predictions. Thus, it may be proposed that speech perception is shaped by evolutionary tuning, a preference for certain speaking rates, and predictive tuning, associated with cortical tracking of the constantly changing-rate of linguistic information in a speech stream.Peer reviewe

Cortical entrainment

The popular framework of cortical entrainment postulates that speech comprehension crucially depends on the continuous alignment of low-frequency cortical oscillatory activity with the amplitude envelope of perceived acoustic speech signals. The evidence for cortical entrainment mostly stems from tightly controlled experimental paradigms focusing on repeated perception of isolated sentences that feature a very constant speaking rate. However, these kinds of decontextualised and extremely regular stimuli do not reflect natural speech as we encounter it in real life. We thus advance the view that naturalistic experimental paradigms, utilising spontaneously produced speech as stimuli and suitable frequency-domain methodological tools, should be used to address an important question that remains open: whether cortical entrainment is observed during speech perception and comprehension in real-life communicative situations. In addition, we discuss how the phenomenon currently labelled as cortical entrainment might be confounded by a regular repetition of evoked responses.Peer reviewe

The right hemisphere is highlighted in connected natural speech production and perception

Current understanding of the cortical mechanisms of speech perception and production stems mostly from studies that focus on single words or sentences. However, it has been suggested that processing of real-life connected speech may rely on additional cortical mechanisms. In the present study, we examined the neural substrates of natural speech production and perception with magnetoencephalography by modulating three central features related to speech: amount of linguistic content, speaking rate and social relevance. The amount of linguistic content was modulated by contrasting natural speech production and perception to speech-like non-linguistic tasks. Meaningful speech was produced and perceived at three speaking rates: normal, slow and fast. Social relevance was probed by having participants attend to speech produced by themselves and an unknown person. These speech-related features were each associated with distinct spatiospectral modulation patterns that involved cortical regions in both hemispheres. Natural speech processing markedly engaged the right hemisphere in addition to the left. In particular, the right temporo-parietal junction, previously linked to attentional processes and social cognition, was highlighted in the task modulations. The present findings suggest that its functional role extends to active generation and perception of meaningful, socially relevant speech.Peer reviewe

Beta-band MEG signal power changes in older adults after physical exercise program with and without additional cognitive training

Physical exercise has been considered to be an efficient mean of preserving cognitive function and it influences both the structural and functional characteristics of the brain. It has especially been shown to increase brain plasticity, the capacity to re-structure brain properties in response to interaction, such as cognitive practice. Studies have also examined the potential additive effect of cognitive training on the documented benefit of physical exercise, commonly, however, not at the neural level. We monitored, using magnetoencephalography (MEG), the brain processes associated with executive functions in older individuals who participated in a 12-month randomized controlled trial including two research arms: physical and cognitive training vs physical training alone. Measurements were conducted at 0 months, 6 months, and 12 months. The addition of cognitive training was associated with better performance in the Stroop test that reflects executive control. The extra benefit of cognitive training was also manifested as decreased modulation of beta frequency band (15–25 Hz) especially to difficult distractors. As beta band activity is associated with attentional control, this indicates fewer resources needed to inhibit irrelevant sensory inputs. These results imply an enhancing role of cognitive elements integrated with physical training in improving or maintaining executive functions in older individuals.peerReviewe