An Adaptive Multi-Robot Therapy for Improving Joint Attention and Imitation of ASD Children

Robot-mediated therapies for autism spectrum disorder (ASD) have shown promising results in the past. We have proposed a novel mathematical model based on an adaptive multi-robot therapy of ASD children focusing on two main impairments in autism: 1) joint attention and 2) imitation. Joint attention intervention is based on three different least-to-most (LTM) cues, whereas the adaptive imitation module uses joint attention for activation of the robot. The proposed model uses a multi-robot system as a therapist without any external stimuli (from the environment) to improve the skills of the ASD child. Another novel aspect of this paper is the deployment of a multi-robot system for introducing the ASD child to the concept of multi-person communication. This is particularly useful as, unlike humans, robots can be more consistent and relatively immune to fatigue. Two different therapies of human–robot interaction (i.e., with and without interrobot communication) have been conducted. The model has been tested on 12 ASD children, eight sessions for each intervention over a period of six months. The effectiveness of the model is validated by analyzing the cognitive state of the brain before and after the intervention with electroencephalogram (EEG) neuroheadsets. Moreover, results obtained using the childhood autism rating scale (CARS) to measure the effectiveness of therapy also support the conclusions firmly. The statistical results with the p-value = 3.79E-07 3.28 show reliability and significance of the data. The results strongly indicate significant improvements in both modules, along with a notable improvement in multi-communication skills of the participating children

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status