Investigation of an embedded-optical-base system's functionality in detecting signal events for gait measurements

2018 Fall.Includes bibliographical references.Optical sensors have the potential to provide automated gait analysis and lameness detection in livestock. Measuring animals in motion while under field conditions is difficult for current gait analysis tools, such as plate and mat methods. This has caused a lack in commercially available systems. Additionally, a deficit of these systems and others is too much noise in their signal. Current sensor systems for static or in-motion measurements rely significantly on managing this noise as a source of error. From these problems, the primary objective of this body of work was to assess the use of an embedded-optical-base system (EOBS) and its ability to obtain real-time gait measurements from livestock. The research was composed of 3 field studies and 1 controlled study. Gait data was obtained using a commercial platform (2.4 m x 0.9 m; length x width) containing 1 EOBS. A signal-base-unit (SBU) and computer were setup near the EOBS platform by integrated cabling to collect real-time signal data. Signal fluctuation measurements (i.e., signal amplitude from hoof contact; 0 to 1 arbitrary units (au)) and kinematics (e.g., estimated speed, velocity and time duration) were recorded. The sensor detected hoof contact as signal amplitudes that could be examined in real time. Visual observations and video analyses were used for validating and classifying signal readings. The initial pilot study (field test) included 8 fistulated, crossbred steers (n = 8) tested over 1 d with 2 passes per animal over the EOBS platform. Pilot study data were used to evaluate initial signal fluctuations from animal contact. A second field study included 50 crossbred and purebred (n = 20, Angus; n = 10, Hereford; n = 20, Angus x Hereford) steers and heifers (n = 50; average BW = 292.5 kg) tested on 2 d over a 1-wk period with a total of 6 passes over the EOBS platform per animal. Steer and heifer normal walks, runs, and abnormal passes over the EOBS platform were analyzed. A third controlled study consisted of 3 mixed breed horses (n = 3) that had bilateral forelimb injections. Horses had both deep digital flexor muscles injected (1 with Botox and 1 with saline) with right and left forelimbs randomized. Horses were observed on 3 d over a 124-d period consisting of pre-treatment (baseline), post-treatment, and recovery test days with 10 passes over the EOBS platform per horse per day. Primary fluctuations, true (anomaly free) signal readings, from animal contact with the EOBS platform were analyzed. True signal readings were determined based on no influence observed from other limbs. A fourth field study consisted of 8 commercial bulls (n = 8) tested on 1 d with 3 passes over the EOBS platform per bull. Bulls were classified as either normal or abnormal in musculoskeletal structure and compared to one another to observe differences in signal fluctuation patterns. During the cattle studies, animals were not controlled and allowed to walk over the EOBS platform at their own pace. These studies formed the groundwork to determine the EOBS's functionality when animals passed over the platform. Signalment (i.e., breed, sex and age) and physiological characterizations were recorded. Temperature was also recorded for cattle field tests (e.g., min -6°C to max 4°C, respectively). For all 4 studies individual animal signal measurements were analyzed for each pass over the EOBS platform, compared to video data and classified for analysis. Results from all 4 studies showed intra- and inter-animal repeatability (qualitative observation) of observed signal readings. Though a variety of hoof contact signatures were obtained, repeating patterns were evident for both groups and individual animals. The embedded-optical-base system's (EOBS) functionality proved to be robust and operable under field trial conditions. Additionally, the signal showed extremely minimal noise. Lastly, the EOBS showed a stable baseline with clear deviations from it that could be correlated to hoof contact through video validation. Though the EOBS detected animal contact per pass, future work will investigate the system's operating readiness in accurately assessing variable gait measurements for lameness detection. Overall, data provides evidence that the embedded-optical-base system (EOBS) can detect hoof contact and differentiation between types of gait based on signal events

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness

Abstract Background Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. Methods Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Results Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. Conclusion The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system