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\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; 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\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). 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. Funding: No funding

Traffic Rules Compliance Checking of Automated Vehicle Maneuvers

Automated Vehicles (AVs) are designed and programmed to follow traffic rules. However, there is no separate and comprehensive regulatory framework dedicated to AVs. The current Queensland traffic rules were designed for humans. These rules often contain open texture expressions, exceptions, and potential conflicts (conflict arises when exceptions cannot be handled in rules), which makes it hard for AVs to follow. This paper presents an automatic compliance checking framework to assess AVs behaviour against current traffic rules by addressing these issues. Specifically, it proposes a framework to determine which traffic rules and open texture expressions need some additional interpretation. Essentially this enables AVs to have a suitable and executable formalization of the traffic rules. Defeasible Deontic Logic (DDL) is used to formalize traffic rules and reasoning with AV information (behaviour and environment). The representation of rules in DDL helps effectively in handling and resolving exceptions, potential conflicts, and open textures in rules. 40 experiments were conducted on eight realistic traffic scenarios to evaluate the framework. The evaluation was undertaken both quantitatively and qualitatively. The evaluation result shows that the proposed framework is a promising system for checking Automated Vehicle interpretation and compliance with current traffic rules.Keywords: Automated Vehicle, Defeasible Deontic Logic, Logical Reasoning, Ontology Knowledge Base, Overtaking Maneuver, Traffic Rule Formalisation

Design a lightweight low power multiplier circuits using quantum dot cellular automata architecture

In this paper, we propose a powerful multiplier circuit using QCA 3-dot cell. The architecture is very competent to calculate the multiplication between two numbers. Here, we use a 4-bit 3-dot QCA adder to construct our proposed circuit, which has less number of cells and area from other QCA based adders. [1,2,3] Our new and novel design is improved a lot from existing multipliers, the suggested multiplier circuit enhances 28% on cell, 99% on area than the current finest known one.</p

Validation of Autonomous Vehicle Overtaking under Queensland Road Rules

It is crucial to validate driving behaviour against current road rules to improve Autonomous Vehicle (AV) safety. Validating the AV behaviour is challenging due to the way Queensland Overtaking Road Rules are written, as it includes vague terms and exceptions. This research introduces a Defeasible Deontic Logic (DDL) based framework to validate AV driving behaviour against current overtaking road rules. The overtaking maneuver is the case study to illustrate the usefulness of the proposed system. The evaluation shows the effectiveness of the approach. Keywords: Validation, Autonomous Vehicle (AV), Defeasible Deontic Logic (DDL), Overtaking

Comprehensive Analysis of Augmented Reality Technology in Modern Healthcare System

The recent advances of Augmented Reality (AR) in healthcare have shown that technology is a significant part of the current healthcare system. In recent days, augmented reality has proposed numerous intelligent applications in the healthcare domain including, wearable access, telemedicine, remote surgery, diagnosis of medical reports, emergency medicine, etc. These developed augmented healthcare applications aim to improve patient care, increase efficiency, and decrease costs. Therefore, to identify the advances of AR-based healthcare applications, this article puts on an effort to perform an analysis of 45 peer-reviewed journal and conference articles from scholarly databases between 2011 and 2020. It also addresses concurrent concerns and their relevant future challenges including, user satisfaction, convenient prototypes, service availability, maintenance cost, etc. Despite the development of several AR healthcare applications, there are some untapped potentials regarding secure data trans-mission, which is an important factor for advancing this cutting-edge technology. Therefore, this paper also analyzes distinct AR security and privacy including, security requirements (i.e., scalability, confidentiality, integrity, resiliency, etc.) and attack terminologies (i.e. sniffing, fabrication, modification, interception, etc.). Based on the security issues, in this paper, we propose an artificial intelligence-based dynamic solution to build an intelligent security model to minimize data security risks. This intelligent model can identify seen and unseen threats in the threat detection layer and thus can protect data during data transmission. In addition, it prevents external attacks in the threat elimination layer using threat reduction mechanisms

On Multi-Objective Multi-Item Solid Transportation Problem in Fuzzy Environment

This paper discusses the reliability of multi-objective multi-item solid transport (F-MOMIST) problem with the transportation of penalties represented by the trapezoidal fuzzy numbers. We extended the existing F-MOMIST by introducing the fuzzy efficient concept and fuzzy crisp. We propose a weighting Tchebycheff approach to efficiently solve F-MOMIST. In the proposed approach, we first describe the first type of stability set corresponding to the optimal α-Pareto solution and then use the proposed approach to evaluate the first type of stability set corresponding to the α-optimal compromise solutions. A numerical case study to check the validity of the proposed approach is presented. The results of comparative experiments show that the proposed method is sufficiently effective in solving F-MOMIST and has better performance than the existing methods.</p

A Methodology for Encoding Regulatory Rules

This paper introduces a methodology for the encoding of rules into a semantic logical format to facilitate the automated reasoning process. We demonstrate how to identify, capture, combine, and thus formulate all the components from rules into a computationally-oriented formalism. The need for the methodology is motivated by the desire for automated reasoning of automated vehicle information regarding traffic rules. We use Defeasible Deontic Logic as a formal foundation of our methodology. The overtaking traffic rule is our use-case to illustrate the usefulness of our methodology. Through this use-case, it is seen that the logical semantic representation of the traffic rules seems conceivable to support automated reasoning. This paper includes the source materials, the use cases, proposed methodology, and the example of encoding