Validate and analyze mannequin's spine movements to improve training in pre-hospital contexts

Abstract: After an accident, when spinal injury is suspected, special care must be taken to minimize the risk for further injuries during the patient’s transfer to the hospital. The quality of spinal motion restriction (SMR) manoeuvres performed by responders is therefore crucial. In a training context, the evaluation of these techniques is currently subjectively performed by specialists or simulated patients, resulting in significant variation and learning difficulties. In order to improve training, a team of researchers from the Université of Sherbrooke has created a mannequin that replicates the mass, centre of gravity, and amplitude of movement of each segment of an unconscious person. This mannequin also features an instrumented spine allowing movement to be assessed. The study’s first objective is to model the system to assess the spine’s anatomical movements and validate these measurements. The second objective is to develop feedback metrics based on these measurements to pinpoint the cause of the faulty manoeuvres during a simulation scenario. To achieve these objectives, the spine was modelled using forward kinematics such that the resulting assessment of movement has clinical relevance. To evaluate the accuracy of this measurement, it was compared to that recorded by an optical system regarded as the accepted standard. Forty independent trials where the head and the pelvis were movement in each plane of motion and then in a combined manoeuvre where performed, at two different speeds. Accuracy, assessed by mean squared error, ranges between 0.7° and 1.5° amongst the different anatomical planes and is thus considered acceptable. The speed at which manoeuvres are performed do not have a significant impact on accuracy. To develop feedback metrics from involuntary movements, a total of 154 manoeuvres were performed by 14 individuals with different training level. Trials were then identified as either good or faulty depending on the importance of the relative movement assessed. Faulty trials were further labeled according to the type of error performed. Classification models were developed based on supervised learning. Overall, the decision tree model was selected for its global performance (70% to 83% accuracy) and ease of interpretation. The findings support the mannequin's potential for measuring spinal movement in simulation scenarios. In addition, the error characterization model demonstrates an interesting potential for unbiased and clear feedback to enhance SMR manoeuvre training.Résumé de la communication présentée lors du congrès international tenu conjointement par Canadian Society for Mechanical Engineering (CSME) et Computational Fluid Dynamics Society of Canada (CFD Canada), à l’Université de Sherbrooke (Québec), du 28 au 31 mai 2023

Bien-être animal: Définition

National audienceIn 2018, ANSES (French Agency for Food, Environmental and Occupational Health & Safety) has defined animal welfare as ‘the positive mental and physical state related to the satisfaction of its physiological and behavioural needs, as well as its expectations. This state varies according to the perception of the situation by the animal’. This definition applies to all the animals that live under the control of humans (farming, pets, laboratory, zoos). Here, the definition is applied more specifically to farmed animals, in order to better understand their place in sustainable agriculture...L’ANSES, en 2018, définit le bien-être d’un animal comme « l’état mental et physique positif lié à la satisfaction de ses besoins physiologiques et comportementaux, ainsi que de ses attentes. Cet état varie en fonction de la perception de la situation par l’animal. Cette définition concerne l’ensemble des animaux qui vivent sous la dépendance des humains (élevage, compagnie, loisir, laboratoire). Ici, la définition du bien-être animal s’applique plus particulièrement aux animaux d’élevage afin d’appréhender son rôle dans l’agriculture durable..

Instrumented Pre-Hospital Care Simulation Mannequin for Use in Spinal Motion Restrictions Scenarios: Validation of Cervical and Lumbar Motion Assessment

Background: A mid-fidelity simulation mannequin, equipped with an instrumented cervical and lumbar spine, was developed to investigate best practices and train healthcare professionals in applying spinal motion restrictions (SMRs) during the early mobilization and transfer of accident victims with suspected spine injury. The study objectives are to (1) examine accuracy of the cervical and lumbar motions measured with the mannequin; and (2) confirm that the speed of motion has no bearing on this accuracy. Methods: Accuracy was evaluated by concurrently comparing the orientation data obtained with the mannequin with that from an optoelectronic system. The mannequin’s head and pelvis were moved in all anatomical planes of motion at different speeds. Results: Accuracy, assessed by root-mean-square error, varied between 0.7° and 1.5° in all anatomical planes of motion. Bland–Altman analysis revealed a bias ranging from −0.7° to 0.6°, with the absolute limit of agreement remaining below 3.5°. The minimal detectable change varied between 1.3° and 2.6°. Motion speed demonstrated no impact on accuracy. Conclusions: The results of this validation study confirm the mannequin’s potential to provide accurate measurements of cervical and lumbar motion during simulation scenarios for training and research on the application of SMR

LCA of starch potato from field to starch production plant gate

Organisateurs INRA et AdemeLCA of starch potato from field to starch production plant gate. 8. International Conference on Life Cycle Assessment in the Agri Food Sector (LCA Food 2012

Intracranial pressure monitoring with and without brain tissue oxygen pressure monitoring for severe traumatic brain injury in France (OXY-TC): an open-label, randomised controlled superiority trial

International audienceBackground: Optimisation of brain oxygenation might improve neurological outcome after traumatic brain injury. The OXY-TC trial explored the superiority of a strategy combining intracranial pressure and brain tissue oxygen pressure (PbtO2) monitoring over a strategy of intracranial pressure monitoring only to reduce the proportion of patients with poor neurological outcome at 6 months.Methods: We did an open-label, randomised controlled superiority trial at 25 French tertiary referral centres. Within 16 h of brain injury, patients with severe traumatic brain injury (aged 18-75 years) were randomly assigned via a website to be managed during the first 5 days of admission to the intensive care unit either by intracranial pressure monitoring only or by both intracranial pressure and PbtO2 monitoring. Randomisation was stratified by age and centre. The study was open label due to the visibility of the intervention, but the statisticians and outcome assessors were masked to group allocation. The therapeutic objectives were to maintain intracranial pressure of 20 mm Hg or lower, and to keep PbtO2 (for those in the dual-monitoring group) above 20 mm Hg, at all times. The primary outcome was the proportion of patients with an extended Glasgow Outcome Scale (GOSE) score of 1-4 (death to upper severe disability) at 6 months after injury. The primary analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew consent or had protocol violations. This trial is registered with ClinicalTrials.gov, NCT02754063, and is completed.Findings: Between June 15, 2016, and April 17, 2021, 318 patients were randomly assigned to receive either intracranial pressure monitoring only (n=160) or both intracranial pressure and PbtO2 monitoring (n=158). 27 individuals with protocol violations were not included in the modified intention-to-treat analysis. Thus, the primary outcome was analysed for 144 patients in the intracranial pressure only group and 147 patients in the intracranial pressure and PbtO2 group. Compared with intracranial pressure monitoring only, intracranial pressure and PbtO2 monitoring did not reduce the proportion of patients with GOSE score 1-4 (51% [95% CI 43-60] in the intracranial pressure monitoring only group vs 52% [43-60] in the intracranial pressure and PbtO2 monitoring group; odds ratio 1·0 [95% CI 0·6-1·7]; p=0·95). Two (1%) of 144 participants in the intracranial pressure only group and 12 (8%) of 147 participants in the intracranial pressure and PbtO2 group had catheter dysfunction (p=0.011). Six patients (4%) in the intracranial pressure and PbtO2 group had an intracrebral haematoma related to the catheter, compared with none in the intracranial pressure only group (p=0.030). No significant difference in deaths was found between the two groups at 12 months after injury. At 12 months, 33 deaths had occurred in the intracranial pressure group: 25 (76%) were attributable to the brain trauma, six (18%) were end-of-life decisions, and two (6%) due to sepsis. 34 deaths had occured in the intracranial pressure and PbtO2 group at 12 months: 25 (74%) were attributable to the brain trauma, six (18%) were end-of-life decisions, one (3%) due to pulmonary embolism, one (3%) due to haemorrhagic shock, and one (3%) due to cardiac arrest.Interpretation: After severe non-penetrating traumatic brain injury, intracranial pressure and PbtO2 monitoring did not reduce the proportion of patients with poor neurological outcome at 6 months. Technical failures related to intracerebral catheter and intracerebral haematoma were more frequent in the intracranial pressure and PbtO2 group. Further research is needed to assess whether a targeted approach to multimodal brain monitoring could be useful in subgroups of patients with severe traumatic brain injury-eg, those with high intracranial pressure on admission

Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke The AMETIS Randomized Clinical Trial

International audienceImportance General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France. Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications. Trial Registration ClinicalTrials.gov Identifier: NCT0322914