Influence of respiratory and inflammatory parameters preceding intubation on survival of patients with COVID-19 ARDS- A single centre retrospective analysis

It remains unclear if intubation and ventilation earlier in the disease course confers a survival advantage in acute respiratory distress syndrome. Our objective was to determine whether patients with COVID-19 who died following mechanical ventilation were more advanced in their disease compared to survivors. Forty-seven patients admitted directly to our centre received ventilation, of who 26 (57%) patients died. The rate of fall in SpO2:FiO2 ratio (p = 0.478) and increasing respiratory rate (p = 0.948) prior to IMV were similar between survivors and non-survivors. Our data support a trial of continuous positive airway pressure prior to IMV in patients with moderate-to-severe COVID-19 ARDS

Person-Centred Critical Care: Lessons from a Service Evaluation

Context: ‘Critical care’ encompasses ‘intensive care’, ‘intensive therapy’ and ‘high dependency’ care and is operationalised when patients require specialised monitoring and intervention following complex surgery, or a life-threatening illness or injury. / Background: During the pandemic, the Critical Care Department at UCLH formed a family liaison team to bridge the connection gap between patients, families, and clinical teams. This evolved into the Patient & Family Team (PFT), which organised several engagement events to understand patient and family experiences in critical care. / Methods: Focus group discussions were conducted online and in-person with patients and bereaved families exploring their experience of the service. Discussions revolved around pivotal moments in the critical care journey. Feedback was analysed thematically and validated with the participants. / Findings: Patients described their journey through four stages: Admission, Period of Disorientation, Re-Awakening, and Recovery. Bereaved families categorised their experiences into seven stages from ‘The Phone Call’ to ‘Bereavement.’ The need for effective and compassionate communication and support was evident for both groups. / Discussion: Feedback revealed the emotional journeys of patients and families in critical care. While many experiences align with the existing literature, they also highlight areas for improvement, emphasising the value of human connection in healthcare. This study also demonstrated the need for continuous service evaluation and strategies for understanding underserved populations

Trial of Remote Continuous versus Intermittent NEWS monitoring after major surgery (TRaCINg): protocol for a feasibility randomised controlled trial

Background: Despite medical advances, major surgery remains high risk. Up to 44% of patients experience postoperative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this study is to evaluate the feasibility, acceptability and clinical impacts of continuous remote monitoring after major surgery. Methods: The study is a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery will be invited to participate if they have the capacity to provided informed, written consent and do not have a cardiac pacemaker or an allergy to adhesives. Participants will be randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring will be achieved using the SensiumVitals® wireless patch which is worn on the patient’s chest and monitors heart rate, respiratory rate and temperature continuously and alerts the nurse when there is deviation from pre-set physiological norms. Participants will be followed up throughout their hospital admission and for 30 days after discharge. Feasibility will be assessed by evaluating recruitment rate, adherence to protocol and randomisation, and the amount of missing data. The acceptability of the patch to nursing staff and patients will be assessed using questionnaires and interviews. Clinical outcomes will include time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of readmission within 30 days of discharge. Discussion: Early detection and treatment of complications minimises the need for critical care, improves patient outcomes, and produces significant cost savings for the healthcare system. Remote continuous monitoring systems have the potential to allow earlier detection of complications, but evidence from the literature is mixed. Demonstrating significant benefit over intermittent monitoring to offset the practical and economic implications of continuous monitoring requires well-controlled studies in high-risk populations to demonstrate significant differences in clinical outcomes; this feasibility trial seeks to provide evidence of how best to conduct such a confirmatory trial. Trial registration: This study is listed on the ISRCTN registry with study ID ISRCTN16601772

O OUTRO DIASPÓRICO EM DOIS EPISÓDIOS DE SMALL ISLAND (2004), DE ANDREA LEVY

Analisam-se dois episódios do romance Small Island, de Andrea Levy, publicado em 2004, em que o sujeito colonial e diaspórico encontra-se com o colonizador que o outremiza através da objetificação decorrente de estereótipos de “raça”. Utilizando as teorias proposta por Bhabha, Ashcroft e Spivak, afirma-se que o binarismo hierárquico e a diferença constroem métodos pelos quais o colonizador exclui o sujeito colonial ou dele se serve para fins alheios ao sistema sujeito-sujeito. O revide, especialmente a dissimulação e o silêncio, do sujeito colonial tornam-se instrumentos para a subjetificação do colonizado

Effect of Digital Early Warning Scores on Hospital Vital Sign Observation Protocol Adherence: Stepped-Wedge Evaluation

Background: Early warning scores (EWS) are routinely used in hospitals to assess a patient’s risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed. Objective: This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention. Methods: We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient’s first elevated EWS (EWS ≥3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey. Results: We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73). Conclusions: We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes

Sketch-based interaction and modeling: where do we stand?

Sketching is a natural and intuitive communication tool used for expressing concepts or ideas which are difficult to communicate through text or speech alone. Sketching is therefore used for a variety of purposes, from the expression of ideas on two-dimensional (2D) physical media, to object creation, manipulation, or deformation in three-dimensional (3D) immersive environments. This variety in sketching activities brings about a range of technologies which, while having similar scope, namely that of recording and interpreting the sketch gesture to effect some interaction, adopt different interpretation approaches according to the environment in which the sketch is drawn. In fields such as product design, sketches are drawn at various stages of the design process, and therefore, designers would benefit from sketch interpretation technologies which support these differing interactions. However, research typically focuses on one aspect of sketch interpretation and modeling such that literature on available technologies is fragmented and dispersed. In this paper, we bring together the relevant literature describing technologies which can support the product design industry, namely technologies which support the interpretation of sketches drawn on 2D media, sketch-based search interactions, as well as sketch gestures drawn in 3D media. This paper, therefore, gives a holistic view of the algorithmic support that can be provided in the design process. In so doing, we highlight the research gaps and future research directions required to provide full sketch-based interaction support

Designing and implementing sample and data collection for an international genetics study: the Type 1 Diabetes Genetics Consortium (T1DGC)

Background and Purpose The Type 1 Diabetes Genetics Consortium (T1DGC) is an international project whose primary aims are to: (a) discover genes that modify type 1 diabetes risk; and (b) expand upon the existing genetic resources for type 1 diabetes research. The initial goal was to collect 2500 affected sibling pair (ASP) families worldwide

DMRN+16: Digital Music Research Network One-day Workshop 2021

DMRN+16: Digital Music Research Network One-day Workshop 2021 Queen Mary University of London Tuesday 21st December 2021 Keynote speakers Keynote 1. Prof. Sophie Scott -Director, Institute of Cognitive Neuroscience, UCL. Title: "Sound on the brain - insights from functional neuroimaging and neuroanatomy" Abstract In this talk I will use functional imaging and models of primate neuroanatomy to explore how sound is processed in the human brain. I will demonstrate that sound is represented cortically in different parallel streams. I will expand this to show how this can impact on the concept of auditory perception, which arguably incorporates multiple kinds of distinct perceptual processes. I will address the roles that subcortical processes play in this, and also the contributions from hemispheric asymmetries. Keynote 2: Prof. Gus Xia - Assistant Professor at NYU Shanghai Title: "Learning interpretable music representations: from human stupidity to artificial intelligence" Abstract Gus has been leading the Music X Lab in developing intelligent systems that help people better compose and learn music. In this talk, he will show us the importance of music representation for both humans and machines, and how to learn better music representations via the design of inductive bias. Once we got interpretable music representations, the potential applications are limitless