Supporting public availability and accessibility with Elvin: experiences and reflections.

We provide a retrospective account of how a generic event notification service called Elvin and a suite of simple client applications: CoffeeBiff, Tickertape and Tickerchat, came to be used within our organisation to support awareness and interaction. After overviewing Elvin and its clients, we outline various experiences from data collated across two studies where Elvin and its clients have been used to augment the workaday world to support interaction, to make digital actions visible, to make physical actions available beyond the location of action, and to support content and socially based information filtering. We suggest there are both functional and technical reasons for why Elvin works for enabling awareness and interaction. Functionally, it provides a way to produce, gather and redistribute information from everyday activities (via Elvin) and to give that information a perceptible form (via the various clients) that can be publicly available and accessible as a resource for awareness. The integration of lightweight chat facilities with these information sources enables awareness to easily flow into interaction, starting to re-connect bodies to actions, and starting to approximate the easy flow of interaction that happens when we are co-located. Technically, the conceptual simplicity of the Elvin notification, the wide availability of its APIs, and the generic functionality of its clients, especially Tickertape, have made the use of the service appealing to developers and users for a wide range of uses

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

CVS integration with notification and chat: lightweight software team collaboration

Code management systems like Concurrent Version System (CVS) can play an important role in supporting coordination in software development, but often at some time removed from original CVS log entries or removed from the informal conversations around the code. The focus of this paper is one team's long term use of a solution where CVS is augmented with a lightweight event notification system, Elvin, and a tickertape tool where CVS messages are displayed and where developers can also chat with one another. Through a statistical analysis of CVS logs, and a qualitative analysis of tickertape logs and interview data, there is evidence of the tool transforming archival log entries into communicative acts and supporting timely interactions. Developers used the close integration of CVS with chat for growing team culture, stimulating focused discussion, supplementing log information, marking phases of work, coordinating and negotiating work, and managing availability and interruptibility. This has implications for consideration of more lightweight solutions for supporting collaborative software development, as well as managing awareness and interruptions more generally

Eliciting reactive and reflective feedback for a social communication tool: a multi-session approach

Gaining feedback from users early in the design of a complex, novel social system poses unique challenges. We report on our multi-session, in-context approach to get users to envision how they would use an early prototype in everyday life, combined with projections of how their friends would use it. The prototype is a novel social communication management tool and we required users develop a deep understanding of the complete system over time. Findings from data collected across four sessions show that using personalised task scenarios and giving users longer exposure to an early interactive prototype, combined with peer-to-peer discussion, enables participants to move beyond initial reactions to develop more reflective opinions. Participants were able to overcome first impressions and learning effects, develop deeper understanding of new conceptual models underpinning the system, integrate their understanding of piecemeal components and reflect on own use and use by others in deeper ways

Lessons for the future: experiences with the installation and use of today's domestic sensors and technologies.

Domestic environments are receiving increasing attention as sites of deployment for pervasive technologies, as evidenced by the growing number of studies of homes and maturing technologies in prototype aware/smart homes. The challenge now is to move technologies out of purpose built homes into everyday environments in ways that will fit with existing buildings and the people who live in them. However, there are many aspects of this future vision that people live with right now in the form of sensors and technologies already in the home. We describe findings from three studies – in-home interviews, a questionnaire about home sensors, and interviews with commercial smart home installers – that explore current experiences with sensors and technologies in the home. These lead us to reflect on the implicit assumptions in, and future design directions for, pervasive research for the home

Representing talk and action in collaborative activities for video analysis

This paper introduces a collaboratively developed methodology for the qualitative analysis and visual representation of video data. The data to be analysed were video recordings made by secondary school students whilst engaged in a collaborative, in the field, data collection process using hand-held data logging equipment for monitoring Carbon Monoxide and wind values. We describe the requirement for, and the collaborative and evolutionary development process of, a visual method through drawing overview activity maps. Following this we discuss some issues arising and future challenges for overview activity maps