Classifying Alarms: Seeking Durability, Credibility, Consistency, and Simplicity

Alongside the development and testing of new audible alarms intended to support International Electrotechnical Commission 60601-1-8, a global standard concerned with alarm safety, the categories of risk that the standard denotes require further thought and possible updating. In this article, we revisit the origins of the categories covered by the standard. These categories were based on the ways that tissue damage can be caused. We consider these categories from the varied professional perspectives of the authors: human factors, semiotics, clinical practice, and the patient or family (layperson). We conclude that while the categories possess many clinically applicable and defensible features from our range of perspectives, the advances in alarm design now available may allow a more flexible approach. We present a three-tier system with superordinate, basic, and subordinate levels that fit both within the thinking embodied in the current standard and possible new developments

Exploration Mission Benefits From Logistics Reduction Technologies

Technologies that reduce logistical mass, volume, and the crew time dedicated to logistics management become more important as exploration missions extend further from the Earth. Even modest reductions in logistical mass can have a significant impact because it also reduces the packaging burden. NASA's Advanced Exploration Systems' Logistics Reduction Project is developing technologies that can directly reduce the mass and volume of crew clothing and metabolic waste collection. Also, cargo bags have been developed that can be reconfigured for crew outfitting, and trash processing technologies are under development to increase habitable volume and improve protection against solar storm events. Additionally, Mars class missions are sufficiently distant that even logistics management without resupply can be problematic due to the communication time delay with Earth. Although exploration vehicles are launched with all consumables and logistics in a defined configuration, the configuration continually changes as the mission progresses. Traditionally significant ground and crew time has been required to understand the evolving configuration and to help locate misplaced items. For key mission events and unplanned contingencies, the crew will not be able to rely on the ground for logistics localization assistance. NASA has been developing a radio-frequency-identification autonomous logistics management system to reduce crew time for general inventory and enable greater crew self-response to unplanned events when a wide range of items may need to be located in a very short time period. This paper provides a status of the technologies being developed and their mission benefits for exploration missions

A comparison of linear and logarithmic auditory tones in pulse oximeters

This study compared the ability of forty anaesthetists to judge absolute levels of oxygen saturation, direction of change, and size of change in saturation using auditory pitch and pitch difference in two laboratory-based studies that compared a linear pitch scale with a logarithmic scale. In the former the differences in saturation become perceptually closer as the oxygenation level becomes higher whereas in the latter the pitch differences are perceptually equivalent across the whole range of values. The results show that anaesthetist participants produce significantly more accurate judgements of both absolute oxygenation values and size of oxygenation level difference when a logarithmic, rather than a linear, scale is used. The line of best fit for the logarithmic function was also closer to x ¼ y than for the linear function. The results of these studies can inform the development and standardisation of pulse oximetry tones in order to improve patient safety

Development and Implementation of Tennessee Nonresidential Buprenorphine Treatment Guidelines

Objective: To describe the recent legislation in Tennessee and subsequent development and implementation of state-wide buprenorphine treatment guidelines. Practice Innovation: In 2016, Tennessee began licensing office-based opioid treatment (OBOT) clinics. Due to initial licensing criteria, not all providers were required to be licensed with the Department of Mental Health and Substance Abuse Services (TDMHSAS). The gap in licensing made it difficult to ensure an appropriate standard of care was being met by all addiction treatment providers. Therefore, the state developed legislation that allowed for the creation of best practice guidelines to encompass all providers of buprenorphine in the state of Tennessee, not just the licensed OBOT clinics. The guidelines define what the standard of care should entail while treating this vulnerable addiction population. Results: Tennessee legislation granted the formation of a committee to create the Tennessee Nonresidential Buprenorphine Treatment Guidelines. The committee was comprised of physicians, pharmacists, lawyers, law enforcement, and state officials. The finalized guidelines were published and effective January 1, 2018, and adopted as policy by the boards of medical examiners, osteopathic examination, and pharmacy shortly thereafter. The guidelines are now enforceable by the boards and give them the ability to discipline physicians who practice outside the standard of care. Conclusion: Tennessee legislation provides a model for other states to take action in combating this opioid crisis by not only increasing access to addiction treatment, but increasing access to quality care.   Article Type: Commentary   &nbsp

Complexity of Discrete Energy Minimization Problems

Discrete energy minimization is widely-used in computer vision and machine learning for problems such as MAP inference in graphical models. The problem, in general, is notoriously intractable, and finding the global optimal solution is known to be NP-hard. However, is it possible to approximate this problem with a reasonable ratio bound on the solution quality in polynomial time? We show in this paper that the answer is no. Specifically, we show that general energy minimization, even in the 2-label pairwise case, and planar energy minimization with three or more labels are exp-APX-complete. This finding rules out the existence of any approximation algorithm with a sub-exponential approximation ratio in the input size for these two problems, including constant factor approximations. Moreover, we collect and review the computational complexity of several subclass problems and arrange them on a complexity scale consisting of three major complexity classes -- PO, APX, and exp-APX, corresponding to problems that are solvable, approximable, and inapproximable in polynomial time. Problems in the first two complexity classes can serve as alternative tractable formulations to the inapproximable ones. This paper can help vision researchers to select an appropriate model for an application or guide them in designing new algorithms.Comment: ECCV'16 accepte

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study

INTRODUCTION: We report the impact of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, on inflammation and health-related quality of life (HRQoL) in patients with difficult-to-treat Gouty Arthritis. METHODS: In this eight-week, single-blind, double-dummy, dose-ranging study, patients with acute Gouty Arthritis flares who were unresponsive or intolerant to--or had contraindications for--non-steroidal anti-inflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg) (N = 143) or an intramuscular dose of triamcinolone acetonide 40 mg (N = 57). Patients assessed pain using a Likert scale, physicians assessed clinical signs of joint inflammation, and HRQoL was measured using the 36-item Short-Form Health Survey (SF-36) (acute version). RESULTS: At baseline, 98% of patients were suffering from moderate-to-extreme pain. The percentage of patients with no or mild pain was numerically greater in most canakinumab groups compared with triamcinolone acetonide from 24 to 72 hours post-dose; the difference was statistically significant for canakinumab 150 mg at these time points (P < 0.05). Treatment with canakinumab 150 mg was associated with statistically significant lower Likert scores for tenderness (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.27 to 7.89; P = 0.014) and swelling (OR, 2.7; 95% CI, 1.09 to 6.50, P = 0.032) at 72 hours compared with triamcinolone acetonide. Median C-reactive protein and serum amyloid A levels were normalized by seven days post-dose in most canakinumab groups, but remained elevated in the triamcinolone acetonide group. Improvements in physical health were observed at seven days post-dose in all treatment groups; increases in scores were highest for canakinumab 150 mg. In this group, the mean SF-36 physical component summary score increased by 12.0 points from baseline to 48.3 at seven days post-dose. SF-36 scores for physical functioning and bodily pain for the canakinumab 150 mg group approached those for the US general population by seven days post-dose and reached norm values by eight weeks post-dose. CONCLUSIONS: Canakinumab 150 mg provided significantly greater and more rapid reduction in pain and signs and symptoms of inflammation compared with triamcinolone acetonide 40 mg. Improvements in HRQoL were seen in both treatment groups with a faster onset with canakinumab 150 mg compared with triamcinolone acetonide 40 mg. TRIAL REGISTRATION: clinicaltrials.gov: NCT00798369