A national survey of oxytocin use during caesarean section in Zimbabwe

Background: Post-partum haemorrhage is the leading cause of mortality for labouring women in Zimbabwe. Current literature supports the use of low dose oxytocin to prevent bleeding during Caesarean section. Internationally, clinical practice has been slow to change and the use of potentially harmful, higher than recommended dose is common.Objective: To describe the current clinical practice in Zimbabwe.Design: A self-administered questionnaire survey. Descriptive statistics were used to report the study results.Setting: In 2013 a national survey was conducted on the use of oxytocin by different types of clinicians, who provide either anaesthesia or surgery for Caesarean section.Results: Of a total of 221 (61%) questionnaires returned, 170 (80%) were completed fully. Only 23% of respondents would give an intravenous dose of 5.0 IU or less of oxytocin for elective Caesarean section. The majority of clinicians (77%) would administer more than 5.0 IU of oxytocin at elective. A significant number of nurse anaesthetists 16/59 (27%), and a non-negligible number of specialist anaesthetists 3/48 (6%) would even give 20 IU of oxytocin in elective cases rising to 30% and 13% respectively for emergency cases. In case of persistent bleeding due to uterine atony, oxytocin was more likely to be repeated (45%), rather than using misoprostol (25%) or ergometrine (19%).Conclusion: Most clinicians in Zimbabwe use oxytocin doses well above current internationally recommended. This illustrates the urgent need for updated national guidelines for the prevention of post-partum haemorrhage during Caesarean section

A Disturbance-Aware Trajectory Planning Scheme Based on Model Predictive Control

Despite the development of numerous trajectory planners based on computationally fast algorithms targeting accurate motion of robots, the nowadays robotic applications requiring compliance for interaction with environment demand more comprehensive schemes to cope with unforeseen situations. This letter discusses the problem of online Cartesian trajectory planning, targeting a final state in a desired time interval, in such a way that the generated trajectories comply with the tracking abnormalities due to considerable motion disturbances. We propose a planning scheme based on Model Predictive Control. It utilises a novel strategy to monitor the tracking performance via state feedback and consequently update the trajectory. Also, it ensures the continuity of the generated reference while accounting for realistic implementation constraints, particularly due to computational capacity limits. To validate the efficacy of the proposed scheme, we examine a practical robotic manipulation scenario in which a given task is executed via a Cartesian impedance controller, while an external interaction interrupts the motion. The performance of the proposed strategy as compared to that of a state-of-the-art study is demonstrated in simulation. Finally, a set of experiments verified the effectiveness of the proposed scheme in practice

WALK-MAN: A High-Performance Humanoid Platform for Realistic Environments

In this work, we present WALK-MAN, a humanoid platform that has been developed to operate in realistic unstructured environment, and demonstrate new skills including powerful manipulation, robust balanced locomotion, high-strength capabilities, and physical sturdiness. To enable these capabilities, WALK-MAN design and actuation are based on the most recent advancements of series elastic actuator drives with unique performance features that differentiate the robot from previous state-of-the-art compliant actuated robots. Physical interaction performance is benefited by both active and passive adaptation, thanks to WALK-MAN actuation that combines customized high-performance modules with tuned torque/velocity curves and transmission elasticity for high-speed adaptation response and motion reactions to disturbances. WALK-MAN design also includes innovative design optimization features that consider the selection of kinematic structure and the placement of the actuators with the body structure to maximize the robot performance. Physical robustness is ensured with the integration of elastic transmission, proprioceptive sensing, and control. The WALK-MAN hardware was designed and built in 11 months, and the prototype of the robot was ready four months before DARPA Robotics Challenge (DRC) Finals. The motion generation of WALK-MAN is based on the unified motion-generation framework of whole-body locomotion and manipulation (termed loco-manipulation). WALK-MAN is able to execute simple loco-manipulation behaviors synthesized by combining different primitives defining the behavior of the center of gravity, the motion of the hands, legs, and head, the body attitude and posture, and the constrained body parts such as joint limits and contacts. The motion-generation framework including the specific motion modules and software architecture is discussed in detail. A rich perception system allows the robot to perceive and generate 3D representations of the environment as well as detect contacts and sense physical interaction force and moments. The operator station that pilots use to control the robot provides a rich pilot interface with different control modes and a number of teleoperated or semiautonomous command features. The capability of the robot and the performance of the individual motion control and perception modules were validated during the DRC in which the robot was able to demonstrate exceptional physical resilience and execute some of the tasks during the competition

Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial

Background Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use. Methods and analysis We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6–12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. Discussion This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach

WALK-MAN Humanoid Platform

In this chapter we present WALK-MAN, a humanoid platform that has been developed to operate in realistic unstructured environments and demonstrate new skills including powerful manipulation, robust balanced locomotion, high strength capabilities and physical sturdiness. To enable these capabilities, WALK-MAN design and actuation are based on the most recent advancements of Series Elastic Actuation (SEA) drives with unique performance features that differentiate the robot from previous state-of-the-art compliant actuated robots. Physical interaction performance benefits from both active and passive adaptation thanks to WALK-MAN actuation, which combines customized high performance modules with tuned torque/velocity curves and transmission elasticity for high speed adaptation response and motion reactions to disturbances. The WALK-MAN design also includes innovative design optimization features that consider the selection of kinematic structure and the placement of the actuators with respect to the body structure to maximize the robot performance. Physical robustness is ensured with the integration of elastic transmission, proprioceptive sensing and control. WALK-MAN hardware was designed and built in 11 months, and the prototype of the robot was ready 4 months before the DARPA Robotics Challenge (DRC) Finals. The motion generation of WALK-MAN is based on the unified motion generation framework of whole-body locomotion and manipulation (termed loco-manipulation). WALK-MAN is able to execute simple loco-manipulation behaviours synthesized by combining different primitives defining the behaviour of the center of gravity, of the hands, legs and head, the body attitude and posture, and the constrained body parts such as joint limits and contacts. The motion generation framework including the specific motion modules and software architecture are discussed in detail. A rich perception system allows the robot to perceive and generate 3D representations of the environment as well as detect contacts and sense physical interaction force and moments. The operator station that pilots use to control the robot provides a rich pilot interface with different control modes and a number of tele-operated or semi-autonomous command features. The capability of the robot and the performance of the individual motion control and perception modules were validated during the DARPA Robotics Challenge in which the robot was able to demonstrate exceptional physical resilience and execute some of the tasks during the competition