15 research outputs found

    Autonomous Navigation Apparatus With Neural Network for a Mobile Vehicle

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    An autonomous navigation system for a mobile vehicle arranged to move within an environment includes a plurality of sensors arranged on the vehicle and at least one neural network including an input layer coupled to the sensors, a hidden layer coupled to the input layer, and an output layer coupled to the hidden layer. The neural network produces output signals representing respective positions of the vehicle, such as the X coordinate, the Y coordinate, and the angular orientation of the vehicle. A plurality of patch locations within the environment are used to train the neural networks to produce the correct outputs in response to the distances sensed

    Deformation and Flexibility Equations for Idealized ARIS Umbilicals, Under Planar End-Loading Conditions

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    The International Space Station (ISS) relies on the Active Rack Isolation System (ARIS) as the central component of an integrated, station-wide strategy to isolate microgravity space-science experiments. ARIS uses electromechanical actuators to isolate an International Standard Payload Rack (ISPR) from disturbances due to the motion of the ISS. Disturbances to microgravity experiments on ARIS-isolated racks are primarily transmitted via the ARIS power and vacuum umbilicals. Recent experimental tests indicate that these umbilicals resonate at frequencies outside the ARIS controller's bandwidth. at levels of potential concern for certain microgravity experiments. Reduction in the umbilical resonant frequencies could help to address this issue. This paper develops equations for the in-plane deflections and flexibilities of an idealized umbilical (thin, flexible, cantilever beam) under end-point, in-plane loading (inclined-force and moment). The effect of gravity is neglected due to the on:orbit application. The analysis assumes an initially straight. cantilevered umbilical with uniform cross-section. which undergoes large deflections with no plastic deformation, such that the umbilical terminus remains in a single quadrant and the umbilical slope changes monotonically. The analysis is applicable to the ARIS power and vacuum umbilicals. under the indicated assumptions

    Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

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    Deformation and Flexibility Equations for ARIS Umbilicals Idealized as Planar Elastica

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    The International Space Station relies on the active rack isolation system (ARIS) as the central component of an integrated, stationwide strategy to isolate microgravity space-science experiments. ARIS uses electromechanical actuators to isolate an international standard payload rack from disturbances due to the motion of the Space Station. Disturbances to microgravity experiments on ARIS isolated racks are transmitted primarily via the ARIS power and vacuum umbilicals. Experimental tests indicate that these umbilicals resonate at frequencies outside the ARIS controller s bandwidth at levels of potential concern for certain microgravity experiments. Reduction in the umbilical resonant frequencies could help to address this issue. This work documents the development and verification of equations for the in-plane deflections and flexibilities of an idealized umbilical (thin, flexible, inextensible, cantilever beam) under end-point, in-plane loading (inclined-force and moment). The effect of gravity is neglected due to the on-orbit application. The analysis assumes an initially curved (not necessarily circular), cantilevered umbilical with uniform cross-section, which undergoes large deflections with no plastic deformation, such that the umbilical slope changes monotonically. The treatment is applicable to the ARIS power and vacuum umbilicals under the indicated assumptions

    Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

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    Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

    Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

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    Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

    Liver injury in hospitalized patients with COVID-19: An International observational cohort study

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    Background: Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes.MethodsWe included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component & GE;3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI).ResultsOf 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]).ConclusionsLiver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes
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