Mediating Cognitive Transformation with VR 3D Sketching during Conceptual Architectural Design Process

Communications for information synchronization during the conceptual design phase require designers to employ more intuitive digital design tools. This paper presents findings of a feasibility study for using VR 3D sketching interface in order to replace current non-intuitive CAD tools. We used a sequential mixed method research methodology including a qualitative case study and a cognitive-based quantitative protocol analysis experiment. Foremost, the case study research was conducted in order to understand how novice designers make intuitive decisions. The case study documented the failure of conventional sketching methods in articulating complicated design ideas and shortcomings of current CAD tools in intuitive ideation. The case study’s findings then became the theoretical foundations for testing the feasibility of using VR 3D sketching interface during design. The latter phase of study evaluated the designers’ spatial cognition and collaboration at six different levels: “physical-actions”, “perceptualac ons”, “functional-actions”, “conceptual-actions”, “cognitive synchronizations”, and “gestures”. The results and confirmed hypotheses showed that the utilized tangible 3D sketching interface improved novice designers’ cognitive and collaborative design activities. In summary this paper presents the influences of current external representation tools on designers’ cognition and collaboration as well as providing the necessary theoretical foundations for implementing VR 3D sketching interface. It contributes towards transforming conceptual architectural design phase from analogue to digital by proposing a new VR design interface. The paper proposes this transformation to fill in the existing gap between analogue conceptual architectural design process and remaining digital engineering parts of building design process hence expediting digital design process

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status