A Voice and Pointing Gesture Interaction System for Supporting Human Spontaneous Decisions in Autonomous Cars

Autonomous cars are expected to improve road safety, traffic and mobility. It is projected that in the next 20-30 years fully autonomous vehicles will be on the market. The advancement on the research and development of this technology will allow the disengagement of humans from the driving task, which will be responsibility of the vehicle intelligence. In this scenario new vehicle interior designs are proposed, enabling more flexible human vehicle interactions inside them. In addition, as some important stakeholders propose, control elements such as the steering wheel and accelerator and brake pedals may not be needed any longer. However, this user control disengagement is one of the main issues related with the user acceptance of this technology. Users do not seem to be comfortable with the idea of giving all the decision power to the vehicle. In addition, there can be location awareness situations where the user makes a spontaneous decision and requires some type of vehicle control. Such is the case of stopping at a particular point of interest or taking a detour in the pre-calculated autonomous route of the car. Vehicle manufacturers\u27 maintain the steering wheel as a control element, allowing the driver to take over the vehicle if needed or wanted. This causes a constraint in the previously mentioned human vehicle interaction flexibility. Thus, there is an unsolved dilemma between providing users enough control over the autonomous vehicle and route so they can make spontaneous decision, and interaction flexibility inside the car. This dissertation proposes the use of a voice and pointing gesture human vehicle interaction system to solve this dilemma. Voice and pointing gestures have been identified as natural interaction techniques to guide and command mobile robots, potentially providing the needed user control over the car. On the other hand, they can be executed anywhere inside the vehicle, enabling interaction flexibility. The objective of this dissertation is to provide a strategy to support this system. For this, a method based on pointing rays intersections for the computation of the point of interest (POI) that the user is pointing to is developed. Simulation results show that this POI computation method outperforms the traditional ray-casting based by 76.5% in cluttered environments and 36.25% in combined cluttered and non-cluttered scenarios. The whole system is developed and demonstrated using a robotics simulator framework. The simulations show how voice and pointing commands performed by the user update the predefined autonomous path, based on the recognized command semantics. In addition, a dialog feedback strategy is proposed to solve conflicting situations such as ambiguity in the POI identification. This additional step is able to solve all the previously mentioned POI computation inaccuracies. In addition, it allows the user to confirm, correct or reject the performed commands in case the system misunderstands them

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