Optimal time for constant drug infusion initialization in neuromuscular blockade control

This paper presents a control strategy for neuromuscular blockade (NMB) level, in order to determine the optimal time to initialize the administration of the muscle relaxant rocuronium by means of the continuous infusion of a constant dose. The constant value of muscle relaxant for a particular patient undergoing general anesthesia is computed in order to guarantee that the steady-state value of neuromuscular blockade level is the desired reference value. In order to apply this open-loop control strategy, the patient's NMB response to rocuronium is assumed to be modeled by a recently proposed parameter parsimonious model

Story and Transformation in a Reading Laboratory for the Elderly in Pandemic Times – An Experience Report

Literature is one of the finest ways to express the human art and creativeness therefore is a path to reach the understanding of human nature In this article we will discuss the use of literature in group debate of elders which participated in a senior program of a Brazilian university as a resource to stimulate a personal discovery of inner resources to deal with this challenging period of life during the Covid 19 pandemic in 2020 Our participation started in 2017 with a group formed by men and women above 60 years old attending this program Until 2019 there were 65 participants in a yearly program but in 2020 there was a variation between 40-70 The experience to be discussed derives from an aesthetic attitude starting with literary reading followed by a group discussion in order to stimulate affective social bonds among the participants Further discussed themes were the impact of the online version and the use of technology in a senior grou

Total Mass TCI driven by Parametric Estimation

This paper presents the Total Mass Target Controlled Infusion algorithm. The system comprises an On Line tuned Algorithm for Recovery Detection (OLARD) after an initial bolus administration and a Bayesian identification method for parametric estimation based on sparse measurements of the accessible signal. To design the drug dosage profile, two algorithms are here proposed. During the transient phase, an Input Variance Control (IVC) algorithm is used. It is based on the concept of TCI and aims to steer the drug effect to a predefined target value within an a priori fixed interval of time. After the steady state phase is reached the drug dose regimen is controlled by a Total Mass Control (TMC) algorithm. The mass control law for compartmental systems is robust even in the presence of parameter uncertainties. The whole system feasibility has been evaluated for the case of Neuromuscular Blockade (NMB) level and was tested both in simulation and in real cases

Round of conversation on landslide disaster risks in the Rocinha favela (Rio de Janeiro, Brazil): experiences of struggle, resistance, knowledge and art

Landslide disasters are often the result of an unequal socio-spatial organization, characterized by the rapid and haphazard occupation of susceptible areas. Such adverse events primarily affect poor populations with a high degree of vulnerability, while their social demands are often neglected by local authorities. This paper presents and discusses the use of the round-of-conversation method for knowledge and information exchange between academics and representatives of the exposed population in the community of Rocinha, a favela in Rio de Janeiro. It is an adaptation of the photovoice method for the promotion of debates between academics from the fields of anthropology, engineering and sociology, and residents, and was complemented by an artistic intervention. The round-of-conversation method contributed to the empowerment of the participants by providing a forum for reflective interaction based on experiences of struggle, resistance and knowledge production. Therefore, the images used during the experience stimulated the discussions on topics such as resettlement, local policies and solidarity among the inhabitants. Lastly, the artistic perspective translated the debate into the creation of a piece of graffiti art, which remained in the community as a legacy.Os desastres associados a deslizamentos de terra revelam uma organização socioespacial desigual, caracterizada pela ocupação rápida e informal de áreas suscetíveis a estes eventos adversos. Estes afetam principalmente populações mais pobres com elevado grau de vulnerabilidade, cujas demandas sociais são frequentemente negligenciadas pelo poder público. O presente trabalho, portanto, visa apresentar e discutir a experimentação do método roda de conversa para troca de saberes entre acadêmicos e representantes da população exposta na comunidade da Rocinha, uma das favelas do Rio de Janeiro. Trata-se de uma adaptação do método photovoice para a promoção de debates entre acadêmicos das áreas de antropologia, engenharia e sociologia com moradores da favela, tendo sido associado a uma intervenção artística. A roda de conversa contribuiu para a emancipação dos diferentes sujeitos ao proporcionar a interação reflexiva a partir de suas experiências vividas de luta, resistência e produção de saberes. Além disso, as imagens usadas suscitaram discussões sobre temas, tais como reassentamento, políticas públicas locais e solidariedade entre moradores. Por último, o olhar artístico traduziu o debate na criação de um grafite que ficou de legado na comunidade

Automated Total IntraVenous Anesthesia (amTIVA) from induction to recovery

This paper presents a multi-functional automatic control approach for total intravenous anesthesia (TIVA) administration, valid for several drug combinations and able to run autonomously during the three main phases of general anesthesia: induction, maintenance and recovery. While using this standalone TIVA module, named as amTIVA, the anesthesiologist has the crucial role of system supervisor. Bolus administration, open-loop target controlled infusion (TCI) and closed-loop controlled infusion modes are implemented and available for the control of the two main components of anesthesia: the neuromuscular blockade and the depth of anesthesia. This multi-functional module is implemented in the GALENO Platform and was successfully tested in more than thirty clinical cases

Robust Control of Maintenance-Phase Anesthesia

In biomedical systems, feedback control can be applied whenever adequate sensors, actuators, and sufficiently accurate mathematical models are available. The key issue is the capacity of the control algorithm to tackle the large levels of uncertainty, both structured and unstructured, associated with patient dynamics. In the particular case of intravenous anesthesia considered here, manipulated variables are drug infusion rates, administered by syringe pumps, and the measured signal outputs are the levels of hypnosis or depth of anesthesia (DoA) and of neuromuscular blockade (NMB). Figure 1 provides an example of a loop closed for the control of NMB

A research agenda to support the development and implementation of genomics-based clinical informatics tools and resources.

OBJECTIVE: The Genomic Medicine Working Group of the National Advisory Council for Human Genome Research virtually hosted its 13th genomic medicine meeting titled Developing a Clinical Genomic Informatics Research Agenda . The meeting\u27s goal was to articulate a research strategy to develop Genomics-based Clinical Informatics Tools and Resources (GCIT) to improve the detection, treatment, and reporting of genetic disorders in clinical settings. MATERIALS AND METHODS: Experts from government agencies, the private sector, and academia in genomic medicine and clinical informatics were invited to address the meeting\u27s goals. Invitees were also asked to complete a survey to assess important considerations needed to develop a genomic-based clinical informatics research strategy. RESULTS: Outcomes from the meeting included identifying short-term research needs, such as designing and implementing standards-based interfaces between laboratory information systems and electronic health records, as well as long-term projects, such as identifying and addressing barriers related to the establishment and implementation of genomic data exchange systems that, in turn, the research community could help address. DISCUSSION: Discussions centered on identifying gaps and barriers that impede the use of GCIT in genomic medicine. Emergent themes from the meeting included developing an implementation science framework, defining a value proposition for all stakeholders, fostering engagement with patients and partners to develop applications under patient control, promoting the use of relevant clinical workflows in research, and lowering related barriers to regulatory processes. Another key theme was recognizing pervasive biases in data and information systems, algorithms, access, value, and knowledge repositories and identifying ways to resolve them

Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe