Abstract: A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.
Abstract: The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.
Abstract: Autonomous mobile robots (AMR) are expected as smart tools for operations in every automation industry. Path planning and obstacle avoidance is the backbone of AMR as robots have to reach their goal location avoiding obstacles while traversing through optimized path defined according to some criteria such as distance, time or energy. Path planning can be classified into global and local path planning where environmental information is known and unknown/partially known, respectively. A number of sensors are used for data collection. A number of algorithms such as artificial potential field (APF), rapidly exploring random trees (RRT), bidirectional RRT, Fuzzy approach, Purepursuit, A* algorithm, vector field histogram (VFH) and modified local path planning algorithm, etc. have been used in the last three decades for path planning and obstacle avoidance for AMR. This paper makes an attempt to review some of the path planning and obstacle avoidance algorithms used in the field of AMR. The review includes comparative analysis of simulation and mathematical computations of path planning and obstacle avoidance algorithms using MATLAB 2018a. From the review, it could be concluded that different algorithms may complete the same task (i.e. with a different set of instructions) in less or more time, space, effort, etc.
Abstract: This work approaches the automatic planning of paths
for Unmanned Aerial Vehicles (UAVs) through the application of the
Rapidly Exploring Random Tree Star-Smart (RRT*-Smart) algorithm.
RRT*-Smart is a sampling process of positions of a navigation
environment through a tree-type graph. The algorithm consists of
randomly expanding a tree from an initial position (root node) until
one of its branches reaches the final position of the path to be
planned. The algorithm ensures the planning of the shortest path,
considering the number of iterations tending to infinity. When a
new node is inserted into the tree, each neighbor node of the
new node is connected to it, if and only if the extension of the
path between the root node and that neighbor node, with this new
connection, is less than the current extension of the path between
those two nodes. RRT*-smart uses an intelligent sampling strategy
to plan less extensive routes by spending a smaller number of
iterations. This strategy is based on the creation of samples/nodes
near to the convex vertices of the navigation environment obstacles.
The planned paths are smoothed through the application of the
method called quintic pythagorean hodograph curves. The smoothing
process converts a route into a dynamically-viable one based on the
kinematic constraints of the vehicle. This smoothing method models
the hodograph components of a curve with polynomials that obey
the Pythagorean Theorem. Its advantage is that the obtained structure
allows computation of the curve length in an exact way, without the
need for quadratural techniques for the resolution of integrals.
Abstract: This paper presents an algorithm which extends the rapidly-exploring random tree (RRT) framework to deal with change of the task environments. This algorithm called the Retrieval RRT Strategy (RRS) combines a support vector machine (SVM) and RRT and plans the robot motion in the presence of the change of the surrounding environment. This algorithm consists of two levels. At the first level, the SVM is built and selects a proper path from the bank of RRTs for a given environment. At the second level, a real path is planned by the RRT planners for the given environment. The suggested method is applied to the control of KUKA™,, a commercial 6 DOF robot manipulator, and its feasibility and efficiency are demonstrated via the cosimulatation of MatLab™, and RecurDyn™,.