Lessons learned from the Hospital Without Walls project

2002 ◽  
Vol 8 (3_suppl) ◽  
pp. 11-14 ◽  
Author(s):  
Michael Dadd ◽  
Briony Doyle ◽  
Laurie Wilson ◽  
Marcus Gunaratnam
Keyword(s):  
Vital Signs ◽  
Home Monitoring ◽  
Relevant Information ◽  
Base Station ◽  
Lessons Learned ◽  
Physiological Data ◽  
Prototype System ◽  
Radio Communication ◽  
Radio System ◽  
Emergency Events

summary The Hospital Without Walls is an ongoing ambitious project in home telecare that incorporates research into physiological monitoring, low-power radio communication, database storage of physiological data and methods of viewing clinically relevant information from large quantities of stored data. The system records vital signs from patients in their homes using a body-mounted, two-way radio system and a base station located in the home, which transmits data records to a central recording facility every day or in response to predefined emergency events. The prototype system has successfully undergone preliminary clinical trials, with a particular clinical emphasis on monitoring activity using three-axis accelerometers. Our experience with the trial suggests that there are significant differences in the technical design required for a long-term, home monitoring system and one where monitoring takes place in an environment staffed by health professionals.

scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

Abstract 18150: Prediction of Imminent Deterioration of Children after Stage I Palliation Using Real-Time Processing of Physiological Data

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Craig G Rusin ◽  
Sebastian I Acosta ◽  
Eric L Vu ◽  
Risa B Myers ◽  
Kenneth M Brady ◽  
...  
Keyword(s):  
Early Life ◽  
Physiological State ◽  
Vital Signs ◽  
Clinical Deterioration ◽  
Physiological Data ◽  
Real Time Processing ◽  
Life Saving ◽  
St Segment ◽  
The Hours ◽  
Roc Area

Patients after stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) and related lesions are at risk of life threatening deterioration resulting in shock, cardiac arrest, & hypoxemia. We hypothesize that these sudden deteriorations may be forecast by subtle, previously unidentified changes in cardiorespiratory dynamics. Identification of these precursors may provide an opportunity for early, life-saving intervention. We created complete high-resolution physiological recordings for all patients who had a primary admission of S1P after Jan. 1, 2013. We used the SickbayTM system (Medical Informatics Corp, Houston, TX) to collect high frequency physiological waveforms including EKG, ABP, LAP, SpO2 and Chest Impedance (60Hz - 240Hz), as well as HR, RR, Temp. and ST segment vital signs (0.5 Hz) during the patient’s interstage hospitalization. A logistic regression model was constructed to discriminate between physiological characteristics observed in the hours prior to deterioration from the characteristics observed >24 hours prior to or >96 hours after a clinical deterioration. Model validation was done using a standard bagging approach with a REPtree classifier and 10 fold cross validation. Twenty five patients were included in the study. Of these, 15 (60%) were found to have one or more deterioration events (arrest, CPR, unplanned intubation), with 24 total events observed during the interstage period. Characteristics associated with imminent deterioration were low SpO2 and depressed ST segment. Changes in physiological dynamics could be detected 1-2 hours before overt deterioration occurs (ROC area = 0.89) (Figure 1). This altered physiological state remains for ~96 hours after deterioration. In conclusion, it is possible to identify clinical deterioration in HLHS patients during their interstage period ~1-2 hours before overt deterioration occurs, providing an opportunity for early, life-saving intervention to be administered.

Secure Intelligent Radio for Trains (SIRT)

2017 ◽  
Author(s):  
K. R. Damindra S. Bandara ◽  
Satish Kolli ◽  
Duminda Wijesekara
Keyword(s):  
Critical Infrastructure ◽  
Adaptive Modulation ◽  
Radio Spectrum ◽  
Spectrum Management ◽  
Worker Safety ◽  
Radio Noise ◽  
Radio Communication ◽  
Radio System ◽  
Cognitive Engine ◽  
Prototype Development

American Railroads are planning to complete implementing their Positive Train Control (PTC) systems by 2020. Safety objectives of PTC are to avoid inter-train collisions, train derailments and ensuring railroad worker safety. Under published specifications of I-ETMS (the PTC system developed by Class I freight railroads), the on-board PTC controller communicates with two networks; namely, the Signaling network and the Wayside Interface Unit network to gather navigational information such as the positions of other trains, the status of critical infrastructure (such as switches) and any hazardous conditions that may affect the train path. By design, PTC systems are predicated on having a reliable radio network operating in reserved radio spectrum, although the PTC system itself is designed to be a real-time fail safe distributed control systems. Secure Intelligent Radio for Trains (SIRT) is an intelligent radio that is customized to train operations with the aim of improving the reliability and security of the radio communication network. SIRT has two tiers. The upper tier has the Master Cognitive Engine (MCE) which communicates with other SIRT nodes to obtain signaling and wayside device information. To do so, the MCE communicates with cognitive engines at the lower tier of SIRT; namely the Cryptographic Cognitive Engine (CCE) (that provide cryptographic security and threat detection) and the Spectrum Management Cognitive Engine (SCE) (that uses spectrum monitoring, frequency hopping and adaptive modulation to ensure the reliability of the radio communication medium). We presented the architecture and the prototype development of the CCE in [1]. This paper presents the design of the MCE and the SCE. We are currently developing a prototype of the SCE and the MCE and testing the performance of our cognitive radio system under varying radio noise conditions. Our experiments show that SIRT dynamically switches modulation schemes in response to radio noise and switches channels in response to channel jamming.

scholarly journals Performance of Base Stations in Railway Digital Radio Communication Networks

2021 ◽  
Vol 19 (2) ◽  
pp. 41-48
Author(s):  
Yu. V. Nemtsov ◽  
I. V. Seryogin ◽  
P. I. Volnov
Keyword(s):  
Communication Network ◽  
Communication Networks ◽  
Base Station ◽  
Base Stations ◽  
Radio Communication ◽  
Radio Communications ◽  
Digital Radio ◽  
Cargo Transportation ◽  
Assess Quality

Base station (BS) is a terminal device of a radio communication network, while railway radio communications play an important role in ensuring safety of passenger and cargo transportation.A proposed method for calculating the performance of base stations in railway digital radio communication networks is intended to calculate for the BS the probabilities of being in certain state.BS was decomposed and such functional elements as circuit groups and a radio frequency path were identified, as well as the central module ensuring the exchange of information with elements of this BS and with other BSs. A detailed study of each element has increased accuracy of the proposed method. Following the Markov model, BS is presented as a system in which all possible states are considered. Models for BS with two and three circuit groups have been constructed. The parameters of each functional element of the model can be obtained through observation over a certain period. The solution of the system of equations for each of the models presented in the article will allow obtaining the values of the system being in a certain state. The obtained characteristics can be used to calculate the reliability of the entire radio communication network, and then to assess quality of service provided to the users of this network.Conclusions are made about the possibilities of using the obtained models when designing new railway communication networks and when calculating quality indices of existing ones. The proposed models can be applied not only to railway radio communication networks but also to mobile communication networks of commercial operators. 

Transarterial embolization for postpartum hemorrhage: lessons learned

2018 ◽  
Vol 59 (12) ◽  
pp. 1451-1457
Author(s):  
Chen-Ju Fu ◽  
Wiwan Irama ◽  
Yon-Cheong Wong ◽  
Hsiao-Jung Tseng ◽  
Li-Jen Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postpartum Hemorrhage ◽  
Transarterial Embolization ◽  
Laboratory Data ◽  
Vital Signs ◽  
International Normalized Ratio ◽  
Lessons Learned ◽  
Clinical Failure ◽  
Shock Index ◽  
Independent Risk Factors

Background Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. Purpose To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. Material and Methods We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. Results In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. Conclusion The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.

scholarly journals Analytical TCP Model for Millimeter-Wave 5G NR Systems in Dynamic Human Body Blockage Environment

Sensors ◽  
2020 ◽  
Vol 20 (14) ◽  
pp. 3880
Author(s):  
Dmitri Moltchanov ◽  
Aleksandr Ometov ◽  
Pavel Kustarev ◽  
Oleg Evsutin ◽  
Jiri Hosek ◽  
...  
Keyword(s):  
Transmission Control Protocol ◽  
Base Station ◽  
Radio System ◽  
Tcp Protocol ◽  
Trip Time ◽  
Air Interface ◽  
New Radio ◽  
High Bandwidth ◽  
State Changes ◽  
Tcp Throughput

Dynamic blockage of radio propagation paths between the user equipment (UE) and the 5G New Radio (NR) Base Station (BS) induces abrupt rate fluctuations that may lead to sub-optimal performance of the Transmission Control Protocol (TCP) protocol. In this work, we characterize the effects of dynamic human blockage on TCP throughput at the 5G NR air interface. To this aim, we develop an analytical model that expresses the TCP throughput as a function of the round-trip time (RTT), environmental, and radio system parameters. Our results indicate that the blockage affects TCP throughput only when the RTT is comparable to the blocked and non-blocked state durations when the frequency of state changes is high. However, such conditions are not typical for dynamic body blockage environments allowing TCP to benefit from the high bandwidth of 5G NR systems fully.

scholarly journals Developing a Building Fire Information Management System Based on 3D Object Visualization

2020 ◽  
Vol 10 (3) ◽  
pp. 772 ◽  
Author(s):  
Jung ◽  
Cha ◽  
Jiang
Keyword(s):  
Decision Making ◽  
Information Management ◽  
Management System ◽  
Relevant Information ◽  
Information Management System ◽  
Information Modeling ◽  
Prototype System ◽  
Building Fire ◽  
Emergency Responders ◽  
Fire Information

In a building fire disaster, a variety of information on hazardous factors is crucial for emergency responders, facility managers, and rescue teams. Inadequate information management limits the accuracy and speed of fire rescue activities. Furthermore, a poor decision-making process, which is solely dependent on the experiences of emergency responders, negatively affects the fire response activities. Building information modeling (BIM) enables the sharing of locations of critical elements and key information necessary for effective decision-making on disaster prevention. However, it is non-trivial to integrate and link the relevant information generated during the life cycle of the building. In particular, the information requirements for building fires should be retrieved in the BIM software because most of them have spatial characteristics. This paper proposes a prototype system for a building’s fire information management using three-dimensional (3D) visualization by deriving the relevant information required for mitigating building fire disasters. The proposed system (i.e., Building Fire Information Management System (BFIMS)) automatically provides reliable fire-related information through a computerized and systematic approach in conjunction with a BIM tool. It enables emergency responders to intuitively identify the location data of indoor facilities with its pertinent information based on 3D objects. Through scenario-based applications, the system has effectively demonstrated that it has contributed to an improvement of rapid access to relevant information.

Addressing Challenges in Web Accessibility for the Blind and Visually Impaired

2011 ◽  
Vol 9 (4) ◽  
pp. 1-13 ◽  
Author(s):  
Angela Guercio ◽  
Kathleen A. Stirbens ◽  
Joseph Williams ◽  
Charles Haiber
Keyword(s):  
Visually Impaired ◽  
Visual Cues ◽  
Preliminary Test ◽  
Relevant Information ◽  
Prototype System ◽  
Preliminary Evaluation ◽  
Blind And Visually Impaired ◽  
Visually Impaired People ◽  
Blind Persons ◽  
The Waves

Searching for relevant information on the web is an important aspect of distance learning. This activity is a challenge for visually impaired distance learners. While sighted people have the ability to filter information in a fast and non sequential way, blind persons rely on tools that process the information in a sequential way. Learning is slowed by screen readers which do not interact well with web pages. This paper introduces WAVES, a tool for the fast retrieval of information in a web page for blind and visually impaired people. The paper describes the WAVES prototype, a system that performs a page restructuring of webpages. The system analyzes webpages, identifies elements of interests from a webpage, evaluates their importance by using semantic information and visual cues, sorts them by importance and uses them to restructure the webpage so that data from the original webpage are presented to the reader in a concise format. A preliminary evaluation test of the prototype system has been performed with a sample set of users. The results of the preliminary test show an increase in speed and accuracy when the WAVES system has been used.

scholarly journals Fighting for Credibility: US Reputation Building in Asymmetric Conflicts from the Gulf War to Syria (1991–2013)

2015 ◽  
Vol 48 (3) ◽  
pp. 503-530
Author(s):  
Frank P. Harvey ◽  
John Mitton
Keyword(s):  
Relevant Information ◽  
Lessons Learned ◽  
Policy Implications ◽  
Military Force ◽  
Quantitative Studies ◽  
Policy Debates ◽  
Asymmetric Conflicts ◽  
Crucial Information ◽  
Extensive Collection ◽  
Reputation Building

AbstractDo international reputations matter and are they transferable from one context to another? These critically important questions continue to frame policy debates surrounding US responses to crises in Syria and Ukraine. For skeptics, past actions and reputations for resolve have no bearing on an adversary's assessment of US credibility; relative “power” and “interests” explain behaviour (Hopf, 1994; Mercer, 1996; Press, 2005; Walt, 2013; Zakaria 2013). We argue that scholars who dismiss the relevance of reputations typically sidestep important questions about how adversaries actually acquire relevant information about US interests and power. Building on an extensive collection of qualitative and quantitative studies of US deterrence encounters in asymmetric conflicts over the last two decades, we argue that lessons from past actions inform an adversary's interpretation of US interests in any given case and provide crucial information about Washington's willingness to deploy military force (capabilities). By implication, lessons learned from Bosnia 1992–1995 informed actions in Kosovo 1999, which, in turn, informed subsequent assessments of US interests and commitments in Iraq 1991, 1998 and 2003. Similarly, lessons about US reputations and credibility in Iraq from 1991 to 2003 were critically important to successful WMD diplomacy in Syria. Policy implications are addressed in the conclusion.

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