A Multivent System for Non-invasive Ventilation: Solving the Problem of Ventilator Shortage during the COVID-19 Pandemic

The COVID-19 pandemic has caused a severe global problem of ventilator shortage. Placing multiple patients on a single ventilator (ventilator sharing) or dual patient ventilation has been proposed and conducted to increase the cure efficiency for ventilated patients. However, the ventilator-sharing method needs to use the same ventilator settings for all the patients, which cannot meet the ventilation needs of different patients. Therefore, a novel multivent system for non-invasive ventilation has been proposed in this study. The close loop system consists of the proportional valve and the flow-pressure sensor can regulate the airway pressure and flow for each patient. Multiple ventilation circuits can be combined in parallel to meet patients’ventilation demands simultaneously. Meanwhile, the mathematical model of the multivent system is established and validated through experiments. The experiments for different inspired positive airway pressure (IPAP), expired positive airway pressure (EPAP), inspiratory expiratory ratio (I:E), and breath per minute (BPM) have been conducted and analyzed to test the performance of the multivent system. The results show that the multivent system can realize the biphasic positive airway pressure (BIPAP) ventilation mode in non-invasive ventilation without interfering among the three ventilation circuits, no matter the change of IPAP, EPAP, I:E, and BPM. However, pressure fluctuation exists during the ventilation process because of the exhaust valve effect, especially in EPAP control. The control accuracy and stability need to be improved. Nevertheless, the novel designed multivent system can theoretically solve the problem of ventilator shortage during the COVID-19 pandemic and may bring innovation to the current mechanical ventilation system. Author

Design of a Tuned Proportional-Integral-Derivative Water Level Controller for First-Order Automated Irrigation System in Rice Field

Some problems of Filipino farmers in Nueva Ecija are irrigation systems and labor shortage. Most of them are unable to work due to old age while others chose to stop because of the COVID-19 pandemic. Meanwhile, irrigation systems have been an issue due to the lack of resources such as continuous water supply and control. Fortunately, there is a progression of smart farming in the country which could assist in optimizing farming processes. This study presents a systematic literature survey on rice farming technologies and challenges. This study also aims to help address these problems by creating a rice irrigation system that introduces a water level control system. The system was comprised of a mobile application, Arduino ESP32 module, and a tank with water level sensors. The mobile application was used to set the desired water level while the proportional- integral-derivative (PID) controller adjusted the water level automatically. When current water level is lower than the setpoint, the valves to the tank will open. Tank specifications were used to come up with a transfer function for the system. The proposed design was simulated in MATLAB Simulink and PID parameters were tuned to enhance system performance. The tuned control system obtained an output response with less overshoot and faster settling time. © 2022 IEEE.

Clinical Features and Risk Factors for Mortality in Patients with Stenotrophomonas maltophilia Infection

Introduction: It is important to know the risk factors for death in reducing mortality in patients with Stenotrophomonas maltophilia infections. The purpose of this study was to examine the risk factors associated with mortality in hospitalized patients with S. maltophilia infections. Material(s) and Method(s): Patients with S. maltophilia infections aged 18 years and older who were hospitalized in Haseki Research and Training between January 1, 2017, and April 30, 2022, were included in the study. The patients were divided into two groups, non-survivors and survivors, and the clinical features and laboratory parameters of the groups were compared. Mortality risk factors were analyzed by logistic and Cox regression analyses. Result(s): A total of 75 patients with S. maltophilia infections were included. The mortality rate was 38.6% (n= 29). Advanced age (OR= 1.05, 95% CI= 1.012-1.085, p= 0.009), COVID-19 pneumonia (OR= 9.52, 95% CI= 1.255-72.223, p= 0.029), and presence of central venous catheter (CVC) (OR= 18.25, 95% CI= 2.187-152.323, p= 0.007) were risk factors for death. Conclusion(s): Physicians should be aware of the potential risk of S. maltophilia infections for mortality, particularly in patients with predefined risk factors such as advanced age, the presence of CVC, and COVID-19. Performing CVC care in accordance with infection prevention and control measures and timely removal of CVC may be beneficial in reducing deaths due to S. maltophilia infection.Copyright © 2023 Bilimsel Tip Yayinevi. All rights reserved.

Understanding resource deployment efficiency for ESG and financial performance: A DEA approach

COVID-19 has stimulated additional research interest on economic sustainability and ESG in both academia and industry. This study adopts a DEA approach to examine the efficiency of achieving ESG targets and their relationships with financial performance. Using MSCI ESG data from 2015 to 2019 on 1108 Chinese firms, we examine the ESG proportional and pillar mix efficiencies. The dominant strategies for our sampled firms are to improve overall ESG performance by enhancing the E and S pillars through sacrificing G's performance. The second result shows a positive relationship between proportional efficiency and financial performance while a mixed relationship between pillar mix efficiency and financial performance. However, for the technology sector, there exists some trade-offs between ESG performance and financial performance. Specifically, relative to non-technology firms, improving proportional and pillar mix efficiencies for technology firms could result in some sacrifice in stock valuation. © 2023 Elsevier B.V.

Determination of control area and design of fuzzy rule-tuned PID controller for LFC of multimachine power system

In load frequency control (LFC) study of a large power system, the key concept is control area, which is the segment of the system consisting of strongly interconnected buses, generator buses thereof working in unison. For accurate linearization of load frequency control problem, proper determination of control area is important. In the present work, a novel deterministic method is proposed and formulated to calculate the sharing of load changes by the generators to determine the control areas for LFC study of multimachine systems. This method is applied on a weakly interconnected two-area system and then on the 10-Machine New England Test System for area segmentation of each of the two systems. Furthermore, LFC studies are carried out with proposed Fuzzy Rule-tuned PID controllers (FRT-PID Controllers) for both the systems incorporated with Dish-Stirling Solar thermal system (DSTS) in each area. The scaling factors and the controller gains are optimized using Coronavirus Herd Immunity Optimizer Algorithm (CHIOA). Performance of the proposed FRT-PID controllers is compared with that of the Conventional PID controllers for the LFC studies of the systems. To test effectiveness of the FRT-PID controllers, effect of random step load perturbation (SLP) in load buses located in different areas are considered. © 2023 Elsevier B.V.

Trajectory Tracking Analysis of Fractional-Order Nonlinear PID Controller for Single Link Robotic Manipulator System

Increasing demand for automation is being observed especially during the recent scenarios like the Covid-19 pandemic, wherein direct contact of the healthcare workers with the patients can be life-threatening. The use of robotic manipulators facilitates in minimizing such risky interactions and thereby providing a safe environment. In this research work, a single link robotic manipulator (SLRM) system is taken, which is a nonlinear multi–input–multi–output system. In order to address the limitations like heavy object movements, uncontrolled oscillations in positional movement, and improper link variations, an adaptive fractional-order nonlinear proportional, integral, and derivative (FONPID) controller has been suggested. This aids in the effective trajectory tracking of the performance of the SLRM system under step input response. Further, by tuning the controller gains using genetic algorithm optimization (GA) based on the minimum objective function (JIAE ) of the integral of absolute error (IAE) index, the suggested controller has been made more robust for trajectory tracking performance. Finally, the comparative analysis of the simulation results of proportional & integral (PI), proportional, integral, & derivative (PID), fractional-order proportional, integral, & derivative (FOPID), and the suggested FONPID controllers validated that the FONPID controller has performed better in terms of minimum JIAE and lower oscillation amplitude in trajectory tracking of positional movement of SLRM system. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Design of Auto-Tuning Nonlinear PID Tracking Speed Control for Electric Vehicle with Uncertainty Consideration

This study presents a new auto-tuning nonlinear PID controller for a nonlinear electric vehicle (EV) model. The purpose of the proposed control was to achieve two aims. The first aim was to enhance the dynamic performance of the EV regarding internal and external disturbances. The second aim was to minimize the power consumption of the EV. To ensure that these aims were achieved, two famous controllers were implemented. The first was the PID controller based on the COVID-19 optimization. The second was the nonlinear PID (NPID) optimized controller, also using the COVID-19 optimization. Several driving cycles were executed to compare their dynamic performance and the power consumption. The results showed that the auto-tuning NPID had a smooth dynamic response, with a minimum rise and settling time compared to other control techniques (PID and NPID controllers). Moreover, it achieved low continuous power consumption throughout the driving cycles. © 2023 by the author.

Review on Design and Performance of the Medical Ventilators

Ventilators we are available with have several drawbacks such as difficult to port, expensive and meant to be operated by professionals which create hardness in fighting with medical care. Thus, it creates suffering for people in the pandemic like COVID19. So, it is required to develop a ventilator that can be affordable, easy to port and install. We aimed to design a IoT based ventilator system using various electronic devices such as microcontroller and sensors that could monitor patient's body status. People suffering from COVID19 or any lung disease find difficulty in breathing so in such condition of emergency this smart ventilator system can be used. Ambu bag is used to provide certain volume of air that is pressed by using motor mechanism. A portable low-cost ventilator with computerized controlling and feedback system is installed. Ventilator designed can be connected to an interface for smart functioning. This paper provides us with different methods to monitor the patient's health condition by measurement of pressure, level of breathing to know whether the condition is healthy or unhealthy. The designing and developing of low-cost portable ventilator deliver breaths to patients when Ambu bag is compressed by using a piston connected to servo motor whose speed can be varied. Input of the designed system is patient's heart beat and breathing rate and the volume of oxygen provided to patient's lung with required beathing rate is the output of the system. PID (proportional Integral Derivative) and Full state feedback H2 controllers are used for the performance analysis of the system. Result of this review paper is found that a low-cost ventilator is developed removing all the possible shortcomings of existing conventional ventilator. Ventilator designed is portable and smart by using Arduino, servo motor and ambu bag preferred for emergency uses and available for clinical application. © 2023 IEEE.

One Degree of Freedom Copter Design and Control using Smart and Simple PID Controller

A one-degree-of-freedom (1-Dol) copter is designed, implemented, and controlled by an electronically programmed PID controller. The control of (1-DOF) copter leads to rising of the required vision for controlling stability in the designing of (2-Dofs) quadcopter;were copters are used in many fields. Nowadays, the Covid-19 pandemic causes many challenges in health sectors, especially in patient's isolation centers, which forces the health team to take a lot of precautions when dealing with the patient, by using an optimally controlled quadcopter for dealing patients, one can prevent them from infection. The required dealing involves pharmaceutical submission and temperature monitoring which can be handled by these copters with specific sensors and vision. So, there is a need for high stability and accuracy in the movement with a high speed of balancing. This work is testing one axis of these copters by designing, implementing, and controlling a one-axis copter with a simple PID controller, the controller is implemented by using an Arduino controller, with a satisfaction measure for the required balancing of 97% accuracy. © 2022 IEEE.

Treatment Effects of Integrated TCM and Western Medicine Treatment Scheme on COVID-19: A Single-armed Clinical Trial

Backgroud: The outbreak of COVID-19 has brought unprecedented perils to human health and raised public health concerns in more than two hundred countries. Safe and effective treatment scheme is needed urgently. Objective(s): To evaluate the effects of integratedTCM and western medicine treatment scheme on COVID-19. Method(s): A single-armed clinical trial was carried out in Hangzhou Xixi Hospital, an affiliated hospital with Zhejiang Chinese Medical University. 102 confirmed cases were screened out from 725 suspected cases and 93 of them were treated with integrated TCM and western medicine treatment scheme. Result(s): 83 cases were cured, 5 cases deteriorated, and 5 cases withdrew from the study. No deaths were reported. The mean relief time of fever, cough, diarrhea, and fatigue were (4.78 +/- 4.61) days, (7.22 +/- 4.99) days, (5.28 +/- 3.39) days, and (5.28 +/- 3.39) days, respectively. It took (14.84 +/- 5.50) days for SARS-CoV-2 by nucleic acid amplification-based testing to turn negative. Multivariable cox regression analysis revealed that age, BMI, PISCT, BPC, AST, CK, BS, and UPRO were independent risk factors for COVID-19 treatment. Conclusion(s): Our study suggested that integrated TCM and western medicine treatment scheme was effective for COVID-19.Copyright © 2021

Optimized PI Control with Tracking Differentiator for Negative Pressure Cabin Control

To block the epidemics like "Corona Virus Disease 2019(COVID-19)"spreading, an effective isolation of the infected patients during the transportation is an important issue, which makes the negative pressure cabin (NPC) become a key equipment. There exist some practical NPCs in service, whose pressures are mostly controlled using the conventional PID controller with parameters regulated by engineering methods. Until now, there is no report about the model of NPC system from the authors' best knowledge. In this paper, the model of the NPC system is reported, which is an inherent nonlinear system. Because of the nonlinear nature of the cabin pressure, the conventional PID controller cannot achieve desire performance to balance the transient and the steady state performance, even though the optimized PID parameters are chosen using the on-line optimization based on genetic algorithm. To solve such a problem, Tracking Differentiator (TD) and PI controller are combined to achieve the desire performance using the optimized parameters. The experiment results show the improvement of the proposed method. © 2022 IEEE.

Semiparametric regression analysis of doubly-censored data with applications to incubation period estimation.

The incubation period is a key characteristic of an infectious disease. In the outbreak of a novel infectious disease, accurate evaluation of the incubation period distribution is critical for designing effective prevention and control measures . Estimation of the incubation period distribution based on limited information from retrospective inspection of infected cases is highly challenging due to censoring and truncation. In this paper, we consider a semiparametric regression model for the incubation period and propose a sieve maximum likelihood approach for estimation based on the symptom onset time, travel history, and basic demographics of reported cases. The approach properly accounts for the pandemic growth and selection bias in data collection. We also develop an efficient computation method and establish the asymptotic properties of the proposed estimators. We demonstrate the feasibility and advantages of the proposed methods through extensive simulation studies and provide an application to a dataset on the outbreak of COVID-19.

The Influence of the Rapid Increase in the Number of Adverse Event Reports for COVID-19 Vaccine on the Disproportionality Analysis Using JADER.

BACKGROUND/AIM: The COVID-19 prophylactic vaccine for the prevention of coronavirus infection was approved in Japan on February 14, 2021. Adverse event reports for the vaccine were collected from the Japan Adverse Drug Event Relief (JADER) database, similar to those for drugs. Reported odds ratios (RORs) and proportional reporting ratios (PRRs) are commonly used in disproportionality analysis to detect safety signals. Therefore, adverse event reports from the vaccinated population may affect the detection of safety signals for the registered drugs. This study determined the impact of adverse event reports on the detection of safety signals for a COVID-19 prophylactic vaccine by analyzing the JADER database using disproportionality analysis. PATIENTS AND METHODS: We extracted data from the JADER dataset, in which the COVID-19 vaccine was reported as a suspected drug, and selected the top 10 adverse events in terms of the number of reports. We then extracted the top 30 drugs by the amount of information in the selected 10 adverse events and compared the changes in the number of signal detections with and without the COVID-19 vaccine report data. RESULTS: The total number of adverse events reported in the JADER database during the study period was 2,002,564. Of the total number of reports, 85,489 (4.3%) reported adverse events related to the COVID-19 vaccine. Of the top 30 drugs reported in the 10 selected adverse events, the ROR and PRR were found to be lower with the inclusion of COVID-19 vaccine data than without. Detection by ROR excluded 23 out of 245 drugs, and detection by PRR excluded 34 out of 204 drugs. CONCLUSION: The rapid increase in the number of adverse event reports for the COVID-19 vaccine in JADER may affect the detection of safety signals by disproportionality analysis.

A Volume and Assist Controlled Mechanical Emergency Ventilator for Respiratory Support

Even before the COVID-19 pandemic, most hospitals in the Philippines, especially the rural and small hospitals, lacked respirators such as medical ventilators. With only a few thousand of these devices, the lack of emergency ventilators is a crucial problem in battling the COVID-19 pandemic in the Philippines. Hence, the study aimed to design an economical and portable mechanical emergency ventilator for respiratory support. It was achieved by effectively calibrating, automating, and controlling the working principle of BVM. Particularly, a CAM arm was designed to allow constant, smooth, and repeatable compression on the bag. Subsequently, driving the arm is a motor that was selected carefully according to the necessary motor torque and power calculations. Consequently, an effective close loop control system using a PID controller was implemented to control the motor position and speed. Although, the controller contains small inaccuracies that generate discrepancies in the volume measurement, and the pressure sensor records unusual readings due to breathing connection issues. The overall prototype confirms the minimum clinical specifications for a mechanical ventilator. As a result, the prototype has two ventilator modes, volume and assist control. It weighs 6.75 kg and has adimension of 385 × 270 × 235 mm. © 2022 IEEE.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach.

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

Survival Analysis of Thai Micro and Small Enterprises during the Covid-19 Pandemic

Micro and small enterprises (MSEs) are important to the local economy and are the most crucial source of employment in Thailand. Using the three-round survey data, we assess the impact of COVID-19 on the survival probability of MSEs in the tourism and manufacturing sectors. Enter-prise characteristics such as owner characteristics, employment and business strategies are examined as potential factors to mitigate or stimulate business failures. The Cox proportional hazards model and Kaplan-Meier estimator are employed. Our findings reveal that the survival probability paths from the three rounds of survey show a gradual decrease of survival probability from the first week of interview and approximately 50% of MSEs could not survive longer than 52 weeks during the COVID-19 pandemic. We also find that the survival of MSEs mainly depends on location, number of employees, and business model adjustment, namely operation with social distancing and online marketing. Particularly, retaining employees and not reducing the working hours are one of the key factors increasing the survivability of MSEs. However, the longer length of the crisis reduces the contribution of these key factors. The longer the period of the COVID-19 pandemic, the lower the chance of MSEs survivability.

COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study.

BACKGROUND: Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. OBJECTIVE: The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. METHODS: We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. RESULTS: During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre-COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. CONCLUSIONS: The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population.

Controller Design For Respiratory Systems Used During The Covid-19 Pandemic

During pandemics, Intensive care units (ICUs) play a major role in providing necessary medical treatment to the patients and stabilizing dire situations. Mechanical ventilation systems are an integral part of ICUs in every medical facility. A Mechanical Ventilation system must provide accurate and fast tracking of a pre-set pressure profile. Therefore various controller designs are tested and analyzed in the presented paper for a blower-hose-patient mechanical ventilation system. The basic framework for the control problem, and necessary mathematical and simulation background is presented along with a comparative analysis of the designed control schemes. An attempt is also made to find an optimal controller design providing the desired system output with minimal trade-offs. © 2022 IEEE.

Design of a Simulator for Ventricular Assistance Devices

Recent research shows that the number of patients with heart disease is still bigger than Covid 19 disease. Some indicators in Brazil indicate about 400,000 deaths per year. Because of heart disease, heart failure is responsible for the main cause of hospitalization of patients over 65 years of age. Part of these patients eventually developed one or more severe disease because of heart disease, leaving as clinical alternatives, treatments, and more aggressive procedures such as heart transplantation. The current scenario for patients waiting for a heart transplantation is actually aggravated each day by the pandemic. Other problem is the organ rejection that is 15% of mortality rate. Then a clinical alternative that can provide support and improve the life quality of patients with heart failure is the mechanical circulatory assistance devices. This kind of device is aiding and/or substitutes in cardiovascular function and it is recognized by the medicine showing satisfactory results over the years. However, the homologation of this kind of device to clinical use is hard and these devices need to be submitted to exhaustive tests, in distinct phases. “In Vitro” validations are applied, a test performed in simulators, whether they physical, computational or hybrid and “In Vivo”, a test that is performed on animals. After these validations, clinical evaluations are started for equipment approval. In this context, the objective of this work is to present the design, construction and functioning of a physical fluid dynamic simulator, which allows testing in ventricular assist devices, with the ability to reproduce the variations of systolic and diastolic blood pressure, as well as the other phenomena related to the functioning of the cardiovascular system. For the project, we used a review of the historical line of the simulators, concepts of hydraulics, anatomy of the human cardiovascular system, heart diseases and PID control algorithms from the theoretical basis. The construction of the physical plant is finished and some tests are made presenting excellent results. The simulator is equipped with two tanks, one proportional control valves, recirculation systems, two level control sensors, blood flow meters, an Microcontroller with a PID control algorithm and a man machine interface developed in android platform. The tests demonstrated the full functioning of the simulator, with the automatic stabilization of the levels, pressure and flow. The tests were made based on the patient body conditions and the variation parameters were observed of the ventricular assist device response. Then the some heart disease were simulated with the modulation of the valve and the monitoring of the ventricular assist device flow as a function of the setpoint change, all these parameters inserted and monitored through a cellular application. (Figure Presented).