The effect of human-machine interface modality, specificity, and timing on driver performance and behavior while using vehicle automation.

The effectiveness of the human-machine interface (HMI) in a driving automation system during takeover situations is based, in part, on its design. Past research has indicated that modality, specificity, and timing of the HMI have an impact on driver behavior. The objective of this study was to examine the effectiveness of two HMIs, which vary by modality, specificity, and timing, on drivers' takeover time, performance, and eye glance behavior. Drivers' behavior was examined in a driving simulator study with different levels of automation, varying traffic conditions, and while completing a non-driving related task. Results indicated that HMI type had a statistically significant effect on velocity and off-road eye glances such that those who were exposed to an HMI that gave multimodal warnings with greater specificity exhibited better performance. There were no effects of HMI on acceleration, lane position, or other eye glance metrics (e.g., on road glance duration). Future work should disentangle HMI design further to determine exactly which aspects of design yield between safety critical behavior.

Neurogenic diabetes insipidus in a critical patient with COVID-19 pneumonia in treatment with extracorporeal membrane oxygenation: a case report.

The following case report analyses a patient with extracorporeal membrane oxygenation (ECMO), who suffered from a severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 pneumonia. ARDS is defined as a diffuse and inflammatory injury of the lungs; classifying this as severe when the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO2/FiO2) is equal to or lower than 100 mmHg. To decide if the patient was suitable for the use of ECMO therapy, the ELSO criteria were used; and in this case, the patient matched with the criteria of hypoxemic respiratory failure (with a PaO2/FiO2 < 80 mmHg) after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. During hospitalization, the patient presented a Central Diabetes Insipidus (CDI), probably explained by the damage hypoxia generated on the central nervous system. There are few reports of this complication produced by COVID-19. The case is about a 39-year-old woman, who started with ECMO 6 days after the beginning of Invasive Mechanical Ventilation (IMV), because of a severe ARDS. On the fifth day of ECMO, the patient started with a polyuria of 7 L in 24 h. A series of paraclinical studies were made, but no evidence of central nervous system lesions was found. After treatment with desmopressin was initiated and the ARDS was solved, polyuria stopped; with this, CDI was diagnosed. There are many complications secondary to the evolution of COVID-19 infection, and some of them are not yet well explained.

The low-harm score for predicting mortality in patients diagnosed with COVID-19: A multicentric validation study.

Objective: We sought to determine the accuracy of the LOW-HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury) for predicting death from coronavirus disease 2019) COVID-19. Methods: We derived the score as a concatenated Fagan's nomogram for Bayes theorem using data from published cohorts of patients with COVID-19. We validated the score on 400 consecutive COVID-19 hospital admissions (200 deaths and 200 survivors) from 12 hospitals in Mexico. We determined the sensitivity, specificity, and predictive values of LOW-HARM for predicting hospital death. Results: LOW-HARM scores and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 5 (SD: 14) versus 70 (SD: 28). The overall area under the curve for the LOW-HARM score was 0.96, (95% confidence interval: 0.94-0.98). A cutoff > 65 points had a specificity of 97.5% and a positive predictive value of 96%. Conclusions: The LOW-HARM score measured at hospital admission is highly specific and clinically useful for predicting mortality in patients with COVID-19.

Appropriate use of antibiotics: an unmet need.

Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.

Analysis of vehicle-following heterogeneity using self-organizing feature maps.

A self-organizing feature map (SOM) was used to represent vehicle-following and to analyze the heterogeneities in vehicle-following behavior. The SOM was constructed in such a way that the prototype vectors represented vehicle-following stimuli (the follower's velocity, relative velocity, and gap) while the output signals represented the response (the follower's acceleration). Vehicle trajectories collected at a northbound segment of Interstate 80 Freeway at Emeryville, CA, were used to train the SOM. The trajectory information of two selected pairs of passenger cars was then fed into the trained SOM to identify similar stimuli experienced by the followers. The observed responses, when the stimuli were classified by the SOM into the same category, were compared to discover the interdriver heterogeneity. The acceleration profile of another passenger car was analyzed in the same fashion to observe the interdriver heterogeneity. The distribution of responses derived from data sets of car-following-car and car-following-truck, respectively, was compared to ascertain inter-vehicle-type heterogeneity.

Determination of organochlorine pesticides in complex matrices by single-drop microextraction coupled to gas chromatography-mass spectrometry.

A rapid and simple single-drop microextraction method (SDME) has been used to preconcentrate eighteen organochlorine pesticides (OCPs) from water samples with a complex matrix. Exposing two microlitre toluene drop to an aqueous sample contaminated with OCPs proved an excellent preconcentration method prior to analysis by gas chromatography-mass spectrometry (GC-MS). A Plackett-Burman design was used for screening and a central composite design for optimizing the significant variables in order to evaluate several possibly influential and/or interacting factors. The studied variables were drop volume, aqueous sample volume, agitation speed, ionic strength and extraction time. The optimum experimental conditions of the proposed SDME method were: 2 microL toluene microdrop exposed for 37 min to 10 mL of the aqueous sample containing 0% w/v NaCl and stirred at 380 rpm. The calculated calibration curves gave high-level linearity for all target analytes with correlation coefficients ranging between 0.9991 and 0.9999. The repeatability of the proposed method, expressed as relative standard deviation, varied between 5.9 and 9.9% (n=8). The detection limits were in the range of 0.022-0.101 microg L(-1) using GC-MS with selective ion monitoring. The LOD values obtained are able to detect these OCPs in aqueous matrices as required by EPA Method 625. Analysis of spiked effluent wastewater samples revealed that the matrix had no effect on extraction for eleven of the analytes but exerted notable effect for the other analytes.

Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial.

PURPOSE: To evaluate the effectiveness of uterine artery embolization (UAE) in the management of bleeding in patients with uterine fibroids and to compare UAE with hysterectomy, particularly with regard to length of hospital stay and associated complications (ie, safety). MATERIALS AND METHODS: A prospective clinical trial was performed with patients who were randomly assigned to one of two groups: patients who were offered the option of undergoing either UAE or hysterectomy (group 1) and patients who were not informed of the alternative treatment-that is, UAE (group 2). The primary variables that were considered for evaluation of the effectiveness, efficiency, and safety of the two procedures were, respectively, bleeding cessation, total length of hospital stay, and resulting complications. The lengths of hospital stay in the two study arms were compared on an intent-to-treat basis. Owing to crossover between the treatment arms, however, effectiveness and safety were evaluated on the basis of the actual treatment received. RESULTS: The clinical success rate for the patients who underwent UAE, which was based on the cessation of bleeding, was 86% (31 of 36 patients). The mean hospital stay for group 1 was 4.14 days shorter than that for group 2 (P <.001). Ten (25%) of the 40 patients who underwent UAE experienced minor complications, in contrast to four (20%) of the 20 who underwent hysterectomy and experienced major complications. CONCLUSION: Compared with hysterectomy, UAE is safe and effective for treatment of bleeding fibroids, necessitates a shorter hospital stay, and results in fewer major complications.

Embolización de arterias uterinas como tratamiento de miomas sintomáticos / Embolization of uterine arteries to treat symptomatic myomas

Objetivos: 1. Medir la eficacia de la embolización de las arterias uterinas en el control del sangrado vaginal a corto y medio plazo, causado por miomas uterinos. 2. Evaluar la seguridad de este procedimiento, analizando las complicaciones del mismo. Material y métodos: La población de estudio consiste en 40 mujeres sometidas a embolización de las arterias uterinas, consecutivamente enviadas desde las consultas de ginecología. Todas tenían miomas uterinos sangrantes, y eran candidatas a histerectomía. Se excluyeron pacientes con deseos de mantener la fertilidad, con miomas mayores de 10 cm de diámetro, con contraindicaciones quirúrgicas o con alergias a contrastes yodados. Las variables principales medidas en relación con los objetivos, han sido, el control del sangrado vaginal postembolización, y la frecuencia y tipo de complicaciones relacionadas con dicha intervención. Resultados: El éxito técnico en cuanto a la embolización de ambas arterias uterinas fue de un 87,5 por ciento (35/40). El éxito clínico, o el cese del sangrado, valorado en 36 pacientes a los seis meses de seguimiento, fue de un 86,1 por ciento (31/36). La complicación más frecuente, durante el procedimiento fue el espasmo de las arterias uterinas 17,5 por ciento (10/40) y el síndrome postembolización 25 por ciento (10/40) en el seguimiento postintervención. Conclusiones: La embolización de las arterias uterinas es un tratamiento seguro, y puede ser una terapia alternativa a la histerectomía, en pacientes con miomas uterinos con sangrado vaginal. (AU)

Factores socioeconómicos y culturales de los padres de los niños hospitalizados en el servicio en pediatría, que determina el uso de la medicina tradicional. Hospital Provincial Cotopaxi, Latacunga 1993 / Socioeconomic and cultural factors of the parents of the children hospitalized in the service in pediatría, that determines the use of the traditional medicine. Provincial Hospital Cotopaxi, Latacunga 1993

El Ecuador, por pertenecer al área Andina, se encuentra en proceso de desarrollo, sisendo enminentemente agrícola. La mayor parte de sus productos se cultivan en la costa y valles profundos de la sierra, posee una cultura invalorable en cuanto a su forma de vida y comportamiento, siendo ésta una de las causas principales para que se transmitan creencias y costumbres arraigadas desde la antihuedad como es la práctica de la medicina tradicional. Nosotros como parte integral del equipo de salud del servicio de Pediatría hemos detectado que la población con mayor frecuencia hace uso de la Medicina Tradicional antes de recibir tratamiento Profesional es la de Chimborazo, aspecto que queremos investigar, estudio que servirá de guía para incorporar la Medicina Profesional a la Tradicional y conjuntamente lograr una recuperación precoz del paciente evitando complicaciones futuras que peligren la vida del niño...