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"Ansari, Muhammad Imran"
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Autonomous airborne wireless networks
\"Airborne networks have led to the development of a range of applications including surveillance and monitoring, military and rescue operations. Whilst the conventional focus on airborne networks revolves around control, trajectory optimization and navigation, its application for providing communications has recently emerged and is developing at a very fast pace. With contributions from international experts, this book explores recent advances in the theory and practice of airborne wireless networks for the next generation of wireless networks to support various applications including emergency communications, coverage and capacity expansion, Internet of Things, information dissemination, future healthcare, pop-up networks, etc.\"-- Provided by publisher.
Book
Seeing Isn’t measuring: ICU staff’s ability to estimate patient height and weight — A cross-sectional study from Pakistan’s largest cardiac centre
ObjectiveIn critical care, intensive care unit (ICU) staff and physicians often estimate patients' height and weight visually, impacting calculations for cardiac function, ventilation, medication, nutrition and renal function. However, accurate assessment is challenging in critically ill patients. This study evaluates the accuracy of visual estimations by ICU staff.DesignDescriptive cross-sectional study.SettingNational Institute of Cardiovascular Diseases, Karachi, Pakistan.ParticipantsWe included a convenient sample of adult (≥18 years) cardiac patients admitted to the critical care unit in this study. Patients who refused to give consent, trauma/surgery of lower limbs or patients with below-knee or above-knee amputation were excluded to avoid bias.Outcome measureA convenient sample of cardiac ICU patients was included. Measured weight (kg) and height (cm) were compared with visual estimations by senior ICU nurse, senior non-ICU nurse, ICU consultants, fellows and residents. Correlation and agreement were analysed using Bland–Altman plots and 95% agreement limits.ResultsA total of 356 patients were evaluated, of whom 204 (57.3%) were male, with a mean age of 55.2 ± 14.3 years. The median SOFA score was 3 [2–5], and 101 patients (28.4%) were on mechanical ventilation. The mean difference between measured and estimated weight by senior non-ICU nurse was 4.7±9.2 [–13.38–22.83] kg, senior ICU nurse was 7.8±9.9 [–11.56–27.12] kg, ICU consultants was 3.0±6.6 [–9.89–15.79] kg, ICU fellow was 3.0±7.1 [–10.88–16.92] kg and ICU resident was 8.0±9.6 [–10.83–26.79] kg. Similarly, the mean difference between measured and estimated height by senior non-ICU nurse was 2.0±7.3 [-12.36–16.34] cm, senior ICU nurse was 2.4±7.5 [–12.19–17.00] cm, ICU consultants was 1.5±5.6 [–9.51–12.48] cm, ICU fellow was 1.1±5.5 [–9.68–11.95] cm and ICU resident was 2.3±8.5 [–14.40–19.01] cm.ConclusionThe findings indicate that healthcare professionals tend to overestimate both weight and height. The accuracy of these estimations varied among professional groups, underscoring the potential clinical consequences of such errors. This emphasises the need for objective measurements in clinical decision-making.
Journal Article
SITE OF CENTRAL VENOUS ACCESS IS NOT IMPORTANT FOR FLUID RESUSCITATION AND MONITORING
Objective: To find the correlation between thoracic and femoral central venous pressure (CVP) and changes in femoral CVP, if any, incurred by intra-abdominal pressure. Study Design: Cross sectional observational study. Place and Duration of Study: Coronary care unit of National Institute of Cardiovascular Diseases Karachi, from Jul 2017 to Sep 2017. Material and Methods: We randomly selected 90 patients who had a thoracic central catheter and another femoral catheter in place. A central venous pressure (CVP) pressure was recorded at both sites simultaneously with the same electronic transducer after zero calibration. An intra-abdominal pressure was also noted. Results: Ninety patients participated in our study where mean age was 58.90 ± 11.34 years. The mean thoracic CVP was 11.22 ± 3.53 mmHg while mean femoral CVP was 11.38 ± 3.53 mmHg, with a mean pressure difference of -0.16 mmHg between the two. We also calculated intra-abdominal pressure with mean of 6.20 ± 2.47 mmHg. The reliability of the two methods was determined by intra class coefficient model where we got a higher value of 0.97 with significant p-value of <0.001. We analyzed the limits of agreement between the two approaches by Bland and Altman plot, where the mean difference between thoracic and femoral CVP was -0.16 mmHg (95 % CI - 0.34 - 0.02). Conclusion: Central venous pressure can be reliably and accurately measured through femoral site.
Journal Article
Mechanical ventilation in acute myocardial infarction: Outcomes from a prospective audit at a cardiovascular hospital in Pakistan
This clinical audit aims to evaluate the clinical data regarding the management and outcomes of acute myocardial infarction (AMI) patients requiring mechanical ventilator (MV) support, along with identifying factors associated with prolonged MV support and 180-day mortality. In this study, we audited clinical data regarding management, in-hospital and short-term outcomes of adult patients with AMI required MV support. Patients with prolonged MV duration (>24h) and/or 180-day mortality were compared with their counterparts, and associated factors were identified. The binary logistic and Cox regression analyses were performed to determine the predictors of prolonged MV duration and 180-day mortality. In a sample of 312 patients, 72.8% were male, and the mean age was 60.3±11.5 years. The median MV duration was 24 [24-48] hours, with 48.7% prolonged MV duration. The admission albumin level was found to be the independent predictor of prolonged MV duration with an adjusted OR of 0.42 [0.22-0.82]. Overall 7.4% were re-intubated, 6.7% needed renal replacement therapy, 17.6% required intra-aortic balloon pump (IABP) placement, and 16.7% required temporary pacemaker placement. The survival rate was 80.4% at the time of hospital discharge, 74.7% at 30-day, 71.2% at 90-day, and 68.6% at 180-day follow-up. Age, prolonged MV duration, and ejection fraction were found to be the independent predictors of cumulative 180-day mortality with adjusted HR of 1.04 [1.02-1.07], 1.02 [1.01-1.03], and 0.95 [0.92-0.98], respectively. Prolonged ventilator duration has significant prognostic implications; hence, tailored early recognition of high-risk patients needing more aggressive care can improve the outcomes.
Journal Article
Survival Trends, Determinants of Mortality, and the Impact of Advance Directives: An Observational Study from the Pakistan Registry of Intensive Care
Objective: This study assesses survival trends and identifies determinants of adverse outcomes (at hospital discharge and 90-day) among ICU patients, for the whole cohort and in the context of advanced directives (AD). Study Design: Correlational Study. Place and Duration of Study: Pakistan Registry of Intensive Care (PRICE), National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, between Jan 22 and Dec 23. Methodology: Data for a total of 1570 patients were analyzed from the PRICE registry. We included patients of either gender, aged≥ 18 years, who were admitted to the ICU. Patients who deferred consent for participation in the PRICE registry were excluded. Data included clinical and laboratory parameters at ICU admission, treatment details, AD, ICU, and hospital discharge outcomes, and 90-day post-discharge survival. Results: Of the 1570 patients (mean age 57.6±14.3 years, 945 males), 83.3% required mechanical ventilation (MV), 76.7% needed vasoactive therapy, 2.9% underwent renal replacement therapy, and 34.9% received antibiotics. ICU mortality was 16.6%, and 20.4% died by hospital discharge. At 90 days post-discharge, follow-up was successful for 59.1% of patients, with a 20.6% mortality rate. Among 436 DNR patients, 41.1% died in-hospital. DNR status raised in-hospital and 90-day mortality risks (OR: 4.91, 3.48). Conclusion: High ICU and hospital mortality rates underscore the challenges in managing critically ill patients, particularly those on MV. The study calls for a culturally sensitive approach to ICU management, emphasizing AD, early risk factor identification, and individualized patient care strategies.
Journal Article
Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock
Background Preventing end-organ failure in patients with shock requires rapid and easily accessible measurements of fluid responsiveness. Unlike septic shock, not all patients in cardiogenic shock are preload responsive. We conducted this study to determine the discriminant power of changes in end-tidal carbon dioxide (ETCO
), systolic blood pressure (SBP), inferior vena cava (IVC) collapsibility index (IVC-CI), and venous to arterial carbon dioxide (Pv-aCO
) gap after a fluid challenge and compared it to increases in cardiac output. Methodology In a prospective, quasi-experimental design, mechanically ventilated patients in cardiogenic shock were assessed for fluid responsiveness by comparing improvement in cardiac output (velocity time integral) with changes in ETCO
, heart rate, SBP, Pv-aCO
gap, IVC-CI after a fluid challenge (a crystalloid bolus or passive leg raise). Results Out of 60 patients, with mean age 61.3 ± 14.8 years, mean acute physiology and chronic health evaluation (APACHE) score -14.82 ± 7.49, and median ejection fraction (EF) 25% (25-35), 36.7% (22) had non ST-segment elevation myocardial infarction (NSTEMI) and 60% (36) were ST-segment elevation myocardial infarction (STEMI). ETCO
was the best predictor of fluid responsiveness; area under the curve (AUC) 0.705 (95% confidence interval (CI) 0.57-0.83), p=0.007, followed by reduction in Pv-aCO
gap; AUC 0.598 (95% CI; 0.45-0.74), p= 0.202. Changes in SBP, mean arterial pressure (MAP), IVC-CI weren't significant; 0.431 (p=0.367), 0.437 (p=0.410), 0.569 (p=0.367) respectively. The discriminant value identified for ETCO
was more than equal to 2 mmHg, with sensitivity 58.6%, specificity 80.7%, positive predictive value 73.9% [95% CI; 56.5% to 86.1%], negative predictive value 69.7% [95% CI; 56.7% to 76.9%]. Conclusions Change in ETCO
is a useful bedside test to predict fluid responsiveness in cardiogenic shock.
Journal Article
Evaluating the Knowledge of Endotracheal Cuff Pressure Monitoring Among Critical Care Providers by Palpation of Pilot Balloon and By Endotracheal Tube Cuff Manometer
Introduction Mishandled endotracheal cuff pressure may either make ventilation difficult or cause damage to the airway. Therefore, the aim of this audit was to assess the knowledge about endotracheal cuff pressure monitoring with a manometer and manual palpation of pilot balloon among critical care providers. Methods This audit includes 150 critical care providers having experience of handling endotracheal tube (ETT) cuff at critical care area of National Institute of Cardiovascular Diseases (NICVD), Karachi from April 2017 to June 2017. Knowledge about endotracheal cuff pressure monitoring with the manometer and deleterious effects of mishandled ETT cuff was assessed using a self-reported questionnaire. Enrolled healthcare providers were asked to palpate the patient and cuff pressure was recorded and categorized. Results Out of 150 participants, 66 (44.0%) were doctors. Only 46 (30.67%) participants had prior knowledge about ETT cuff manometer and 110 (73.33%) had never used a manometer. Similarly only 42 (28.0%) had knowledge of hazardous effects of mishandled ETT cuff. Kappa coefficient of 0.155 with p=0.015 showed significant yet low agreement between participant prediction and the actual amount of air in cuff balloon. Agreement level was comparatively higher for staff as compared to doctors with a Kappa coefficient of 0.210 (p=0.018) vs. 0.133 (p=0.099). Conclusion In this study of knowledge and practice of ETT tube cuff pressure monitoring, we observed low levels of knowledge (30.67%), poor adherence to standard practice (73.33%) and were able to demonstrate poor agreement (Kappa coefficient 0.155; p=0.015) between the palpation method and cuff manometer measurements for assessing cuff pressure.
Journal Article
Blockchain enabled data security in vehicular networks
Recently, researchers have applied blockchain technology in vehicular networks to take benefit of its security features, such as confidentiality, authenticity, immutability, integrity, and non-repudiation. The resource-intensive nature of the blockchain consensus algorithm makes it a challenge to integrate it with vehicular networks due to the time-sensitive message dissemination requirements. Moreover, most of the researchers have used the Proof-of-Work consensus algorithm, or its variant to add a block to a blockchain, which is a highly resource-intensive process with greater latency. In this paper, we propose a consensus algorithm for vehicular networks named as Vehicular network Based Consensus Algorithm (VBCA) to ensure data security across the network using blockchain that maintains a secured pool of confirmed messages exchanged in the network. The proposed scheme, based on a consortium blockchain, reduces average transaction latency, and increases the number of confirmed transactions in a decentralized manner, without compromising the integrity and security of data. The simulation results show improved performance in terms of confirmed transactions, transaction latency, number of blocks, and block creation time.
Journal Article
Multimodal Sensing-Enabled Large Language Models for Automated Emotional Regulation: A Review of Current Technologies, Opportunities, and Challenges
Emotion regulation is essential for mental health. However, many people ignore their own emotional regulation or are deterred by the high cost of psychological counseling, which poses significant challenges to making effective support widely available. This review systematically examines the convergence of multimodal sensing technologies and large language models (LLMs) for the development of Automated Emotional Regulation (AER) systems. The review draws upon a comprehensive analysis of the existing literature, encompassing research papers, technical reports, and relevant theoretical frameworks. Key findings indicate that multimodal sensing offers the potential for rich, contextualized data pertaining to emotional states, while LLMs provide improved capabilities for interpreting these inputs and generating nuanced, empathetic, and actionable regulatory responses. The integration of these technologies, including physiological sensors, behavioral tracking, and advanced LLM architectures, presents the improvement of application, moving AER beyond simpler, rule-based systems towards more adaptive, context-aware, and human-like interventions. Opportunities for personalized interventions, real-time support, and novel applications in mental healthcare and other domains are considerable. However, these prospects are counterbalanced by significant challenges and limitations. In summary, this review synthesizes current technological advancements, identifies substantial opportunities for innovation and application, and critically analyzes the multifaceted technical, ethical, and practical challenges inherent in this domain. It also concludes that while the integration of multimodal sensing and LLMs holds significant potential for AER, the field is nascent and requires concerted research efforts to realize its full capacity to enhance human well-being.
Journal Article
Suitability of NB-IoT for Indoor Industrial Environment: A Survey and Insights
The Internet of Things (IoT) and its applications in industrial settings are set to bring in the fourth industrial revolution. The industrial environment consisting of high profile manufacturing plants and a variety of equipment is inherently characterized by high reflectiveness, causing significant multi-path components that affect the propagation of wireless communications—a challenge among others that needs to be resolved. This paper provides a detailed insight into Narrow-Band IoT (NB-IoT), Industrial IoT (IIoT), and Wireless Sensor Networks (WSN) within the context of indoor industrial environments. It presents the applications of NB-IoT for industrial settings, such as the challenges associated with these applications. Furthermore, future research directions were put forth in the areas of NB-IoT network management using self-organizing network (SON) technology, edge computing for scalability enhancement, security in NB-IoT generated data, and proposing a suitable propagation model for reliable wireless communications.
Journal Article