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IDEAL-D: a rational framework for evaluating and regulating the use of medical devices
High profile device failures have highlighted the inadequacies of current regulation. Art Sedrakyan and colleagues call for a move to a graduated model of approval and suggest a framework to achieve this goal
Journal Article
Safe and fun playgrounds : a handbook
\"This handbook is [intended to help] create pleasing and challenging playgrounds that are safe, but not boring, [using] the four components experts have identified for safety: supervision by appropriate individuals, age-appropriate design, fall-surfacing that contains approved materials, equipment maintenance\"-- Provided by publisher.
Book
A systematic review of computer vision-based personal protective equipment compliance in industry practice: advancements, challenges and future directions
Computerized compliance of Personal Protective Equipment (PPE) is an emerging topic in academic literature that aims to enhance workplace safety through the automation of compliance and prevention of PPE misuse (which currently relies on manual employee supervision and reporting). Although trends in the scientific literature indicate a high potential for solving the compliance problem by employing computer vision (CV) techniques, the practice has revealed a series of barriers that limit their wider applications. This article aims to contribute to the advancement of CV-based PPE compliance by providing a comparative review of high-level approaches, algorithms, datasets, and technologies used in the literature. The systematic review highlights industry-specific challenges, environmental variations, and computational costs related to the real-time management of PPE compliance. The issues of employee identification and identity management are also discussed, along with ethical and cybersecurity concerns. Through the concept of CV-based PPE Compliance 4.0, which encapsulates PPE, human, and company spatio-temporal variabilities, this study provides guidelines for future research directions for addressing the identified barriers. The further advancements and adoption of CV-based solutions for PPE compliance will require simultaneously addressing human identification, pose estimation, object recognition and tracking, necessitating the development of corresponding public datasets.
Journal Article
Measurement of filtration efficiencies of healthcare and consumer materials using modified respirator fit tester setup
During the current SARS-CoV-2 pandemic there is unprecedented demand for personal protective equipment (PPE), especially N95 respirators and surgical masks. The ability of SARS-CoV-2 to be transmitted via respiratory droplets from asymptomatic individuals has necessitated increased usage of both N95 respirators in the healthcare setting and masks (both surgical and homemade) in public spaces. These precautions rely on two fundamental principles of transmission prevention: particle filtration and droplet containment. The former is the focus of NIOSH N95 testing guidelines, and the latter is an FDA guideline for respirators and surgical masks. While studies have investigated droplet containment to provide guidance for homemade mask production, limited work has been done to characterize the filtration efficiency (FE) of materials used in home mask making. In this work, we demonstrate the low-cost (<$300) conversion of standard equipment used to fit-test respirators in hospital and industrial settings into a setup that measures quantitative FEs of materials based on NIOSH N95 guidelines, and subsequently measure FEs of materials found in healthcare and consumer spaces. These materials demonstrate significant variability in filtration characteristics, even for visually similar materials. We demonstrate a FE of 96.49% and pressure drop of 25.4 mmH20 for a double-layer of sterilization wrap used in surgical suites and a FE of 90.37% for a combination of consumer-grade materials. The excellent filtration characteristics of the former demonstrate potential utility for emergent situations when N95 respirators are not available, while those of the latter demonstrate that a high FE can be achieved using publicly available materials.
Journal Article
How do robots diffuse bombs?
\"The military and police use robots to stop bombs from exploding. Read this book to discover how engineers create these life-saving machines.\"-- Provided by publisher.
Book
Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults
Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults.
To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging.
This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021.
The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral.
The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life.
A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35).
This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network.
ClinicalTrials.gov Identifier: NCT02392013.
Journal Article
A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock
Despite major advances in the treatment of heart failure, cardiogenic shock (CGS) remains associated with substantial mortality. Recent data suggest that the TandemHeart percutaneous ventricular assist device (pVAD) may be useful in the management of CGS. The aim of this prospective randomized study was to test the hypothesis that the TandemHeart (pVAD) provides superior hemodynamic support compared with intraaortic balloon pumping (IABP).
Forty-two patients from 12 centers presenting within 24 hours of developing CGS were included in the study and treated in an initial roll-in phase (n = 9) or randomized to treatment with IABP (n = 14) or TandemHeart pVAD (n = 19). Thirty patients (71%) had persistent CGS despite having an IABP in place at the time of study enrollment.
Cardiogenic shock was due to myocardial infarction in 70% of the patients and decompensated heart failure in most of the remaining patients. The mean duration of support was 2.5 days. Compared with IABP, the TandemHeart pVAD achieved significantly greater increases in cardiac index and mean arterial blood pressure and significantly greater decreases in pulmonary capillary wedge pressure. Overall 30-day survival and severe adverse events were not significantly different between the 2 groups.
In patients presenting within 24 hours of the development of CGS, TandemHeart significantly improves hemodynamic parameters, even in patients failing IABP. Larger-scale studies are required to assess the influence of improved hemodynamics on survival.
Journal Article
The Ergonomics of Wheelchair Configuration for Optimal Performance in the Wheelchair Court Sports
Optimizing mobility performance in wheelchair court sports (basketball, rugby and tennis) is dependent on a combination of factors associated with the user, the wheelchair and the interfacing between the two. Substantial research has been attributed to the wheelchair athlete yet very little has focused on the role of the wheelchair and the wheelchair-user combination. This article aims to review relevant scientific literature that has investigated the effects of wheelchair configuration on aspects of mobility performance from an ergonomics perspective. Optimizing performance from an ergonomics perspective requires a multidisciplinary approach. This has resulted in laboratory-based investigations incorporating a combination of physiological and biomechanical analyses to assess the efficiency, health/safety and comfort of various wheelchair configurations. To a lesser extent, field-based testing has also been incorporated to determine the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports. The available literature has demonstrated that areas of seat positioning, rear wheel camber, wheel size and hand-rim configurations can all influence the ergonomics of wheelchair performance. Certain configurations have been found to elevate the physiological demand of wheelchair propulsion, others have been associated with an increased risk of injury and some have demonstrated favourable performance on court. A consideration of all these factors is required to identify optimal wheelchair configurations. Unfortunately, a wide variety of different methodologies have immerged between studies, many of which are accompanied by limitations, thus making the identification of optimal configurations problematic. When investigating an area of wheelchair configuration, many studies have failed to adequately standardize other areas, which has prevented reliable cause and effect relationships being established. In addition, a large number of studies have explored the effects of wheelchair configuration in either able-bodied populations or in daily life or racing wheelchairs. As such, the findings are not specific and transferable to athletes competing in the wheelchair court sports. This review presents evidence about the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports to better inform athletes, coaches and manufacturers about the consequences of their selections. It also provides researchers with guidance on the design of future investigations into areas of wheelchair configuration, which are essential.
Journal Article