Critical events in mechanically ventilated patients

Mechanical Ventilation is an artificial way to help a Patient to breathe. This procedure is used to support patients with respiratory diseases however in many cases it can provoke lung damages, Acute Respiratory Diseases or organ failure. With the goal to early detect possible patient breath problems a set of limit values was defined to some variables monitored by the ventilator (Average Ventilation Pressure, Compliance Dynamic, Flow, Peak, Plateau and Support Pressure, Positive end-expiratory pressure, Respiratory Rate) in order to create critical events. A critical event is verified when a patient has a value higher or lower than the normal range defined for a certain period of time. The values were defined after elaborate a literature review and meeting with physicians specialized in the area. This work uses data streaming and intelligent agents to process the values collected in real-time and classify them as critical or not. Real data provided by an Intensive Care Unit were used to design and test the solution. In this study it was possible to understand the importance of introduce critical events for Mechanically Ventilated Patients. In some cases a value is considered critical (can trigger an alarm) however it is a single event (instantaneous) and it has not a clinical significance for the patient. The introduction of critical events which crosses a range of values and a pre-defined duration contributes to improve the decision-making process by decreasing the number of false positives and having a better comprehension of the patient condition.

Optimization techniques to detect early ventilation extubation in intensive care units

The decision support models in intensive care units are developed to support medical staff in their decision making process. However, the optimization of these models is particularly difficult to apply due to dynamic, complex and multidisciplinary nature. Thus, there is a constant research and development of new algorithms capable of extracting knowledge from large volumes of data, in order to obtain better predictive results than the current algorithms. To test the optimization techniques a case study with real data provided by INTCare project was explored. This data is concerning to extubation cases. In this dataset, several models like Evolutionary Fuzzy Rule Learning, Lazy Learning, Decision Trees and many others were analysed in order to detect early extubation. The hydrids Decision Trees Genetic Algorithm, Supervised Classifier System and KNNAdaptive obtained the most accurate rate 93.2%, 93.1%, 92.97% respectively, thus showing their feasibility to work in a real environment.

Can the Cardiopulmonary 6-Minute Walk Test Reproduce the Usual Activities of Patients with Heart Failure?

OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45±12 years, ejection fraction 23±7%, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max), cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale) (6EB), and cardiopulmonary 6-minute walk test using the usual recommendations (6RU). The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption (ml.kg-1.min-1) 15.4±1.8, 9.8±1.9 (60±10%), and 13.3±2.2 (90±10%); heart rate (bpm) 142±12, 110±13 (77±9%), and 126±11 (89±7%); distance walked (m) 733±147, 332±66, and 470±48; and respiratory exchange ratio (R) 1.13±0.06, 0.9±0.06, and 1.06±0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p<0.05). CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients.

The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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The illustrated dictionary of gardening :a practical and scientific encyclopædia of horticulture for gardeners and botanists /edited by George Nicholson ; assisted by J.W.H. Trail ... and J. Garrett ...

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Creación de un test neuropsicológico de denominación confrontacional

La evaluación de la capacidad de denominar (encontrar las palabras adecuadas para nombrar objetos) tiene una importancia decisiva en el diagnóstico temprano de la enfermedad de Alzheimer ya que la anomia (pérdida de esta capacidad) es uno de los signos más tempranos de la enfermedad. Dicha evaluación también adquiere importancia en el diagnóstico de otras patologías tales como la demencia semántica o la afasia. Por lo tanto es importante contar con un test de denominación que sea adecuadamente diseñado para nuestro contexto cultural. Debido a que las pruebas de denominación creadas en otros contextos culturales no funcionan adecuadamente al aplicarse transculturalmente es que se comenzó, hace algunos años, a construir el Test de Denominación Córdoba. Éste es un test neuropsicológico para evaluar la capacidad de denominación confrontacional (implica la producción de los nombres correctos de figuras que se le presentan al individuo). Se diseñaron las láminas, y se realizó un estudio piloto para determinar el orden correcto de las mismas y eliminar láminas técnicamente inadecuadas. Luego se comenzaron los estudios de validez y la estandarización del test. En este proyecto se propone finalizar con los estudios de validez, confiabilidad y los baremos. Para ello se propone administrar alrededor de 200 tests a personas cognitivamente sanas para completar el baremo y alrededor de 20 a 25 personas con Enfermedad de Alzheimer para el estudio de validez