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Nature Communications Jul 2023We investigate how reliable movement can emerge in aggregates of highly error-prone individuals. The individuals-robotic modules-move stochastically using vibration...
We investigate how reliable movement can emerge in aggregates of highly error-prone individuals. The individuals-robotic modules-move stochastically using vibration motors. By coupling them via elastic links, soft-bodied aggregates can be created. We present distributed algorithms that enable the aggregates to move and deform reliably. The concept and algorithms are validated through formal analysis of the elastic couplings and experiments with aggregates comprising up to 49 physical modules-among the biggest soft-bodied aggregates to date made of autonomous modules. The experiments show that aggregates with elastic couplings can shrink and stretch their bodies, move with a precision that increases with the number of modules, and outperform aggregates with no, or rigid, couplings. Our findings demonstrate that mechanical couplings can play a vital role in reaching coherent motion among individuals with exceedingly limited and error-prone abilities, and may pave the way for low-power, stretchable robots for high-resolution monitoring and manipulation.
Topics: Humans; Movement; Motion; Robotics; Algorithms; Vibration
PubMed: 37463918
DOI: 10.1038/s41467-023-39660-6 -
European Journal of Pediatrics Oct 2023To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and... (Meta-Analysis)
Meta-Analysis
To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and Web of Science. Randomized controlled trials focusing on lumbar puncture positions were included. Other lumbar puncture position than standard lateral decubitus position. First puncture success and overall success rate. Secondary outcome was desaturation during puncture and procedure-related harms. Risk of bias 2.0 assessment was performed. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). We screened 225 abstracts, and six studies were included. Four studies compared sitting position, one study head elevated lateral position, and one study prone position to lateral position. Risk of bias was high in two studies. First puncture success rate in sitting position (RR 1.00, CI: 0.78-1.18; 2 studies) and overall success rate in sitting position were similar to lateral position (RR 0.97, CI: 0.87-1.17; 3 studies). First attempt success rate was higher in elevated lateral position (RR 1.48, CI: 1.14-1.92; 1 study) and in prone position (RR 1.09, CI: 1.00-1.17; 1 study). Conclusion: Sitting position seems to be equally effective in terms of first attempt and overall success in lumbar puncture than standard lateral position. Elevated lateral position and prone positions had better first attempt success than standard lateral position, but these were assessed only in one study each and thus further studies in these positions are needed. Trial registration: This review was registered in PROSPERO. ID: CRD42022382953. What is Known: • Success rate in lumbar puncture has been poor and first attempt success rate has varied between 50 to 80% in literature. • Optimal lumbar puncture positions for infants have been debated between sitting and lateral decubitus position mostly. What is New: • This is the first meta-analysis focused on lumbar puncture positions in infants, and it found that sitting position was equal to standard lateral position. • Prone position and head elevated lateral positions had higher first puncture success rates, but these were assessed both only in one study, which creates uncertainty to the finding.
Topics: Humans; Infant; Spinal Puncture; Patient Positioning; Prone Position
PubMed: 37540241
DOI: 10.1007/s00431-023-05137-3 -
Journal of Clinical Anesthesia Aug 2024To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Comparison of volume-controlled ventilation, pressure-controlled ventilation and pressure-controlled ventilation-volume guaranteed in infants and young children in the prone position: A prospective randomized study.
STUDY OBJECTIVE
To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled ventilation (VCV) in optimizing intraoperative respiratory mechanics in infants and young children in the prone position.
DESIGN
A single-center prospective randomized study.
SETTING
Children's Hospital, Zhejiang University School of Medicine.
PATIENTS
Pediatric patients aged 1 month to 3 years undergoing elective spinal cord detethering surgery.
INTERVENTIONS
Patients were randomly allocated to the VCV group, PCV group and PCV-VG group. The target tidal volume (V) was 8 mL/kg and the respiratory rate (RR) was adjusted to maintain a constant end tidal CO.
MEASUREMENTS
The primary outcome was intraoperative peak airway pressure (Ppeak). Secondary outcomes included other respiratory and ventilation variables, gas exchange values, serum lung injury biomarkers concentration, hemodynamic parameters and postoperative respiratory complications.
MAIN RESULTS
A total of 120 patients were included in the final analysis (40 in each group). The VCV group showed higher Ppeak at T2 (10 min after prone positioning) and T3 (30 min after prone positioning) than the PCV and PCV-VG groups (T2: P = 0.015 and P = 0.002, respectively; T3: P = 0.007 and P = 0.009, respectively). The prone-related decrease in dynamic compliance was prevented by PCV and PCV-VG ventilation modalities at T2 and T3 than by VCV (T2: P = 0.008 and P = 0.015, respectively; T3: P = 0.015 and P = 0.014, respectively). Additionally, there were no significant differences in other secondary outcomes among the three groups.
CONCLUSION
In infants and young children undergoing spinal cord detethering surgery in the prone position, PCV-VG may be a better ventilation mode due to its ability to mitigate the increase in Ppeak and decrease in Cdyn while maintaining consistent V.
Topics: Humans; Prone Position; Infant; Prospective Studies; Male; Female; Child, Preschool; Tidal Volume; Respiration, Artificial; Respiratory Mechanics; Postoperative Complications; Patient Positioning; Positive-Pressure Respiration
PubMed: 38460413
DOI: 10.1016/j.jclinane.2024.111440 -
Psychonomic Bulletin & Review Dec 2023Despite the crucial role of complex temporal sequences, such as speech and music, in our everyday lives, our ability to acquire and reproduce these patterns is prone to...
Despite the crucial role of complex temporal sequences, such as speech and music, in our everyday lives, our ability to acquire and reproduce these patterns is prone to various contextual biases. In this study, we examined how the temporal order of auditory sequences affects temporal reproduction. Participants were asked to reproduce accelerating, decelerating or random sequences, each consisting of four intervals, by tapping their fingers. Our results showed that the reproduction and the reproduction variability were influenced by the sequential structure and interval orders. The mean reproduced interval was assimilated by the first interval of the sequence, with the lowest mean for decelerating and the highest for accelerating sequences. Additionally, the central tendency bias was affected by the volatility and the last interval of the sequence, resulting in a stronger central tendency in the random and decelerating sequences than the accelerating sequence. Using Bayesian integration between the ensemble mean of the sequence and individual durations and considering the perceptual uncertainty associated with the sequential structure and position, we were able to accurately predict the behavioral results. The findings highlight the critical role of the temporal order of a sequence in temporal pattern reproduction, with the first interval exerting greater influence on mean reproduction and the volatility and the last interval contributing to the perceptual uncertainty of individual intervals and the central tendency bias.
Topics: Humans; Bayes Theorem; Auditory Perception; Time Perception; Uncertainty; Music
PubMed: 37291447
DOI: 10.3758/s13423-023-02310-5 -
PloS One 2023Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental... (Review)
Review Meta-Analysis
INTRODUCTION
Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position.
METHODS
Twenty-one women >28 weeks' gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies.
RESULTS
Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies).
CONCLUSION
Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy.
TRIAL REGISTRATION
This trial was registered at clinicaltrials.gov (NCT04586283).
Topics: Pregnancy; Female; Humans; Pregnancy Trimester, Third; Prone Position; Cohort Studies; Prospective Studies; Hemodynamics; Heart Rate, Fetal
PubMed: 37819872
DOI: 10.1371/journal.pone.0287804 -
Critical Care (London, England) Nov 2023Prone position has been shown to improve oxygenation and survival in patients with early acute respiratory distress syndrome (ARDS). These beneficial effects are partly... (Observational Study)
Observational Study
Effects of early versus delayed application of prone position on ventilation-perfusion mismatch in patients with acute respiratory distress syndrome: a prospective observational study.
BACKGROUND
Prone position has been shown to improve oxygenation and survival in patients with early acute respiratory distress syndrome (ARDS). These beneficial effects are partly mediated by improved ventilation/perfusion (V/Q) distribution. Few studies have investigated the impact of early versus delayed proning on V/Q distribution in patients with ARDS. The aim of this study was to assess the regional ventilation and perfusion distribution in early versus persistent ARDS after prone position.
METHODS
This is a prospective, observational study from June 30, 2021, to October 1, 2022 at the medical ICU in Zhongda Hospital, Southeast University. Fifty-seven consecutive adult patients with moderate-to-severe ARDS ventilated in supine and prone position. Electrical impedance tomography was used to study V/Q distribution in the supine position and 12 h after a prone session.
RESULTS
Of the 57 patients, 33 were early ARDS (≤ 7 days) and 24 were persistent ARDS (> 7 days). Oxygenation significantly improved after proning in early ARDS (157 [121, 191] vs. 190 [164, 245] mm Hg, p < 0.001), whereas no significant change was found in persistent ARDS patients (168 [136, 232] vs.177 [155, 232] mm Hg, p = 0.10). Compared to supine position, prone reduced V/Q mismatch in early ARDS (28.7 [24.6, 35.4] vs. 22.8 [20.0, 26.8] %, p < 0.001), but increased V/Q mismatch in persistent ARDS (23.8 [19.8, 28.6] vs. 30.3 [24.5, 33.3] %, p = 0.006). In early ARDS, proning significantly reduced shunt in the dorsal region and dead space in the ventral region. In persistent ARDS, proning increased global shunt. A significant correlation was found between duration of ARDS onset to proning and the change in V/Q distribution (r = 0.54, p < 0.001).
CONCLUSIONS
Prone position significantly reduced V/Q mismatch in patients with early ARDS, while it increased V/Q mismatch in persistent ARDS patients. Trial registration ClinicalTrials.gov (NCT05207267, principal investigator Ling Liu, date of registration 2021.08.20).
Topics: Adult; Humans; Lung; Perfusion; Prone Position; Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Prospective Studies
PubMed: 38012731
DOI: 10.1186/s13054-023-04749-3 -
European Journal of Sport Science Dec 2023This study assessed the reliability of mean concentric bar velocity from 3- to 0-repetitions in reserve (RIR) across four sets in different exercises (bench press and...
This study assessed the reliability of mean concentric bar velocity from 3- to 0-repetitions in reserve (RIR) across four sets in different exercises (bench press and prone row) and with different loads (60 and 80% 1-repetition maximum; 1RM). Whether velocity values from set one could be used to predict RIR in subsequent sets was also examined. Twenty recreationally active males performed baseline 1RM testing before two randomised sessions of four sets to failure with 60 or 80% 1RM. A linear position transducer measured mean concentric velocity of repetitions, and the velocity associated with each RIR value up to 0-RIR. For both exercises, velocity decreased between each repetition from 3- to 0-RIR (≤ 0.010). Mean concentric velocity of RIR values was not reliable across sets in the bench press (mean intraclass correlation coefficient [ICC] = 0.40, mean coefficient of variation [CV] = 21.3%), despite no significant between-set differences (= 0.530). Better reliability was noted in the prone row (mean ICC = 0.80, mean CV = 6.1%), but velocity declined by 0.019-0.027 m·s (= 0.032) between sets. Mean concentric velocity was 0.050-0.058 m·s faster in both exercises with 60% than 80% 1RM with (< 0.001). At the individual level, the velocity of specific RIR values from set one accurately predicted RIR from 5- to 0-RIR for 30.9% of repetitions in subsequent sets. These findings suggest that velocity of specific RIR values vary across exercises, loads and sets. As velocity-based RIR estimates were not accurate for 69.1% of repetitions, alternative methods to should be considered for autoregulating of resistance exercise in recreationally active individuals.
Topics: Male; Humans; Resistance Training; Reproducibility of Results; Muscle Strength; Weight Lifting; Muscle, Skeletal
PubMed: 37552530
DOI: 10.1080/17461391.2023.2235314 -
Cardiovascular Ultrasound Jun 2024To evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position.
AIMS
To evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position.
METHODS
Prospective study of adults who required a prone position during IMV. A pillow was placed only under the left hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist (prone group) acquired and evaluated the images using the apical-subcostal protocol. Besides, we used ambulatory echocardiograms performed as a comparative group (supine group).
RESULTS
86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to perform an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters, and the mean end-expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patients in the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group analyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heart valve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardial effusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supine position, a statistical difference was found when evaluating the left ventricle apical 2-chamber view (65.1 versus 100%, p < 0.01) and its segmental function (53.4 versus 100%, p < 0.01).
CONCLUSION
The echocardiogram using an apical-subcostal protocol is feasible in patients in the IMV and prone position.
Topics: Humans; Male; Prone Position; Female; Prospective Studies; Respiration, Artificial; Echocardiography; Feasibility Studies; Middle Aged; Intensive Care Units; Patient Positioning; Aged
PubMed: 38858752
DOI: 10.1186/s12947-024-00326-y -
Revista Paulista de Pediatria : Orgao... 2023To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance...
OBJECTIVE
To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants.
METHODS
Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants.
RESULTS
The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18).
CONCLUSIONS
The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.
Topics: Pregnancy; Female; Infant, Newborn; Infant; Humans; Infant, Premature; Prone Position; Brazil; Premature Birth; Sleep; Supine Position; Pregnancy Complications; Parents
PubMed: 37493671
DOI: 10.1590/1984-0462/2024/42/2022163 -
Cureus Jul 2023Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi...
INTRODUCTION
Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi of more than 2 cm in size. While both the supine and prone positions offer their unique advantages, it is still being debated which position offers the most in terms of surgical outcomes. We have evaluated the two approaches in terms of operative time, success rate, stone clearance rate, safety, and complications.
METHODS
This prospective cohort study was done in the urology department of a tertiary care center in South India between January 2018 and October 2020. A total of 166 patients, with 83 in supine and 83 in prone positions, were included in the study.
RESULTS
Both groups were matched in terms of age, body mass index, stone size and location, co-morbidities, medications taken, presence of diverticular stone, history of surgery, and baseline creatinine level. Mean operative time and pain scores were noted to be less in supine position as compared to prone. Ease of puncture was superior in supine position. Stone residue was noted to be higher in supine PCNL as well.
CONCLUSION
Supine PCNLs are preferred in high-risk patients while the prone position is preferred in bilateral PCNLs, complex anatomy, or larger stone burden.
PubMed: 37588325
DOI: 10.7759/cureus.41944