Enhancing Well-Being: A Comparative Study of Virtual Reality Chromotherapy Rooms with Static, Dynamic, and Empty Environments.

Chromotherapy rooms (CRs) are physical spaces with colored lights able to enhance an individual's mood, well-being, and, in the long term, their health. Virtual reality technology can be used to implement CR (VRCRs) and provide higher flexibility at lower costs. However, existing VRCRs are limited to a few use cases, and they do not fully explore the potential and pitfalls of the technology. This work contributes by comparing three VRCR designs: empty, static, and dynamic. Empty is just a void but a blue-colored environment. Static adds static abstract graphics (flowers and sea texture), and dynamic adds dynamic elements (animated star particle systems, fractals, and ocean flow). All conditions include relaxing low-beta and ocean sounds. We conducted a between-subject experiment (n = 30) with the three conditions. Subjects compiled a self-perceived questionnaire and a mathematical stress test before and after the VRCR experience. The results demonstrated that the dynamic condition provided a higher sense of presence, while the self-perceived stress level was insignificant. Dynamic VR conditions are perceived as having a shorter duration, and participants declared that they felt more involved and engaged than in the other conditions. Overall, the study demonstrated that VRCRs have a non-trivial behavior and need further study of their design, especially considering their role in a future where VR will be an everyday working interface.

The Importance of Early Femoral Access When REBOA Catheter Must Be Removed Prior to Hemorrhage Control.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool for hemorrhage control. We describe a case where the REBOA Catheter needed to be removed prior to hemorrhage control. The patient is a 40-year-old man that presented following motor vehicle collision. A REBOA Catheter was placed via the right common femoral artery (CFA). CT scan demonstrated extravasation from the left inferior epigastric artery. The Interventional Radiology (IR) team would only be able to perform angioembolization via contralateral access where the REBOA Catheter was in place. Prior to removing the REBOA Catheter on the right, left CFA access was obtained in the event a new catheter needed to be deployed. Ultimately, IR performed angioembolization without a second REBOA Catheter. In gaining contralateral access prior to removing the REBOA Catheter, this case provides a strategy for expeditious replacement of REBOA Catheters in situations where the catheter interferes with hemorrhage control procedures.

Sitting or Standing in VR: About Comfort, Conflicts, and Hazards.

This article examines the choices between sitting and standing in virtual reality (VR) experiences, addressing conflicts, challenges, and opportunities. It explores issues such as the risk of motion sickness in stationary users and virtual rotations, the formation of mental models, consistent authoring, affordances, and the integration of embodied interfaces for enhanced interactions. Furthermore, it delves into the significance of multisensory integration and the impact of postural mismatches on immersion and acceptance in VR. Ultimately, the article underscores the importance of aligning postural choices and embodied interfaces with the goals of VR applications, be it for entertainment or simulation, to enhance user experiences.

More Arrows in the Quiver: Investigating the Use of Auxiliary Models to Localize In-View Components with Augmented Reality.

The creation and management of content are among the main open issues for the spread of Augmented Reality. In Augmented Reality interfaces for procedural tasks, a key authoring strategy is chunking instructions and using optimized visual cues, i.e., tailored to the specific information to convey. Nevertheless, research works rarely present rationales behind their choice. This work aims to provide design guidelines for the localization of in-view and not occluded components, which is recurrent information in technical documentation. Previous studies revealed that the most suited visual cues to convey this information are auxiliary models, i.e., abstract shapes that highlight the space region where the component is located. Among them, 3D arrows are widely used, but they may produce ambiguity of information. Furthermore, from the literature, it is unclear how to design auxiliary model shapes and if they are affected by the component shapes. To fill this gap, we conducted two user studies. In the first study, we collected the preference of 45 users regarding the shape, color, and animation of auxiliary models for the localization of various component shapes. According to the results of this study, we defined guidelines for designing optimized auxiliary models based on the component shapes. In the second user study, we validated these guidelines by evaluating the performance (localization time and recognition accuracy) and user experience of 24 users. The results of this study allowed us to confirm that designing auxiliary models following our guidelines leads to a higher recognition accuracy and user experience than using 3D arrows.

The Geriatric Patient One Year After Trauma: Palliative Performance Scale Predicts Functional Outcomes.

INTRODUCTION: Frailty in trauma has been found to predict poor outcomes after injury including additional in-hospital complications, mortality, and discharge to dependent care. These gross outcome measures are insufficient when discussing long-term recovery as they do not address what is important to patients including functional status and quality of life. The purpose of this study is to determine if the Palliative Performance Scale (PPS) predicts mortality and functional status one year after trauma in geriatric patients. MATERIAL AND METHODS: Prospective observational study of trauma survivors, age ≥55 years. Patients were stratified by pre-injury PPS high (>70) or low (≤70). Outcomes were functional status at 1 year measured by Glasgow Outcome Scale Extended (GOSE), Euroqol-5D and SF-36. Adjusted relative risks (aRR) were obtained using modified Poisson regression. RESULTS: Follow-up was achieved on 215/301 patients. Mortality was 30% in low PPS group vs 8% in the high PPS group (P<0.001). A greater percentage of patients in the high group had a good functional outcome at one year compared to patients in the low group (78% vs 30% p<0.001). The high PPS patients were more likely to have improvement of GOSE at 1 year from discharge compared to low group (66% vs 27% P<0.001). Low PPS independently predicted poor functional outcome (aRR, 2.64; 95% confidence interval, 1.79-3.89) and death at 1 year (aRR, 3.64; 95% confidence interval 1.68-7.92). An increased percentage of low PPS patients reported difficulty with mobility (91% vs 46% p<0.0001) and usual activities (82% vs 56% p=0.002). Both groups reported pain (65%) and anxiety/depression (47%). CONCLUSION: Low pre-Injury PPS predicts mortality and poor functional outcomes one year after trauma. Low PPS patients were more likely to decline, rather than improve. Regardless of PPS, most patients have persistent pain, anxiety, and limitations in performing daily activities.

Immersive and desktop virtual reality in virtual fashion stores: a comparison between shopping experiences.

With the high growth and prosperity of e-commerce, the retail industry needs to explore new technologies that improve digital shopping experiences. In the current technological scenario, Virtual Reality (VR) emerges as a tool and an opportunity for enhancing shopping activities, especially for the fashion industry. This study explores whether using Immersive Virtual Reality (IVR) technologies enhances the shopping experience in the fashion industry compared to Desktop Virtual Reality (DVR). A within-subject experiment was carried out involving a sample of 60 participants who completed a simulated shopping experience. In the first mode (DVR), a desktop computer setup was used to test the shopping experience using a mouse and keyboard for navigation. The second mode (IVR) exploited a Head-Mounted Display (HMD), and controllers, that allowed navigation while seated on a workstation to avoid sickness. Participants had to find a bag in the virtual shop and explore its features until they were ready to purchase it. Post-hoc measures of time duration of the shopping experience, hedonic and utilitarian values, user experience, and cognitive load were compared. Results showed that participants experienced higher hedonism and utilitarianism in the IVR shop compared to DVR. The cognitive load was comparable in both modes, while user experience was higher in IVR. In addition, the time duration of the shopping experience was higher in IVR, where users stayed immersed and enjoyed it for longer. This study has implications for fashion industry research, as the use of IVR can potentially lead to novel shopping patterns by enhancing the shopping experience. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-023-00806-y.

IEEE ISMAR 2022 Report: Toward Better Mixed Realities.

On October 21, 2022, the 21st IEEE International Symposium on Mixed and Augmented Reality (ISMAR 2022) was successfully completed in Singapore. ISMAR is the leading international conference in the fields of augmented reality, mixed reality, and virtual reality. This was the first time that ISMAR was held in Southeast Asia and the first time in hybrid mode. ISMAR 2022 achieved a historically high number of papers and attendees, witnessing the steady growth of the community and the scientific contributions. In this article, we report the key outcomes, impressions, research trends, and lessons learned from the conference.

Stercoral Perforation in the Setting of Chronic Antipsychotic Use: A Case Report.

Stercoral perforation is a rare form of colonic perforation with limited reports in the literature, accounting for less than 140 documented cases. This complication occurs due to increased intraluminal pressure created by fecal impaction, ultimately causing colonic ulceration and necrosis. It is most often seen in elderly or debilitated patients with chronic constipation. The long-term use of drugs or medications with side effects of chronic constipation such as opioids, antispasmodics, tricyclic antidepressants, and calcium channel blockers have been implicated in these cases. Here we present a case of stercoral perforation in a patient with short-term opioid use following an orthopedic procedure, but more likely complicated by long-term use of antipsychotics and antidepressants.

Minimal AR: visual asset optimization for the authoring of augmented reality work instructions in manufacturing.

This work investigates the possibility of using a novel "minimal AR" authoring approach to optimize the visual assets used in augmented reality (AR) interfaces to convey work instructions in manufacturing. In the literature, there are no widely supported guidelines for the optimal choice of visual assets (e.g., CAD models, drawings, and videos). Therefore, to avoid the risk of having AR technical documentation based only on the author's preference, our work proposes a novel authoring approach that enforces the minimal amount of information to accomplish a task. Minimal AR was tested through a simulated AR LEGO-based assembly task. The performance (completion time, mental workload, errors) of 40 users was evaluated with 4 combinations of visual assets in 4 tasks with an increasing amount of information needed. The main result is that visual assets with an excess of information do not significantly increase performance. Therefore, the location of a specified object should be "minimally" authored by an auxiliary model (e.g., a circle and an arrow). For identifying an object within a couple, color coding is preferred to using additional visual assets. If more than two objects must be identified, a drawing visual asset is also needed. Only when the orientation of a selected object must be conveyed, animated product models are required. These insights could be helpful for an optimal design of AR work instructions in a wide range of industrial fields. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00170-021-08449-6.

Dexmedetomidine and paralytic exposure after damage control laparotomy: risk factors for delirium? Results from the EAST SLEEP-TIME multicenter trial.

PURPOSE: To evaluate factors associated with ICU delirium in patients who underwent damage control laparotomy (DCL), with the hypothesis that benzodiazepines and paralytic infusions would be associated with increased delirium risk. We also sought to evaluate the differences in sedation practices between trauma (T) and non-trauma (NT) patients. METHODS: We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry admitted from January 1, 2017 to December 31, 2018. We included all adults undergoing DCL, regardless of diagnosis, who had completed daily Richmond Agitation Sedation Score (RASS) and Confusion Assessment Method-ICU (CAM-ICU). We excluded patients younger than 18 years, pregnant women, prisoners and patients who died before the first re-laparotomy. Data collected included age, number of re-laparotomies after DCL, duration of paralytic infusion, duration and type of sedative and opioid infusions as well as daily CAM-ICU and RASS scores to analyze risk factors associated with the proportion of delirium-free/coma-free ICU days during the first 30 days (DF/CF-ICU-30) using multivariate linear regression. RESULTS: A 353 patient subset (73.2% trauma) from the overall 567-patient cohort had complete daily RASS and CAM-ICU data. NT patients were older (58.9 ± 16.0 years vs 40.5 ± 17.0 years [p < 0.001]). Mean DF/CF-ICU-30 days was 73.7 ± 96.4% for the NT and 51.3 ± 38.7% in the T patients (p = 0.030). More T patients were exposed to Midazolam, 41.3% vs 20.3% (p = 0.002). More T patients were exposed to Propofol, 91.0% vs 71.9% (p < 0.001) with longer infusion times in T compared to NT (71.2 ± 85.9 vs 48.9 ± 69.8 h [p = 0.017]). Paralytic infusions were also used more in T compared to NT, 34.8% vs 18.2% (p < 0.001). Using linear regression, dexmedetomidine infusion and paralytic infusions were associated with decreases in DF/CF-ICU-30, (- 2.78 (95%CI [- 5.54, - 0.024], p = 0.040) and (- 7.08 ([- 13.0, - 1.10], p = 0.020) respectively. CONCLUSIONS: Although the relationship between paralytic use and delirium is well-established, the observation that dexmedetomidine exposure is independently associated with increased delirium and coma is novel and bears further study.

A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service.

PURPOSE: The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians. METHODS: Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician's interpretations of these ultrasounds were compared to gold standard references of CT imaging or operating room findings. The outcomes measured include the calculated accuracy of eFAST for detecting intraperitoneal free fluid (IPFF), pneumothorax, hemothorax, and pericardial fluid compared to available gold standard results. RESULTS: Of the 411 patients with adequate data for comparison, the median age was 39.5 years with 73% male and 98% sustaining blunt force trauma. For the detection of IPFF, eFAST had a sensitivity of 25% (95% CI 16-36%) and specificity of 96% (95% CI 93-98%). Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), hemothorax (17% and 97% respectively), and pericardial effusion (17% and 100% respectively). These results did not change significantly when reassessed with several sensitivity analyses. CONCLUSION: Prehospital eFAST is reliable for detecting the presence of intraperitoneal free fluid. This finding should inform receiving trauma teams to prepare for early definitive care in these patients. The low sensitivities across all components of the eFAST highlight the importance of cautiously interpreting negative studies while prompting the need for further studies. TRIAL REGISTRATION: ACTRN12618001973202 (Registered on 06/12/2018).

Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry).

PURPOSE: Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. METHODS: We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. RESULTS: In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2-93.9%, p < 0.001). Time to first re-laparotomy was highly significant (p < 0.001) in terms of odds of achieving PFC, with no difference between 12 and 24 h to first re-laparotomy (ref), and decreases in odds of PFC of 78.4% (65.8-86.4%, p < 0.001) for first re-laparotomy after 24.1-36 h, 90.8% (84.7-94.4%, p < 0.001) for 36.1-48 h, and 98.1% (96.4-99.0%, p < 0.001) for > 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). CONCLUSION: Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. LEVEL OF EVIDENCE: 2B.

Changes in antidepressant medication use in the workplace and sustainable employability: a qualitative study of experiences, strategies and solutions.

This study explores patients' experiences of how antidepressant medication transition events (ceasing, changing or reducing) affect employment and workplace functioning. An anonymous online survey was conducted with adults who had experienced antidepressant medication transition events (AMTEs). Data were analyzed using a hybrid inductive and deductive thematic analysis approach. While a majority of participants perceived many positive impacts of antidepressant medication on their workplace functioning, considerable negative effects during AMTEs were reported. Participants provided practical solutions to assist employers, policy and clinicians. Significant and detrimental impact of antidepressant medication changes occurred in the workplace. There is an urgent need to raise awareness of the vulnerability of people during AMTEs and to develop educational and supportive resources to assist clinicians and practitioners to support people during this vulnerable time.

What, How, and Why are Visual Assets Used in Industrial Augmented Reality? A Systematic Review and Classification in Maintenance, Assembly, and Training (From 1997 to 2019).

Industrial Augmented Reality (iAR) has demonstrated its advantages to communicate technical information in the fields of maintenance, assembly, and training. However, literature is scattered among different visual assets (i.e., AR visual user interface elements associated with a real scene). In this work, we present a systematic literature review of visual assets used in these industrial fields. We searched five databases, initially finding 1757 papers. Then, we selected 122 iAR papers from 1997 to 2019 and extracted 348 visual assets. We propose a classification for visual assets according to (i) what is displayed, (ii) how it conveys information (frame of reference, color coding, animation), and, (iii) why it is used. Our review shows that product models, text and auxiliary models are, in order, the most common, with each most often used to support operating, checking and locating tasks respectively. Other visual assets are scarcely used. Product and auxiliary models are commonly rendered world-fixed, color coding is not used as often as expected, while animations are limited to product and auxiliary model. This survey provides a snapshot of over 20 years of literature in iAR, useful to understand established practices to orientate in iAR interface design and to present future research directions.

Trauma and nontrauma damage-control laparotomy: The difference is delirium (data from the Eastern Association for the Surgery of Trauma SLEEP-TIME multicenter trial).

BACKGROUND: Damage-control laparotomy (DCL) has been used for traumatic and nontraumatic indications. We studied factors associated with delirium and outcome in this population. METHODS: We reviewed DCL patients at 15 centers for 2 years, including demographics, Charlson Comorbidity Index (CCI), diagnosis, operations, and outcomes. We compared 30-day mortality; renal failure requiring dialysis; number of takebacks; hospital, ventilator, and intensive care unit (ICU) days; and delirium-free and coma-free proportion of the first 30 ICU days (DF/CF-ICU-30) between trauma (T) and nontrauma (NT) patients. We performed linear regression for DF/CF-ICU-30, including age, sex, CCI, achievement of primary fascial closure (PFC), small and large bowel resection, bowel discontinuity, abdominal vascular procedures, and trauma as covariates. We performed one-way analysis of variance for DF/CF-ICU-30 against traumatic brain injury severity as measured by Abbreviated Injury Scale for the head. RESULTS: Among 554 DCL patients (25.8% NT), NT patients were older (58.9 ± 15.8 vs. 39.7 ± 17.0 years, p < 0.001), more female (45.5% vs. 22.1%, p < 0.001), and had higher CCI (4.7 ± 3.3 vs. 1.1 ± 2.2, p < 0.001). The number of takebacks (1.7 ± 2.6 vs. 1.5 ± 1.2), time to first takeback (32.0 hours), duration of bowel discontinuity (47.0 hours), and time to PFC were similar (63.2 hours, achieved in 73.5%). Nontrauma and T patients had similar ventilator, ICU, and hospital days and mortality (31.0% NT, 29.8% T). Nontrauma patients had higher rates of renal failure requiring dialysis (36.6% vs. 14.1%, p < 0.001) and postoperative abdominal sepsis (40.1% vs. 17.1%, p < 0.001). Trauma and NT patients had similar number of hours of sedative (89.9 vs. 65.5 hours, p = 0.064) and opioid infusions (106.9 vs. 96.7 hours, p = 0.514), but T had lower DF/CF-ICU-30 (51.1% vs. 73.7%, p = 0.029), indicating more delirium. Linear regression analysis indicated that T was associated with a 32.1% decrease (95% CI, 14.6%-49.5%; p < 0.001) in DF/CF-ICU-30, while achieving PFC was associated with a 25.1% increase (95% CI, 10.2%-40.1%; p = 0.001) in DF/CFICU-30. Increasing Abbreviated Injury Scale for the head was associated with decreased DF/CF-ICU-30 by analysis of variance (p < 0.001). CONCLUSION: Nontrauma patients had higher incidence of postoperative abdominal sepsis and need for dialysis, while T was independently associated with increased delirium, perhaps because of traumatic brain injury. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Nanoindentation of mesenchymal stem cells using atomic force microscopy: effect of adhesive cell-substrate structures.

The procedure commonly adopted to characterize cell materials using atomic force microscopy neglects the stress state induced in the cell by the adhesion structures that anchor it to the substrate. In several studies, the cell is considered as made from a single material and no specific information is provided regarding the mechanical properties of subcellular components. Here we present an optimization algorithm to determine separately the material properties of subcellular components of mesenchymal stem cells subjected to nanoindentation measurements. We assess how these properties change if the adhesion structures at the cell-substrate interface are considered or not in the algorithm. In particular, among the adhesion structures, the focal adhesions and the stress fibers were simulated. We found that neglecting the adhesion structures leads to underestimate the cell mechanical properties thus making errors up to 15%. This result leads us to conclude that the action of adhesion structures should be taken into account in nanoindentation measurements especially for cells that include a large number of adhesions to the substrate.

Teaching Residents Communication Skills around Death and Dying in the Trauma Bay.

AbstractBackground: Traumatic events are sudden, unexpected, and often devastating. The delivery of difficult news to patients and families in the trauma setting has unique challenges that necessitate communication skills that may differ from those used in other clinical environments. Objective: Design and implement a novel curriculum to teach, assess, and provide feedback to trauma residents on the communication skills necessary for delivering difficult news to patients and families in the trauma setting. Methods: This communication curriculum was delivered in three separate phases: (1) didactics using a video education e-module, (2) simulated practice of trauma resuscitation with a high-fidelity mannequin followed by role play of delivering difficult news, (3) an observed skills assessment using standardized patients (SPs). Each phase focused on delivery of difficult news of death and of uncertain/poor prognosis after a resuscitation in the trauma bay. Learners were trauma residents that included postgraduate year (PGY) 1-2 general surgery residents and PGY 1-4 emergency medicine residents at a level 1 trauma center. Outcomes include resident comfort, knowledge, and confidence in delivering difficult news in the trauma setting. Results: Thirty-nine trauma residents participated in the three-phase curriculum. There was an increase in the mean scores of resident-reported comfort, knowledge, and confidence in delivering difficult news for the seriously injured. SPs rated 78% of residents as competent to perform delivery of difficult news in the trauma bay independently. Conclusions: A curriculum to teach and assess trauma residents in the skills necessary to deliver difficult news in the trauma setting is both feasible and effective.

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital.

BACKGROUND: Emergency general surgery (EGS) has high rates of morbidity, mortality, and readmission. Therefore, it might be expected that an EGS service fields many consultations for postoperative patients. However, with the known overutilization of emergency department visits for nonurgent conditions, we hypothesized most postoperative consults received by an EGS service would be nonurgent and could be appropriately managed as an outpatient. METHODS: We reviewed all EGS consults at a single urban safety net hospital over a 12-month period, screening for patients who had undergone surgery in the previous 12 mo. This included consultations from the emergency room and inpatient setting. Demographics, admission status, procedures performed, and other details were abstracted from the chart and Vizient reports. Consultation questions were categorized and then reviewed by an expert panel to determine if conditions could have been managed as an outpatient. RESULTS: The EGS service received a total of 1112 consults, with 99 (9%) for a postoperative condition. Overall, 85% of postoperative consults were admitted after consultation, 19% underwent surgery and 21% underwent a procedure with gastroenterology or interventional radiology. Expert review classified slightly over one-third (36%) of consults as nonurgent. CONCLUSIONS: Most postoperative consults seen at our urban safety net hospital represent true morbidity that required admission, intervention, or surgery. Despite this high acuity, one-third of postoperative consults could have been managed as an outpatient. Efforts to improve discharge instructions and set patient expectations could limit unnecessary postoperative emergency department visits.

A Body Tracking-Based Low-Cost Solution for Monitoring Workers' Hygiene Best Practices during Pandemics.

Since its beginning at the end of 2019, the pandemic spread of the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) caused more than one million deaths in only nine months. The threat of emerging and re-emerging infectious diseases exists as an imminent threat to human health. It is essential to implement adequate hygiene best practices to break the contagion chain and enhance society preparedness for such critical scenarios and understand the relevance of each disease transmission route. As the unconscious hand-face contact gesture constitutes a potential pathway of contagion, in this paper, the authors present a prototype system based on low-cost depth sensors able to monitor in real-time the attitude towards such a habit. The system records people's behavior to enhance their awareness by providing real-time warnings, providing for statistical reports for designing proper hygiene solutions, and better understanding the role of such route of contagion. A preliminary validation study measured an overall accuracy of 91%. A Cohen's Kappa equal to 0.876 supports rejecting the hypothesis that such accuracy is accidental. Low-cost body tracking technologies can effectively support monitoring compliance with hygiene best practices and training people in real-time. By collecting data and analyzing them with respect to people categories and contagion statistics, it could be possible to understand the importance of this contagion pathway and identify for which people category such a behavioral attitude constitutes a significant risk.

Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation.

BACKGROUND: Obstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI). METHODS: Nationwide Inpatient Sample (2009-2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant. RESULTS: Among the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06). CONCLUSION: OSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes. LEVEL OF EVIDENCE: Prognostic Level IV.