Quantifying rider posture variability in powered two- and three-wheelers for safety assessment.

OBJECTIVE: Injury outcomes for powered two- and three-wheeler (PTW) riders are influenced by the rider posture. To enable analysis of PTW rider accidents and development of protection systems, detailed whole-body posture data is needed. Therefore, the aim of this study is to fill this gap by providing collections of average male whole-body postures, including subpopulation variability, for different PTW types. This will enable future studies to explore the influence of PTW rider posture variation and to support safety system development. METHODS: 3D photometric measurements of 51 anatomical landmarks were recorded on 20 (50th percentile male) volunteers in their preferred riding postures across three PTW types (naked, scooter, and touring). Following an outlier removal process, a principal component analysis (PCA) was performed to calculate average postures and principal components (PCs), to describe the observed posture variation, for each PTW. The visualization of the PCs was facilitated through kinematic linkage representations, connecting anatomical landmarks and estimated joint centers to form segments and characteristic joint angles. RESULTS: The first seven PCs explained 80% of the variance in posture for each of the three PTWs. Across PTWs, these PCs frequently described combinations of postural features including variation in fore-aft seat positions, pelvic tilt, spinal curvature, head position, and extremity flexion-extension. Analysis revealed distinct differences in average postures across the three PTWs, on average, 10 ± 9° for the characteristic joint angles within a min-to-max range between the three PTWs. However, for all three PTWs, the variability between volunteers in characteristic joint angles on the same PTW were on average more than twice as large within a ± 2 SD range (26 ± 11°). CONCLUSIONS: The results suggest that PTW rider posture variation must be addressed by involving simultaneous adjustments of multiple body parts, as described by each of the first seven PCs, as a direct consequence of the human body interconnectedness. Furthermore, the study's findings challenge conventional assumptions that the relative distance between PTWs' handlebar, seat, and foot support predominantly influences rider postures. Instead, the research demonstrates that individual variability has a substantial influence on rider posture and should be considered in PTW safety development.

Tobacco smoking and nicotine vaping in persons with first episode psychosis.

Tobacco smoking is highly prevalent in persons with psychosis and is the leading cause of preventable mortality in this population. Less is known about tobacco smoking in persons with first episode psychosis (FEP) and there have been no estimates about the prevalence of nicotine vaping in FEP. This study reports rates of tobacco smoking and nicotine vaping in young people with FEP enrolled in Coordinated Specialty Care programs in Pennsylvania and Maryland. Using data collected from 2021 to 2023, we examined lifetime and recent smoking and vaping and compared smokers and vapers to nonusers on symptoms, functioning, and substance use. The sample included 445 participants aged 13-35 with recent psychosis onset. Assessments were collected by program staff. Overall, 28 % of participants engaged in either smoking or vaping within 30 days of the admission assessment. Smokers and vapers were disproportionately male, cannabis users, and had lower negative symptom severity than non-smokers. Vapers had higher role and social functioning. Both smoking and vaping were related to a longer time from psychosis onset to program enrollment. We compare these findings to previous studies and suggest steps for addressing smoking and vaping in this vulnerable population.

Thoracic epidural analgesia as part of an enhanced recovery program in gynecologic oncology: a prospective cohort study.

OBJECTIVE: To evaluate the safety and the effectiveness of thoracic epidural analgesia as part of the enhanced recovery after surgery (ERAS) multimodal analgesic protocol in patients with gynecologic oncology who have undergone laparotomy for suspected or confirmed malignancy. METHODS: We conducted a prospective cohort study, following an enhanced recovery after surgery pathway, among patients who had undergone laparotomy for confirmed or suspected gynecological malignancy between January 2020 and September 2021. All patients who underwent laparotomy at the gynecologic oncology department for the aforementioned reason during that time were considered eligible. Patients (n=217) were divided into two groups: epidural (n=118) and non-epidural (n=99) group. Both groups were treated with the standard ERAS departmental analgesic protocol. The primary outcomes were length of hospital stay, complications, and readmission rates. RESULTS: Data from 217 patients (epidural group, n=118 vs non-epidural group, n=99) with median age of 61 years (IQR 53-68) were analyzed. The most common type of cancer was of ovarian origin (85/217, 39.2%, p=0.055) and median (Aletti) surgical complexity score was 3 (p=0.42). No differences were observed in the patients' demographics, clinical, and surgical characteristics. Primarily, median length of stay was 4 days in both groups with statistically significant lower IQR in the epidural group (3-5 vs 4-5, p=0.021). Complication rates were more common in the non-epidural group (38/99, 38.3% vs 36/118, 30.5%, p<0.001) with similar rates of grade III (p=0.51) and IV (0%) complications and readmission rates (p=0.51) between the two groups. Secondarily, the epidural group showed lower pain scores (p<0.001) on the day of surgery and in the first post-operative day (p<0.001), higher mobilization rates on the day of surgery (94.1% vs 57.6%, p<0.001), faster removal of urinary catheter (p<0.001), shorter time to flatus (p<0.001), and less nausea on the day of surgery (p<0.001). CONCLUSION: In this study we showed that thoracic epidural analgesia, when used as part of an ERAS protocol, is safe and offers more favorable pain relief along with a number of additional benefits, improving the peri-operative experience of patients with gynecologic cancer.

Enhanced Recovery After Surgery Protocols in Obese Gynecological Oncology Patients: A Single-Center Experience.

Objective The aim of this study is to present our experience and evaluate the safety and outcomes of the implementation of Enhanced Recovery After Surgery (ERAS) protocols in obese patients who underwent surgery for suspected or confirmed gynecological malignancies. Method From January 2020 to September 2021, 217 patients underwent laparotomy for a confirmed or suspected gynecological malignancy following a 19-element ERAS pathway. The patients were divided into two groups: obese (BMI ≥ 30 kg/m2, n = 104) and non-obese (BMI < 30, n = 113). Both groups were treated with a 19-element ERAS protocol. Results After dividing the 217 patients into two groups, significantly more comorbidities were observed in the obese group (diabetes mellitus: 23% vs. 8%, p = 0.004; ASA score grade 3: 25.0% vs. 6.2%, p < 0.001), as well as higher rates of endometrial cancer (51.9% vs. 17.7%, p < 0.001) compared to the non-obese group. The overall ERAS compliance rates when matched element by element were similar. Postoperatively, complication rates of all grades were significantly higher in the obese group (46.1% vs. 27.4%, p < 0.001) without differences in the length of stay, readmission, and reoperation rates. Conclusion In this retrospective study, we showed that obese gynecological oncology patients can be safely managed with ERAS protocols perioperatively while potentially minimizing the adverse outcomes in these otherwise high-risk patients.

From conflicts to crashes: Simulating macroscopic connected and automated driving vehicle safety.

Safety evaluation is a critical aspect through the future stages of automation development. Since there is a lack of historical and generalizable safety data in high levels of Connected and Autonomous Vehicles (CAVs), a possible approach to follow is the microscopic simulation method. Through microsimulation, vehicle trajectories are able to be exported and traffic conflicts to be identified using the Surrogate Safety Assessment Model (SSAM). Therefore, it is crucial to develop techniques in order to analyze conflict data extracted from microsimulation and evaluate crash data aiming to support road safety applications of automation technologies. This paper attempts to propose a safety evaluation approach for estimating crash rate of CAVs through microsimulation. For this purpose, the city center of Athens (Greece) was modelled using the Aimsun Next software paying attention to the calibration and validation of the model using real data of traffic characteristics. Moreover, different scenarios were formulated concerning different market penetration rates (MPRs) of CAVs and two fully automated generations (1st and 2nd generation) were simulated for modelling them. Subsequently, the SSAM software was used in order traffic conflicts to be identified and then converted to crash rate. Analysis of the outputs along with traffic data and network geometry characteristics were then conducted. The results indicated that in higher CAV MPRs, crash rates will be significantly lower as well as when the following-vehicle in the occurred conflict is a 2nd generation CAV. Lane change conflicts caused the highest crash rates compared to rear-end conflicts, which presented the lowest rates.

Clinicopathological Characteristics and Outcomes of Patients With Endometriosis-Related Hemorrhagic Ascites: An Updated Systematic Review of the Literature.

The presence of ascites is a common clinical presentation in gynecologic oncology patients. Hemorrhagic ascites (HA) due to endometriosis is a rare presentation that can be easily misdiagnosed as ovarian malignancies. The present study aims to update the currently available knowledge on the characteristics of patients presenting with HA due to endometriosis. A systematic search was conducted for articles published from January 2000 to July 2020 using the Medline, Scopus, and Google Scholar databases along with the references of the full-text articles retrieved. Papers describing cases of women over 18 years with or without previous history of endometriosis were assessed. Only cases with histologically proven hemorrhagic ascites of endometriosis origin were included. Twenty-nine studies (27 case reports and two case series) comprising 32 patients were evaluated. The mean patients' age was 32 years, while six of the patients had a previous history of endometriosis. The mean amount of drained ascitic fluid was 4,200 mL, whereas three patients underwent thoracentesis due to pleural effusions. The treatment options included not only medical but also surgical therapies. Fertility preservation was achieved in 27 patients, while two of them achieved pregnancy with in vitro fertilization (IVF) techniques. Endometriosis-related hemorrhagic ascites is a relatively rare expression of the disease. Endometriosis-related hemorrhagic ascites should be considered in the differential diagnosis (DD) of women with ascites and clinical suspicion of endometriosis. The available literature is limited to case reports and case series and thus indicates further research in the field to decode the pathophysiology of the disease and decide on the optimal treatment.

The Association Between the Risk of Breast Cancer and Epigallocatechin- 3-Gallate Intake: A Literature Review of a Potential Chemopreventive Agent.

According to the latest epidemiological data, breast cancer has recently been the most frequently diagnosed malignancy. To date, a body of evidence has established the involvement of multiple - and frequently interrelated - genetic and environmental factors in the pathogenesis of the disease. Emerging research on cancer prevention has highlighted the deterrence potential of interventions targeting environmental risk factors, particularly diet. In this aspect, the current review reveals the latest scientific results regarding epigallocatechin-3-gallate (EGCG) - a catechin most commonly found in green tea, as a potential chemopreventive dietary agent against breast cancer. in vitro studies on EGCG have demonstrated its effect on cell cycle progression and its potential to suppress several intracellular signaling pathways involved in breast cancer pathogenesis. In addition, EGCG possesses specific apoptosis-inducing characteristics that seem to enhance its role as a regulator of cell survival. Preclinical data seem to support using EGCG as an effective adjunct to EGFR-targeting treatments. The authors' appraisal of the literature suggests that although preclinical evidence has documented the anticarcinogenic features of EGCG, limited large-scale epidemiological studies are investigating the consumption of EGCG - containing nutrients in the prevention and management of breast cancer risk. This literature review aims to liaise between preclinical and epidemiological research, surveying the existing evidence and unraveling relevant knowledge gaps.

Parental Knowledge, Attitude, and Practices on Antibiotic Use for Childhood Upper Respiratory Tract Infections during COVID-19 Pandemic in Greece.

This cross-sectional study aims to assess parents' knowledge, attitude, and practices on antibiotic use for children with URTIs symptoms in Greece in the era of the COVID-19 pandemic. We distributed a questionnaire to a random sample of parents who visited primary health care centers in Patras, Greece. Out of 412 participants, 86% believed that most infections with common cold or flu symptoms were caused by viruses, although 26.9% believed that antibiotics may prevent complications. Earache was the most common symptom for which antibiotics were needed. Most of them (69%) declare being considerably anxious about their children's health during the COVID-19 pandemic. The majority (85%) knew that COVID-19 was of viral origin, yet half of them declared uncertain whether antibiotics were needed. All demographic characteristics, except for gender, were found to have a significant effect on parents' knowledge, attitude, and practices on antibiotic use for URTIs and COVID-19. Factor analysis revealed six groups of parents with common characteristics associated with misuse of antibiotics. Our findings highlight the need to decrease misconceptions regarding antibiotic use by providing relevant education for parents targeting particular characteristics, especially during the COVID-19 pandemic. Continuous education of healthcare providers in the field is also of paramount importance.

How to Manage a Patient with Haemophilia and ACS Requiring PCI: A Battle between Bleeding and Thrombosis.

We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.

Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology.

The journey of human labor involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of the umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as labor progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labor. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially in the presence of a super-imposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labor may increase the risk of hypoxic-ischemic injury. Clinicians need to move away from "pattern recognition" guidelines ("normal," "suspicious," "pathological"), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.

The Conundrum of Prematurity and Pregnancy Outcomes after Fertility Sparing Treatment Modalities for Early Stage Cervical Cancer: A Systematic Review of the Literature.

Advances in modern medicine have allowed patients with early stage cervical cancer (stages Ia - IIai) to preserve their fertility with oncologic efficacy comparable to previous radical treatments. A variety of conservative-fertility sparing procedures, also known as Fertility Sparing Surgeries (FSS) have been proposed. The present review aimed to provide the current evidence on obstetric outcomes and the prematurity rates as well as to discuss the management modalities of these high-risk pregnancies. Our review of the literature included 3042 women with early cervical cancer, of whom 2838 underwent FSS (204 excluded for oncologic reasons). Almost half of these patients attempted to become pregnant and about two thirds of them achieved at least one pregnancy either spontaneously or with the help of Assisted Reproduction Technologies. Data revealed that 63.9% of these pregnancies resulted in live births, whereas 37.6% of them were preterm. The main cause of preterm births in this subpopulation is the postoperative cervical length restriction that consequently leads to cervical incompetence and ascending infections that eventually lead to (clinical or subclinical) chorioamnionitis. Radical operations such as ART, VRT and MIRT presented with higher prematurity rates. The lack of standardized protocols for the management of pregnancies after FSS precluded reaching to firm results with regards to the efficacy of them in achieving favourable obstetrical outcomes. Further large volume studies are warranted with the intent to acquire standardized guidelines for pregnancies achieved after FSS for early stage cervical cancer.

Platelet to lymphocyte and neutrophil to lymphocyte ratio as predictive indices of endometrial carcinoma: Findings from a retrospective series of patients and meta-analysis.

BACKGROUND: The purpose of the present study is to present new data concerning the diagnostic efficacy of neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios in detecting endometrial carcinoma and to summarize the existing knowledge by accumulating all the available data in the existing literature. MATERIALS AND METHODS: We retrospectively identified patients with evidence of endometrial pathology (vaginal bleeding or increased endometrial thickness) that undergone dilatation and curettage. For the meta-analysis we used the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases to identify relevant articles in the field. RESULTS: In our retrospective series we identified 106 women with endometrioid endometrial carcinoma and 72 controls. PLR and NLR values were comparable among the two groups (p>.05). Eleven studies were included in the present systematic review with a total of 4168 patients. The meta-analysis included 1013 patients. PLR values were not significantly different among the two groups. On the other hand, NLR was significantly raised among patients with endometrial carcinoma (MD 0.73, 95% CI 0.01, 1.45). CONCLUSION: The findings of our meta-analysis support that NLR values are significantly elevated in patients with endometrial cancer compared to controls. Moreover, there seem to be evidence to support that both PLR and NLR values increase in patients with advanced stage disease, including positive lymph nodes, lymphovascular space involvement and distant metastases. Future studies are needed in this field to reach firm conclusions and these should specifically target patients with advanced stage disease.

Cross-Cultural Adaptation and Validation of the SWAL-QoL Questionnaire in Greek.

The purpose of this study was to translate and adapt the 44-item SWAL-QoL into Greek and examine its internal consistency, test-retest reliability, external construct validity, and discriminant validity in order to provide a validated dysphagia-specific QoL instrument in the Greek language. The instrument was translated into Greek using the back translation to ensure linguistic validity and was culturally adapted resulting in the SWAL-QoL-GR. Two groups of participants were included: a patient group of 86 adults (48 males; age range: 18-87 years) diagnosed with oropharyngeal dysphagia, and an age-matched healthy control group (39 adults; 19 males; age range: 18-84 years). The Greek 30-item version of the WHOQOL-BREF was used for assessment of construct validity. Overall, the questionnaire achieved good to excellent psychometric values. Internal consistency of all 10 subscales and the physical symptoms scale of the SWAL-QoL-GR assessed by Cronbach's α was good to excellent (0.811 < α < 0.940). Test-retest validity was found to be good to excellent as well. In addition, moderate to strong correlations were found between seven of the ten subscales of the SWAL-QoL-GR with limited items of the WHOQΟL-BREF (0.401 < ρ < 0.65), supporting good construct validity of the SWAL-QoL-GR. The SWAL-QoL-GR also correctly differentiated between patients with dysphagia and age-matched healthy controls (p < 0.001) on all 11 scales, further indicating excellent discriminant validity. Finally, no significant differences were found between the two sexes. This cultural adaptation and validation allows the use of this tool in Greece, further enhancing our clinical and scientific efforts to increase the evidence-based practice resources for dysphagia rehabilitation in Greece.

Mindfulness training for smoking cessation: A meta-analysis of randomized-controlled trials.

Recent studies have shown that mindfulness training has a promising potential for smoking treatment. In order to examine the efficacy of mindfulness training in smoking cessation, we performed a systematic review of the literature and meta-analysis of randomized controlled trials. Four randomized controlled trials with 474 patients were included in our analysis. The results showed that 25.2 percent of participants remained abstinent for more than 4 months in the mindfulness group compared to 13.6 percent of those who received usual care therapy (relative risk, 1.88; 95 percent confidence interval, 1.04-3.40). Our results suggest that mindfulness training may have an important role to play in efforts to lower cigarette smoking rates.

Revealing and tuning the core, structure, properties and function of polymer micelles with lanthanide-coordination complexes.

Controlling self-assembly processes is of great interest in various fields where multifunctional and tunable materials are designed. We here present the versatility of lanthanide-complex-based micelles (Ln-C3Ms) with tunable coordination structures and corresponding functions (e.g. luminescence and magnetic relaxation enhancement). Micelles are prepared by charge-driven self-assembly of a polycationic-neutral diblock copolymer and anionic coordination complexes formed by Ln(III) ions and the bis-ligand L2EO4, which contains two dipicolinic acid (DPA) ligand groups (L) connected by a tetra-ethylene oxide spacer (EO4). By varying the DPA/Ln ratio, micelles are obtained with similar size but with different stability, different aggregation numbers and different oligomeric and polymeric lanthanide(III) coordination structures in the core. Electron microscopy, light scattering, luminescence spectroscopy and magnetic resonance relaxation experiments provide an unprecedented detailed insight into the core structures of such micelles. Concomitantly, the self-assembly is controlled such that tunable luminescence or magnetic relaxation with Eu-C3Ms, respectively, Gd-C3Ms is achieved, showing potential for applications, e.g. as contrast agents in (pre)clinical imaging. Considering the various lanthanide(III) ions have unique electron configurations with specific physical chemical properties, yet very similar coordination chemistry, the generality of the current coordination-structure based micellar design shows great promise for development of new materials such as, e.g., hypermodal agents.

Dipeptide recognition in water mediated by mixed monolayer protected gold nanoparticles.

Mixed monolayer protected gold nanoparticles were prepared featuring functional groups on their surfaces that can engage in interactions with peptides. DOSY NMR binding studies indicate that nanoparticles containing a combination of three orthogonal functional groups are more efficient in binding to dipeptides than mono or difunctionalised analogues.

Accurate DOSY measure for out-of-equilibrium systems using permutated DOSY (p-DOSY).

NMR spectroscopy is a excellent tool for monitoring in-situ chemical reactions. In particular, DOSY measurement is well suited to characterize transient species by the determination of their sizes. However, here we bring to light a difficulty in the DOSY experiments performed in out-of-equilibrium systems. On such a system, the evolution of the concentration of species interferes with the measurement process, and creates a bias on the diffusion coefficient determination that may lead to erroneous interpretations. We show that a random permutation of the series of gradient strengths used during the DOSY experiment allows to average out this bias. This approach, that we name p-DOSY does not require changes in the pulse sequences nor in the processing software, and restores completely the full accuracy of the measure. This technique is demonstrated on the monitoring of the anomerization reaction of α- to ß-glucose.

An activatable, polarity dependent, dual-luminescent imaging agent with a long luminescence lifetime.

In this proof-of-concept study, a new activatable imaging agent based on two luminophores and two different quenching mechanisms is reported. Both partial and total activation of the luminescence signal can be achieved, either in solution or in vitro. Bond cleavage makes the compound suitable for luminescence lifetime imaging.