The obligation of the physician to save the life of the detainee on a hunger strike: the opinion of the Italian National Bioethics Committee.

Abstract: The Cospito case has highlighted a widely debated bioethical issue regarding the need to choose between safeguarding the life of a detainee and their right to self-determination through the practice of a hunger strike. Recently, the Italian National Bioethics Committee has been called upon to give an opinion on this matter. On the other hand, the media resonance of this case has shed light on the need to pose an ethical and social question regarding such situations: does the physician have an obligation to protect the detainee's health at the expense of their free choice? To be able to answer, it is necessary to understand whether law no. 219/17 is applicable to this context.

Lightning strike­induced cauda equina syndrome: a case report.

Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions. 
Peripheral nerve injury induced by lightning is rare, and the evaluation of people with neurological complaints using electromyography will help determine the true incidence.

Challenges and Future Recommendations for Lightning Strike Damage Assessments of Composites: Laboratory Testing and Predictive Modeling.

Lightning strike events pose significant challenges to the structural integrity and performance of composite materials, particularly in aerospace, wind turbine blade, and infrastructure applications. Through a meticulous examination of the state-of-the-art methodologies of laboratory testing and damage predictive modeling, this review elucidates the role of simulated lightning strike tests in providing inputs required for damage modeling and experimental data for model validations. In addition, this review provides a holistic understanding of what is there, what are current issues, and what is still missing in both lightning strike testing and modeling to enable a robust and high-fidelity predictive capability, and challenges and future recommendations are also presented. The insights gleaned from this review are poised to catalyze advancements in the safety, reliability, and durability of composite materials under lightning strike conditions, as well as to facilitate the development of innovative lightning damage mitigation strategies.

Doctors are striking for a pay-rise, but better conditions are needed to make them feel valued. Key insights from New Zealand.

Degradation of junior doctors pay has led to strikes in the UK. Improved pay is important, however to feel valued at work, doctors must have good conditions as well. The author describes how their experience working in New Zealand (NZ) highlighted several insights into how better working conditions make doctors feel more valued. Three factors are discussed which improve doctors daily experience. Firstly, the use of 'relief doctors', who cover inevitable absences caused by sickness or holiday, allow maintenance of proper staffing levels. Secondly, NZ doctors get 6 weeks of paid study leave to prepare for exams, whereas in UK this does not exist. Lastly, in NZ meals are provided whilst at work, this is not the case in the UK. NZ demonstrates appreciation for its doctors through real and tangible improvements to their working environment. In the UK, pay needs to be improved, but so do working conditions.

Death by hunger strike: suicide or not?

Conventional thinking holds that most inmates who hunger strike do not desire to die. Rather, they want prison officials to concede to their demands. In this paper, I examine whether death by hunger strike can be classified as suicide. After reviewing definitions of suicide and suicidal intent, I conclude that some deaths by hunger strike can be readily classified as suicides. I further propose that conditional intention is a useful way to understand the complex motivations of hunger strikers. I close by discussing the implications of conditional intention for the assessment of suicidal intent among hunger strikers and for the duty of mental health providers to prevent suicide.

Impact-Aware Foot Motion Reconstruction and Ramp/Stair Detection Using One Foot-Mounted Inertial Measurement Unit.

Motion reconstruction using wearable sensors enables broad opportunities for gait analysis outside laboratory environments. Inertial Measurement Unit (IMU)-based foot trajectory reconstruction is an essential component of estimating the foot motion and user position required for any related biomechanics metrics. However, limitations remain in the reconstruction quality due to well-known sensor noise and drift issues, and in some cases, limited sensor bandwidth and range. In this work, to reduce drift in the height direction and handle the impulsive velocity error at heel strike, we enhanced the integration reconstruction with a novel kinematic model that partitions integration velocity errors into estimates of acceleration bias and heel strike vertical velocity error. Using this model, we achieve reduced height drift in reconstruction and simultaneously accomplish reliable terrain determination among level ground, ramps, and stairs. The reconstruction performance of the proposed method is compared against the widely used Error State Kalman Filter-based Pedestrian Dead Reckoning and integration-based foot-IMU motion reconstruction method with 15 trials from six subjects, including one prosthesis user. The mean height errors per stride are 0.03±0.08 cm on level ground, 0.95±0.37 cm on ramps, and 1.27±1.22 cm on stairs. The proposed method can determine the terrain types accurately by thresholding on the model output and demonstrates great reconstruction improvement in level-ground walking and moderate improvement on ramps and stairs.

Study on the Permeability and Absorption Performance of the Crotch Layer in Seamless Knitted Period Underwear.

During the physiological period, women have the problem of lateral and posterior leakage, and they expect to have period underwear that can reduce lateral and posterior leakage. This study is combined with menstrual needs, and in the crotch penetration layer, three types of yarns are used, seaweed viscose yarn, apocynum viscose yarn, and viscose yarn, as well as two fabric structures: honeycomb-shaped convex-concave stitching and grid-shaped convex point stitching. In the crotch absorption layer, three types of yarns are used, modal yarn, bamboo yarn, and viscose yarn, as well as two fabric structures: plush stitching and plain stitching. The above two parts establish a sample scheme according to full-factor experimental tests, and 12 knitted fabric samples were knitted. The experimental data were analyzed through SPSS one-way ANOVA. The results indicate that in terms of veil raw materials, the crotch penetration layer with seaweed viscose yarn has better penetration performance, while the crotch absorption layer with bamboo yarn has better absorption performance. In terms of fabric structure, the crotch penetration layer with grid-shaped convex point stitching has better penetration performance, while the crotch absorption layer with plush stitching has better absorption performance. This study provides a theoretical basis for the development of period underwear.

Predatory and Defensive Strategies in Cone Snails.

Cone snails are carnivorous marine animals that prey on fish (piscivorous), worms (vermivorous), or other mollusks (molluscivorous). They produce a complex venom mostly made of disulfide-rich conotoxins and conopeptides in a compartmentalized venom gland. The pharmacology of cone snail venom has been increasingly investigated over more than half a century. The rising interest in cone snails was initiated by the surprising high human lethality rate caused by the defensive stings of some species. Although a vast amount of information has been uncovered on their venom composition, pharmacological targets, and mode of action of conotoxins, the venom-ecology relationships are still poorly understood for many lineages. This is especially important given the relatively recent discovery that some species can use different venoms to achieve rapid prey capture and efficient deterrence of aggressors. Indeed, via an unknown mechanism, only a selected subset of conotoxins is injected depending on the intended purpose. Some of these remarkable venom variations have been characterized, often using a combination of mass spectrometry and transcriptomic methods. In this review, we present the current knowledge on such specific predatory and defensive venoms gathered from sixteen different cone snail species that belong to eight subgenera: Pionoconus, Chelyconus, Gastridium, Cylinder, Conus, Stephanoconus, Rhizoconus, and Vituliconus. Further studies are needed to help close the gap in our understanding of the evolved ecological roles of many cone snail venom peptides.

Acute Cardiomyopathy in a Prisoner on a Hunger Strike.

Chronic starvation and its associated metabolic derangements are known to have dangerous cardiovascular implications in the long term, but less is known about the cardiovascular consequences of acute starvation, such as in the context of a hunger strike. This case describes a patient who presented with signs and symptoms of acute coronary syndrome which began two weeks into a hunger strike and was ultimately found to have stress cardiomyopathy with complete resolution on subsequent imaging.

The influence of pitcher handedness on pitch-calling behavior: Insights from fMRI study on baseball umpires.

This functional magnetic resonance imaging study delves into the impact of experience and pitcher handedness on the pitch-calling behavior of baseball umpires. Expert and intermediate umpires were asked to make ball/strike calls on videotaped pitches of left- and right-handed pitchers and rate their certainty for the call while undergoing scanning. Behavioral results replicated previous findings that expert umpires were more certain but not more accurate or quicker than intermediate umpires, suggesting that, as sports officials, umpires may learn to project confidence to maintain control of the game. At the neural level, expert umpires exhibited more extensive and pronounced activations within the action observation network, dorsal striatum, and cerebellum. These heightened neural responses were probably associated with their enhanced visual processing abilities for pitching action and ball trajectory, honed over years of officiating. Notably, both expert and intermediate umpires exhibited decreased accuracy when judging pitches from left-handed pitchers compared to right-handed ones. These challenges in accuracy corresponded with weaker neural activations in the aforementioned brain regions, implying difficulties in processing specific visual details of the rarely encountered left-handed pitchers. Moreover, slightly longer reaction times and reduced uncertainty were observed particularly for left-handed ball pitches, as revealed by lower activation in the right premotor cortex, highlighting issues with predictive processing. In summary, our findings shed light on the influence of pitcher handedness on the pitch-calling behavior of baseball umpires and extend the current understanding of the perceptual and decision-making behavior of sports officials.

Use of a behavioural response method to assess the risk of collision between migrating humpback whales and vessels.

With the substantial increase in many large whale populations, paired with the rise in global shipping and recreational vessel activity, it is not surprising that negative interactions between whales and vessels are increasing. Here, the collision risk between migrating groups of humpback whales (Megaptera novaeangliae) and vessels was assessed by determining if changes in their movement trajectories in response to an oncoming vessel translated to vessel avoidance. It was assumed groups would implement an escape response strategy, using cues such as the vessel speed, trajectory, proximity, and received level of noise to inform their response magnitude. However, many groups were unresponsive to an approaching vessel such that the vessel had to take evasive action. This study shows that humpback whales are not likely to take sufficient avoidance action when there is a potential for a vessel and whale to collide. Therefore, when developing a risk management strategy, mitigation measures that reduce the encounter rate between whales and vessels are likely to be the most effective.

How to walk to reduce footstep noise in multi-story residential buildings.

Loud footsteps from upstairs cause disturbance to downstairs neighbours in multi-story residential buildings. In this experiment, we examined how participants walk when asked to walk quietly and evaluated the efficiency of their quiet walking patterns. Changes in vertical impact loading rates during the early stance phase, walking speed, and lower limb muscle activity when asked to walk quietly were evaluated from twenty-six young participants. Study data show that participants who struck the ground with the rearfoot reduced the impact loading rate by 44.6% with 29.3% slower walking speed than normal walking. Those who struck with the fore- or mid-foot reduced the impact loading by 69.2% with a 23.4% decrease in speed. Quiet walking with the non-rearfoot strike pattern reduced the impact loading by 48.7%, even when asked to walk as fast as normal walking. The results support the non-rearfoot strike pattern as an efficient walking strategy for lowering footstep impact.Practitioner summary: Data of this study show that voluntary gait alteration, such as adopting a non-rearfoot strike pattern, can reduce footstep impact. The study results propose that implementing such changes could be beneficial in addressing floor noise issues of multi-story residential buildings.Abbreviations: RFS: Rearfoot strike; NRFS: non-rearfoot strike; COP: Center of pressure; NW: Normal walking; QWs: Quiet walking at a preferred slower speed; QWn: Quiet walking at the speed of normal walking; EMG: Electromyography; BW: Body weight; iNEMG: integrated normalized EMG.

A Novel Gait Event Detection Algorithm Using a Thigh-Worn Inertial Measurement Unit and Joint Angle Information.

This paper describes the development and evaluation of a novel, threshold-based gait event detection algorithm utilizing only one thigh inertial measurement unit (IMU) and unilateral, sagittal plane hip and knee joint angles. The algorithm was designed to detect heel strike (HS) and toe off (TO) gait events, with the eventual goal of detection in a real-time exoskeletal control system. The data used in the development and evaluation of the algorithm were obtained from two gait databases, each containing synchronized IMU and ground reaction force (GRF) data. All database subjects were healthy individuals walking in either a level-ground, urban environment or a treadmill lab environment. Inertial measurements used were three-dimensional thigh accelerations and three-dimensional thigh angular velocities. Parameters for the TO algorithm were identified on a per-subject basis. The GRF data were utilized to validate the algorithm's timing accuracy and quantify the fidelity of the algorithm, measured by the F1-Score. Across all participants, the algorithm reported a mean timing error of -41±20 ms with an F1-Score of 0.988 for HS. For TO, the algorithm reported a mean timing error of -1.4±21 ms with an F1-Score of 0.991. The results of this evaluation suggest that this algorithm is a promising solution to inertial based gait event detection; however, further refinement and real-time evaluation are required for use in exoskeletal control.

Linking Zetaproteobacterial diversity and substratum type in iron-rich microbial mats from the Lucky Strike hydrothermal field (EMSO-Azores observatory).

Zetaproteobacteria have been reported in different marine and terrestrial environments all over the globe. They play an essential role in marine iron-rich microbial mats, as one of their autotrophic primary producers, oxidizing Fe(II) and producing Fe-oxyhydroxides with different morphologies. Here, we study and compare the Zetaproteobacterial communities of iron-rich microbial mats from six different sites of the Lucky Strike Hydrothermal Field through the use of the Zetaproteobacterial operational taxonomic unit (ZetaOTU) classification. We report for the first time the Zetaproteobacterial core microbiome of these iron-rich microbial mats, which is composed of four ZetaOTUs that are cosmopolitan and essential for the development of the mats. The study of the presence and abundance of different ZetaOTUs among sites reveals two clusters, which are related to the lithology and permeability of the substratum on which they develop. The Zetaproteobacterial communities of cluster 1 are characteristic of poorly permeable substrata, with little evidence of diffuse venting, while those of cluster 2 develop on hydrothermal slabs or deposits that allow the percolation and outflow of diffuse hydrothermal fluids. In addition, two NewZetaOTUs 1 and 2 were identified, which could be characteristic of anthropic iron and unsedimented basalt, respectively. We also report significant correlations between the abundance of certain ZetaOTUs and that of iron oxide morphologies, indicating that their formation could be taxonomically and/or environmentally driven. We identified a new morphology of Fe(III)-oxyhydroxides that we named "corals." Overall, our work contributes to the knowledge of the biogeography of this bacterial class by providing additional data from the Atlantic Ocean, a lesser-studied ocean in terms of Zetaproteobacterial diversity.IMPORTANCEUp until now, Zetaproteobacterial diversity studies have revealed possible links between Zetaproteobacteria taxa, habitats, and niches. Here, we report for the first time the Zetaproteobacterial core microbiome of iron-rich mats from the Lucky Strike Hydrothermal Field (LSHF), as well as two new Zetaproteobacterial operational taxonomic units (NewZetaOTUs) that could be substratum specific. We highlight that the substratum on which iron-rich microbial mats develop, especially because of its permeability to diffuse hydrothermal venting, has an influence on their Zetaproteobacterial communities. Moreover, our work adds to the knowledge of the biogeography of this bacterial class by providing additional data from the hydrothermal vent sites along the Mid-Atlantic Ridge. In addition to the already described iron oxide morphologies, we identify in our iron-rich mats a new morphology that we named corals. Finally, we argue for significant correlations between the relative abundance of certain ZetaOTUs and that of iron oxide morphologies, contributing to the understanding of the drivers of iron oxide production in iron-oxidizing bacteria.

Assessment of Foot Strike Angle and Forward Propulsion with Wearable Sensors in People with Stroke.

Effective retraining of foot elevation and forward propulsion is a critical aspect of gait rehabilitation therapy after stroke, but valuable feedback to enhance these functions is often absent during home-based training. To enable feedback at home, this study assesses the validity of an inertial measurement unit (IMU) to measure the foot strike angle (FSA), and explores eight different kinematic parameters as potential indicators for forward propulsion. Twelve people with stroke performed walking trials while equipped with five IMUs and markers for optical motion analysis (the gold standard). The validity of the IMU-based FSA was assessed via Bland-Altman analysis, ICC, and the repeatability coefficient. Eight different kinematic parameters were compared to the forward propulsion via Pearson correlation. Analyses were performed on a stride-by-stride level and within-subject level. On a stride-by-stride level, the mean difference between the IMU-based FSA and OMCS-based FSA was 1.4 (95% confidence: -3.0; 5.9) degrees, with ICC = 0.97, and a repeatability coefficient of 5.3 degrees. The mean difference for the within-subject analysis was 1.5 (95% confidence: -1.0; 3.9) degrees, with a mean repeatability coefficient of 3.1 (SD: 2.0) degrees. Pearson's r value for all the studied parameters with forward propulsion were below 0.75 for the within-subject analysis, while on a stride-by-stride level the foot angle upon terminal contact and maximum foot angular velocity could be indicative for the peak forward propulsion. In conclusion, the FSA can accurately be assessed with an IMU on the foot in people with stroke during regular walking. However, no suitable kinematic indicator for forward propulsion was identified based on foot and shank movement that could be used for feedback in people with stroke.

Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners.

PURPOSE: This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging. METHODS: A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters. RESULTS: A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13) = 23.068, p < 0.001, partial η2 = 0.640). The length (F (1, 13) = 10.086, p = 0.007, partial η2 = 0.437) and CSA (F (1, 13) = 7.475, p = 0.017, partial η2 = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13) = 5.225, p = 0.040, partial η2 = 0.287), average (F (1, 13) = 7.228, p = 0.019, partial η2 = 0.357), and peak AT loading rate (F (1, 13) = 11.687, p = 0.005, partial η2 = 0.473). CONCLUSION: Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.

The relative size of the calcaneal tuber reflects heel strike plantigrady in African apes and humans.

OBJECTIVES: The positional repertoire of the human-chimpanzee last common ancestor is critical for reconstructing the evolution of bipedalism. African apes and humans share a heel strike plantigrade foot posture associated with terrestriality. Previous research has established that modern humans have a relatively large and intrinsically robust calcaneal tuber equipped to withstand heel strike forces associated with bipedal walking and running. However, it is unclear whether African apes have a relatively larger calcaneal tuber than non-heel-striking primates, and how this trait might have evolved among anthropoids. Here, I test the hypothesis that heel-striking primates have a relatively larger calcaneal tuber than non-heel-striking primates. METHODS: The comparative sample includes 331 individuals and 53 taxa representing hominoids, cercopithecoids, and platyrrhines. Evolutionary modeling was used to test for the effect of foot posture on the relative size of the calcaneal tuber in a phylogenetic framework that accounts for adaptation and inertia. Bayesian evolutionary modeling was used to identify selective regime shifts in the relative size of the calcaneal tuber among anthropoids. RESULTS: The best fitting evolutionary model was a Brownian motion model with regime-dependent trends characterized by relatively large calcaneal tubers among African apes and humans. Evolutionary modeling provided support for an evolutionary shift toward a larger calcaneal tuber at the base of the African ape and human clade. CONCLUSIONS: The results of this study support the view that African apes and humans share derived traits related to heel strike plantigrady, which implies that humans evolved from a semi-terrestrial quadrupedal ancestor.

Acute effect of foot strike patterns on in vivo tibiotalar and subtalar joint kinematics during barefoot running.

BACKGROUND: Foot kinematics, such as excessive eversion and malalignment of the hindfoot, are believed to be associated with running-related injuries. The majority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics. However, technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns (RFS and FFS, respectively). This study uses a high-speed dual fluoroscopic imaging system (DFIS) to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics. METHODS: Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models. A high-speed DFIS (100 Hz) was used to collect 6 degrees of freedom kinematics for participants' tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition. RESULTS: Compared with RFS, FFS exhibited greater internal rotation at 0%-20% of the stance phase in the tibiotalar joint. The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS (p < 0.001, Cohen's d = 0.92). RFS showed more dorsiflexion at 0%-20% of the stance phase in the tibiotalar joint than FFS. RFS also presented a larger anterior translation (p < 0.001, Cohen's d = 1.28) in the subtalar joint at initial contact than FFS. CONCLUSION: Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance. The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RFS and FFS during running.

Influence of foot strike patterns and cadences on patellofemoral joint stress in male runners with patellofemoral pain.

OBJECTIVES: This study aimed to determine the effect of foot strike patterns and cadences in male runners with patellofemoral pain (PFP). DESIGN: Cross-sectional study. SETTING: Biomechanics lab. METHODS: 20 male runners with PFP were instructed to randomly complete six running conditions (three cadence conditions in rearfoot strike pattern (RFS) or forefoot strike (FFS)) under a preferred running speed. MAIN OUTCOME MEASURES: The primary outcomes were peak knee joint and moment, and secondary outcomes were patellofemoral joint stress. RESULTS: Running with increased cadence has a lower flexion angle (P = 0.027, η2 = 0.45), lower extension moment (P = 0.011, η2 = 0.29), lower internal rotation moment (P = 0.040, η2 = 0.17), lower patellofemoral stress (P = 0.029, η2 = 0.52) than preferred cadence. FFS running performed significantly lower flexion angle (P = 0.003, η2 = 0.39), lower extension moment (P < 0.001, η2 = 0.91), lower adduction moment (P = 0.020, η2 = 0.25) lower patellofemoral stress (P < 0.001, η2 = 0.81) than RFS running for all cadence. CONCLUSIONS: Preliminary findings provide new perspectives for male runners with PFP to unload patellofemoral joint stress in managing PFP through the combination of the FFS pattern and increased cadence.