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An objective burn scar assessment is essential to informed therapeutic decision-making and to monitor scar development over time. However, widely employed scar rating scales show poor inter-rater reliability. For this study we developed a standardized measurement protocol for the Cutometer© applicable for objective burn scar assessment in everyday clinical practice. We developed a measurement protocol for the Cutometer© MPA 580 including a scar site relocation technique based on anatomical landmarks. The protocol emerged through several steps: Identifying key factors for valid and reliable measurements, preliminary testing, specification of technical details, refining the protocol and final testing. Consecutively, the protocol was validated for inter-rater reliability by assessing 34 burn scars in 17 patients by four clinicians and computing an Intra-class Correlation Coefficient (ICC). Parameter R0, representing scar pliability, was identified as the best suited output parameter yielding excellent inter-rater reliability for average measures (ICC 0.92 [95% CI 0.86; 0.96]) and acceptable reliability for single measures (ICC: 0.74 [0.61; 0.84]). The pressure applied on the measuring probe was identified as an influential confounding factor for reliable measurements. Rater gender did not influence reliability of measurements. The introduced standardized measurement protocol for the Cutometer© MPA 580 enables an objective and reliable burn scar assessment for clinical as well as research purposes.

This study utilized the underlying qualitative research design and examines the dimensions of the readiness of the City Agriculture Personnel in the Implementation of City Agriculture Fishery Extension Services (CAFES) and developed an institutional framework model. Data were derived from interviews with key respondents of the Davao City Agriculture Office and supported by secondary information. Thematic-content analysis was used to analyze transcripts of their own personal opinions, experiences, and insights. Findings from this qualitative inquiry, show that Devolution Transition Plan (DTP); Personnel Structure and Budget, Policies and Ordinances, and enabling mechanisms such as Strategic Action Plans and Projects are the significant elements in the effective implementation of the decentralized agricultural and fishery extension services delivery. Article visualizations

ZusammenfassungDas Karpaltunnelsyndrom (KTS) stellt die häufigste kompressionsbedingte Neuropathie dar. Die Therapieführung ist patientenindividuell zu gestalten. Die initiale konservative Therapie hat insbesondere im Anfangsstadium einen hohen Stellenwert. Die Indikation zur primären chirurgischen Therapie besteht bei therapierefraktären Situationen, ab mittelschweren Stadien oder bei Vorliegen relevanter Begleiterkrankungen (Raumforderungen, komplex regionalem Schmerzsyndrom, diabetische Polyneuropathie) und zunehmend auch beim KTS in der Schwangerschaft. Die unterschiedlichen Operationstechniken, deren differentialtherapeutische Anwendung, sowie deren Vor- und Nachteile sollen in dieser Arbeit pragmatisch dargestellt werden. Auch die herausfordernden Rezidivsituationen und -eingriffe werden hierbei herausgehoben. Vor dem Hintergrund der neu erschienenen aktualisierten S3-Leitlinie „Diagnostik- und Therapie des Karpaltunnelsyndroms“ hat dieser Themenbereich eine aktuelle Relevanz.

Traffic safety is arguably the most important traffic metric from a human perspective. Still, many millions of people are killed on roads every year. In this paper, the concept of Herd Immunity for Traffic Safety (HITS) is presented for the first time. This concept focuses on identifying and describing the increased level of safety that is achieved when Connected Automated Vehicles (CAV) and Human Driven Vehicles (HDV) co-exist in mixed traffic. The underlying mechanism is described with a key component being the ability of CAVs to absorb human error and reduce exposure to risk. With increasing levels of CAV penetration, so-called tipping points occur in which the traffic safety grows in proportion to the penetration rate, which is demonstrated by the non-linearity of the penetration–risk relationship. This is demonstrated in theory and experimental cases while requirements to understand and apply the concept more extensively in the future are presented.

Contains fulltext : 290073.pdf (Publisher’s version ) (Open Access) The urban traffic environment is characterized by the presence of a highly differentiated pool of users, including vulnerable ones. This makes vehicle automation particularly difficult to implement, as a safe coordination among those users is hard to achieve in such an open scenario. Different strategies have been proposed to address these coordination issues, but all of them have been found to be costly for they negatively affect a range of human values (e.g. safety, democracy, accountability...). In this paper, we claim that the negative value impacts entailed by each of these strategies can be interpreted as lack of what we call Meaningful Human Control over different parts of a sociotechnical system. We argue that Meaningful Human Control theory provides the conceptual tools to reduce those unwanted consequences, and show how “designing for meaningful human control” constitutes a valid strategy to address coordination issues. Furthermore, we showcase a possible application of this framework in a highly dynamic urban scenario, aiming to safeguard important values such as safety, democracy, individual autonomy, and accountability. Our meaningful human control framework offers a perspective on coordination issues that allows to keep human actors in control while minimizing the active, operational role of the drivers. This approach makes ultimately possible to promote a safe and responsible transition to full automation. 16 p.

Novel optical tissue clearing techniques enable three-dimensional imaging of entire organs at a subcellular resolution while preserving tissue architecture and fluorescence. In conjunction with computational image segmentation and automated analysis, these techniques provide fast and precise three-dimensional morphometry. Here, we present a tissue clearing protocol adapted to nerves and their motor and sensory targets in experimental rat models. Given their rapid processing times, low costs, and wide-ranging applicability, these techniques are likely to be a key technology for future nerve repair studies.

Cross-face nerve grafting enables the reanimation of the contralateral hemiface in unilateral facial palsy and may recover a spontaneous smile. This chapter discusses various clinically applicable strategies to increase the chances for good functional outcomes by maintaining the viability of the neural pathway and target muscle, increasing the number of reinnervating nerve fibers and selecting functionally compatible donor nerve branches. Adopting those strategies may help to further improve patient outcomes in facial reanimation surgery.

Corneal nerve fibers provide sensation and maintain the epithelial renewal process. Insufficient corneal innervation can cause neurotrophic keratopathy. Here, topically delivered tacrolimus is evaluated for its therapeutic potential to promote corneal reinnervation in rats.A compartmentalized neuronal cell culture was used to determine the effect of locally delivered tacrolimus on sensory axon regeneration in vitro. The regenerating axons but not the cell bodies were exposed to tacrolimus (50 ng/mL), nerve growth factor (50 ng/mL), or a vehicle control. Axon area and length were measured after 48 hours. Then, a biodegradable nanofiber drug delivery system was fabricated via electrospinning of a tacrolimus-loaded polycarbonate-urethane polymer. Biocompatibility, degradation, drug biodistribution, and therapeutic effectiveness were tested in a rat model of neurotrophic keratopathy induced by stereotactic trigeminal nerve ablation.Sensory neurons whose axons were exposed to tacrolimus regenerated significantly more and longer axons compared to vehicle-treated cultures. Trigeminal nerve ablation in rats reliably induced corneal denervation. Four weeks after denervation, rats that had received tacrolimus topically showed similar limbal innervation but a significantly higher nerve fiber density in the center of the cornea compared to the non-treated control. Topically applied tacrolimus was detectable in the ipsilateral vitreal body, the plasma, and the ipsilateral trigeminal ganglion but not in their contralateral counterparts and vital organs after 4 weeks of topical release.Locally delivered tacrolimus promotes axonal regeneration in vitro and corneal reinnervation in vivo with minimal systemic drug exposure.Topically applied tacrolimus may provide a readily translatable approach to promote corneal reinnervation.

Diabetes is by far, the most common cause of neuropathy, inducing neurodegeneration of terminal sensory nerve fibers associated with loss of sensation, paresthesia, and persistent pain. Foretinib prevents die-back degeneration in cultured sensory and sympathetic neurons by rescuing mitochondrial activity and has been proven safe in prospective clinical trials. Here we aimed at investigating a potential neuroprotective effect of Foretinib in experimental diabetic neuropathy. A mouse model of streptozotocin induced diabetes was used that expresses yellow fluorescent protein (YFP) in peripheral nerve fibers under the thy-1 promoter. Streptozotocin-injected mice developed a stable diabetic state (blood glucose > 270 mg/dl), with a significant reduction of intraepidermal nerve fiber density by 25% at 5 weeks compared to the non-diabetic controls. When diabetic mice were treated with Foretinib, a significantly greater volume of the cutaneous nerve fibers (67.3%) in the plantar skin was preserved compared to vehicle treated (37.8%) and non-treated (44.9%) diabetic mice while proximal nerve fiber morphology was not affected. Our results indicate a neuroprotective effect of Foretinib on cutaneous nerve fibers in experimental diabetic neuropathy. As Foretinib treated mice showed greater weight loss compared to vehicle treated controls, future studies may define more sustainable treatment regimen and thereby may allow patients to take advantage of this neuroprotective drug in chronic neurodegenerative diseases like diabetic neuropathy.

BackgroundNigeria has the highest cancer burden in Africa with 124,815 cancer cases and 78,899 cancer deaths in 2020. The limited number of oncology specialists, inaccessibility of essential cancer medicines like chemotherapies, and suboptimal delivery of cancer care lead to poor treatment outcomes. Oncology pharmacy (OP) practitioners are critical oncology professionals in the multidisciplinary team (MDT) for cancer treatment globally. In Nigeria, there is a limited number of OP practitioners providing services like reconstitution of chemotherapy, clinical research, safe use of biosafety cabinets, and monitoring of adverse drug reactions. Although the interest in oncology pharmacy is increasing, the educational needs, available skill sets, and directed training in oncology pharmacy across the nation are unknown. In this study, we examined the educational needs of OP practitioners and worked with the West African College of Pharmacy West African Postgraduate College of Pharmacists (WAPCP), Oncology Pharmacy Practitioners Association of Nigeria (OPPAN), and the International Society of Oncology Pharmacy Practitioners to upgrade the oncology pharmacy practice in Nigeria. MethodA cross-sectional study with a semi-structured questionnaire was done in 2021 with 39 pharmacists working in oncology centers across Nigeria. General descriptive statistics and qualitative analysis was performed. ResultsThere is no board-certified oncology pharmacist in Nigeria. More than 50% of the general pharmacists working in oncology centers are responsible for chemotherapy reconstitution. Understanding chemotherapy reconstitution (automation of chemotherapeutic mixing, use of radiopharmaceuticals, etc), use of biosafety cabinets, knowledge of pharmacology, designing treatment protocols, data management, immunotherapy delivery, and oncology clinical trials were some of the most significant educational needs of the OP practitioners in Nigeria. OP practitioners are lacking in most cancer centers and MDTs. ConclusionThere is an urgent need for a specialty postgraduate training programme in oncology pharmacy in Nigeria. This would help increase oncology clinical trials, improve delivery of cancer medicines, quality of care, and management of toxicities. The West African Postgraduate College of Pharmacists and OPPAN need appropriate training resources to develop an oncology pharmacy curriculum, promote the specialty and collaborate with global institutions for board certifications. Citation Format: Runcie C. Chidebe, Ramatu M. Alabelewe, Darlingtina K. Esiaka, Gloria C. Okwu, Tochukwu C. Orjiakor, Nwamaka Lasebikan, Jacinta Emejulu, Adamu A. Umar, Ndifreke Okwuegbunam, Funsho David, Toyosi Adepoju, Krishna Prasad Sapkota, Candidus C. Nwakasi, Agha A. Agha, Simeon C. Aruah, Katy Graef, Richard Mshelia, Rob Duncombe, Matthew O. Nwaneri, Noel Wannang, Cindy O’Bryant, R. Donald Harvey, Peace C. Babalola, Folakemi T. Odedina. Who reconstitutes my chemotherapy? Examining the educational needs of oncology pharmacy practitioners in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 723.

Background: Nerve entrapment has been hypothesized to contribute to the multicausal etiology of axonopathy in sensorimotor diabetic neuropathy. Targeted surgical decompression reduces external strain on the affected nerve and, therefore, may alleviate symptoms, including pain and sensory dysfunction. However, its therapeutic value in this cohort remains unclear. Aim: Quantifying the treatment effect of targeted lower extremity nerve decompression in patients with preexisting painful sensorimotor diabetic neuropathy and nerve entrapment on pain intensity, sensory function, motor function, and neural signal conduction. Study design: This prospective, controlled trial studies 40 patients suffering from bilateral therapy-refractory, painful (n = 20, visual analogue scale, VAS ≥ 5) or painless (n = 20, VAS = 0) sensorimotor diabetic neuropathy with clinical and/or radiologic signs of focal lower extremity nerve compression who underwent unilateral surgical nerve decompression of the common peroneal and the tibial nerve. Tissue biopsies will be analyzed to explore perineural tissue remodeling in correlation with intraoperatively measured nerve compression pressure. Effect size on symptoms including pain intensity, light touch threshold, static and moving two-point discrimination, target muscle force, and nerve conduction velocity will be quantified 3, 6, and 12 months postoperatively, and compared (1) to the preoperative values and (2) to the contralateral lower extremity that continues non-operative management. Clinical significance: Targeted surgical release may alleviate mechanical strain on entrapped lower extremity nerves and thereby potentially improve pain and sensory dysfunction in a subset of patients suffering from diabetic neuropathy. This trial aims to shed light on these patients that potentially benefit from screening for lower extremity nerve entrapment, as typical symptoms of entrapment might be erroneously attributed to neuropathy only, thereby preventing adequate treatment.

Increased on-road testing and market availability of partially automated vehicles (AV) offers researchers and developers the opportunity to evaluate the AV’s performance. The occurrence of new types of accidents involving AV’s has sparked questions in regard to who is actually in control over and responsible for AV control. In this contribution, we suggest a potential discrepancy in AV control with the review of recently documented accidents involving AV’s. The identification of a gap in control is performed using a recently formulated moral philosophical framework of Meaningful Human Control (MHC). This shows a discrepancy between the attribution of responsibility and the ability of a human to fulfil the role assigned to them. While a gap in control is not evident from the viewpoint of operational control, it requires the more intricate concept of MHC to expose it. Recommendations are further made that AV developers and vehicle approval authorities should consider control from a MHC perspective to avoid future gaps in control with the resulting consequences.

Background: Chronic nerve compression is the most common indication for nerve surgery. However, the clinical diagnosis still relies on surrogate parameters since devices for direct nerve compression pressure measurement (DNCPM) are clinically unavailable yet.Objectives: To review previous approaches to DNCPM and evaluate presently available microsensor systems for their feasibility and reliability in preclinical nerve compression models.Methods: A scoping literature review was conducted in accordance with the PRISMA-ScR guidelines. A subsequent market research aimed at identifying commercially available sensor systems potentially suitable for DNCPM. Sensors were evaluated for feasibility and safety of perineural sensor positioning, tissue compatibility and measurement reliability in a synthetic nerve compression model and an ex-vivo chicken leg model.Results: A scoping literature review identified 197 potentially eligible studies of which 65 were included in the analysis. Previous approaches to DNCPM predominantly used pressure sensing catheters designed for fluid- or intra-compartmental pressure measurement. A market research identified two piezoresistive sensor systems (IntraSense, SMi, United States; Mikro-Cath, Millar, United States) as potentially suitable for intraoperative DNCPM. In both preclinical models, the detected compression pressure differed significantly between sensors and systems showed substantial measurement variability with a median percent coefficient of variation between 15.5% and 32%. Sensor position was accountable for up to 99.1% of the variance.Conclusion: Measurement variability caused by unreliable sensor positioning is a key limitation of presently available sensors when applied for nerve compression measurements. Redesigned systems with small, flat-shaped and longitudinally oriented sensors and dedicated introducers would facilitate sensor positioning and therefore may allow for reliable measurements.

A Field-Operational-Test (FOT) with CACC vehicles and wireless communication with intelligent intersections on arterial roads was performed in autumn 2018, initiated by the Province of Noord-Holland in The Netherlands. The goal of the pilot was to demonstrate the feasibility of CACC platooning and V2I/I2V (infrastructure-to-vehicle) communication and investigate the potential effects on traffic flow and safety in such an urban environment. During the pilot, seven CACC-enabled vehicles traversed a provincial road corridor, crossing five intelligent intersections, sending Cooperative Awareness Message (CAM) and receiving time-to-green information from Intelligent Traffic Signals (iTS). A simulation model was calibrated using the data from the pilot to give indications of the potential future effects of CACC and I2V communication. The results showed that full CACC penetration can lead to 5% lower travel times on average with an enhanced improvement when intelligent intersections with V2I/I2V technology is applied (11% lower). If scaled up to the provincial road network, this could lead to a reduction of 12% in the total experienced delay for road users. As for previous tests on motorways, a reduction in effectiveness was also found for lower CACC- penetration rates with penetration rates of 10% no longer showing any substantial gains.

Is it possible to use just aggregate carriageway data for the evaluation of congestion warning systems (CWS) in large networks—or any system affecting traffic safety for that matter? In this paper, two hypotheses related to this question are tested. The first hypothesis is that it can be done by comparing large-scale congestion patterns on road stretches with and without CWS. The underlying rationale is that heterogeneous congestion patterns with many disturbances, frequent wide moving jams, and large speed differences result in more potentially unsafe traffic conditions than more homogeneous congestion patterns. The second hypothesis is that it is possible to compare differences in average (maximum) deceleration distributions into congestion waves between road stretches with and without CWS. Both hypotheses have been tested for similar bottlenecks with similar demand patterns and the results suggest the first hypothesis must be rejected. Although the idea seems plausible (CWS result in more homogeneous congestion patterns) there were too many confounding factors in the data to make the case. However, persuasive evidence was found for the second hypothesis. Statistically significant differences were found between (maximum) deceleration distributions on road stretches with and without CWS that suggest CWS do—as expected—contribute positively to traffic safety. It thus seems to be possible to monitor safety effects using just average speeds. However, the method is limited to providing relative comparisons. Furthermore, to fully rule out the effects of unobserved factors, more evidence and validation with microscopic data are needed.

BACKGROUND: Unprecedented demand for N95 respirators during the coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of these masks. We validated a rapidly applicable, low-cost decontamination protocol in compliance with regulatory standards to enable the safe reuse of N95 respirators. METHODS: We inoculated 4 common models of N95 respirators with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and evaluated viral inactivation after disinfection for 60 minutes at 70°C and 0% relative humidity. Similarly, we evaluated thermal disinfection at 0% to 70% relative humidity for masks inoculated with Escherichia coli. We assessed masks subjected to multiple cycles of thermal disinfection for structural integrity using scanning electron microscopy and for protective functions using standards of the United States National Institute for Occupational Safety and Health for particle filtration efficiency, breathing resistance and respirator fit. RESULTS: A single heat treatment rendered SARS-CoV-2 undetectable in all mask samples. Compared with untreated inoculated control masks, E. coli cultures at 24 hours were virtually undetectable from masks treated at 70°C and 50% relative humidity (optical density at 600 nm wavelength, 0.02 ± 0.02 v. 2.77 ± 0.09, p < 0.001), but contamination persisted for masks treated at lower relative humidity. After 10 disinfection cycles, masks maintained fibre diameters similar to untreated masks and continued to meet standards for fit, filtration efficiency and breathing resistance. INTERPRETATION: Thermal disinfection successfully decontaminated N95 respirators without impairing structural integrity or function. This process could be used in hospitals and long-term care facilities with commonly available equipment to mitigate the depletion of N95 masks.

To illustrate the influence of bonding social capital in the development initiatives of local communities and to contribute to the on-going theoretical debate on the effects of bonding social capital to communities, the cultural variable was used in the analysis using post-disaster recovery experience of a community. By using interview transcripts and conversation notes for this work, people's cultural and circumstances determined the social formation processes as responses to their circumstantial needs. The ethno-political organization (purok), the cooperative work (pintakasi) and the smooth interpersonal relationship (hugoy-hugoy) were cultural factors that explicate the strength of the bonding social capital. This article concluded that the inclusion of a cultural variable in the bonding social capital discussion is relevant and found that a flood-prone community, and those communities which are susceptible to natural hazards, relied on their social capital with greater expectations from the bonding social capital.

Avian Spirochaetosis is an acute endemic tick-borne disease of birds, caused by Borrelia anserins, a species of Borrelia bacteria. In this paper, we present a compartmental mathematical model of the disease for the bird population and Tick population. The disease steady-state and the conditions for reaching a stable disease-free steady state are determined. The analysis by Lyapunov method shows both local and global stability. Further investigation involves the introduction of controls to the model; the existence and uniqueness of optimal control are established. Finally, the effect of the controls is investigated using numerical solutions.

Elimination of poverty in all its form is a challenge that the United Nations must achieve (SDG 1). Poverty is a complex phenomenon and income poverty, most especially in the rural areas, is a paramount concern that needs to be addressed. A total of 12-month ethnographic work was conducted investigating the contribution of non-farm activities (NFAs) of upland farmers in meeting financial requirements for farm operation and household subsistence. Results showed that non-farm activities both livelihood diversification (LD) and crop diversification (CD) were resorted to by upland farmers as means to meet farm requirements and household subsistence. It is recommended that governments through their line agencies shall come up with policies and programs in support to farmers' economic endeavors such as training and extension and technical services to achieve the goal of poverty-free community.

Providing non-trivial certificates of safety for non-linear stochastic systems is an important open problem that limits the wider adoption of autonomous systems in safety-critical applications. One promising solution to address this problem is barrier functions. The composition of a barrier function with a stochastic system forms a supermartingale, thus enabling the computation of the probability that the system stays in a safe set over a finite time horizon via martingale inequalities. However, existing approaches to find barrier functions for stochastic systems generally rely on convex optimization programs that restrict the search of a barrier to a small class of functions such as low degree SoS polynomials and can be computationally expensive. In this paper, we parameterize a barrier function as a neural network and show that techniques for robust training of neural networks can be successfully employed to find neural barrier functions. Specifically, we leverage bound propagation techniques to certify that a neural network satisfies the conditions to be a barrier function via linear programming and then employ the resulting bounds at training time to enforce the satisfaction of these conditions. We also present a branch-and-bound scheme that makes the certification framework scalable. We show that our approach outperforms existing methods in several case studies and often returns certificates of safety that are orders of magnitude larger.

Axonal regeneration following nerve repair is slow and often incomplete, resulting in poor functional recovery and sometimes lifelong disability. Yet, there are no FDA-approved therapies available to promote nerve regeneration. Tacrolimus accelerates axonal regeneration, but systemic side-effects presently outweigh its potential benefits for peripheral nerve surgery. We have developed a biodegradable drug delivery system for the sustained local release of tacrolimus at the nerve repair site, with suitable properties for large-scale manufacturing and clinical application, aiming to promote axonal regeneration and functional recovery with minimal systemic drug exposure. Tacrolimus is encapsulated in polycarbonate-urethane nanofibers and electrospun to generate an implantable nerve wrap that releases therapeutic doses of bioactive tacrolimus over 31 days. Size and drug loading are adjustable for applications in small and large caliber nerves, and the wrap degrades within 120 days into biocompatible byproducts. Tacrolimus released from the nerve wrap promotes axon elongation in vitro and accelerates nerve regeneration and functional recovery in preclinical nerve repair models while systemic drug exposure is reduced by 80% compared to systemic delivery. Given its surgical suitability and preclinical efficacy and safety, this system may provide a readily translatable approach to support axonal regeneration and recovery in patients undergoing nerve surgery.

Background: Pregnancy involves complex biological interaction and communication between the developing conceptus and maternal uterus, which may alter the blood cellular elements. The present investigation evaluated the hematological changes associated with pregnancy in domestic sows. Methods: Blood samples were collected by auricular venipuncture from twenty sexually mature domestic sows from four pig farms. Hematological analyses were carried out on the blood samples following standard procedures. Result: The mean packed cell volume (PCV), the red blood cell (RBC) count, hemoglobin (Hb) concentration, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and absolute lymphocyte count were higher during pregnancy and lower following parturition, whereas, the mean corpuscular volume (MCV) was lower during pregnancy and declined further following parturition. The mean total white blood cell (TWBC) count and the absolute neutrophil count were higher during pregnancy and further elevated postpartum while the absolute monocyte count was lower during pregnancy and elevated postpartum. The absolute eosinophil count was significantly (p less than 0.05) lower in the pregnant sows (0.35 ± 0.13) and postpartum sows (0.21 ± 0.15) than in the non-pregnant sows (1.06 ± 0.27). These hematological alterations could assist in monitoring the physiological and health status of the dam, fetuses and pregnancy diagnosis.

With automated and cooperative driving making its breakthrough, and related systems in fast development, their future influence and impact on roads and traffic may be extensive. Truck platooning is such an application that relies on the development of Cooperative Adaptive Cruise Control (CACC) and is said to be practice ready. While the main advantages of truck platooning lie in emission and energy reduction, claims are also being made for the influence on traffic flow. In this paper, we pose hypotheses based on some of the main claims. We also attempt to substantiate and give quantitative proof of the potential effects of truck platooning on traffic flow performance. The simulation model LMRS-IDM+ is extended to encompass the main influencing dynamics related to potential effects of truck platooning, based on empirical findings. The effects of truck platooning were tested for the influence of traffic states, truck gap settings, platoon sizes, and the share of equipped trucks. This resulted in outcomes regarding the total traffic performance, the performance of traffic at ramps, and the ability of a platoon to remain platooning as part of a case experiment performed on a part of the Trans-European ITS Corridor. The results showed that truck platooning may have a small negative effect on the total non-saturated traffic flow, however with a much larger negative effect on saturated traffic flow. However, drivers may be reluctant to platoon in saturated traffic in any case. The ability of inflowing traffic to merge at on-ramps was found to be affected by truck platoons, with platoon disengagements occurring under various conditions. The applied gap settings for platooning trucks did not significantly affect the merge time, while a higher gap did lead to a higher number of disengagements. The ability of trucks to platoon was positively affected by a greater percentage of equipped trucks and by larger platoon sizes. Shorter gap times also slightly improved the ability of trucks to remain in platooning formation. Finally, recommendations are given to improve platoon strategies and for policymakers to only allow truck platooning outside of busy (near-) saturated traffic, even though drivers may be reluctant to use the system in these conditions. Also, recommendations are made to investigate potential differences in the effects between the European and American contexts for truck-platooning.

Classification of congestion patterns is important in many areas in traffic planning and management, ranging from policy appraisal, database design, to prediction and real-time control. One of the key constraints in applying machine learning techniques for classification is the availability of sufficient data (traffic patterns) with clear and undisputed labels, e.g. traffic pattern X or Y. The challenge is that labelling traffic patterns (e.g. combinations of congested and freely flow areas over time and space) is highly subjective. In our view this means that assessment of how well algorithms label the data should also include a qualitative component that focuses on what the found patterns really mean for traffic flow operations and applications. In this study, we investigate the application of clustering analysis to obtain labels automatically from the data, where we indeed first qualitatively assess how meaningful the found labels are, and subsequently test quantitatively how well the labels separate the resulting feature space. By transforming traffic measurements (speeds) into (colored) images, two different approaches are proposed to extract the features of a large number of traffic patterns for clustering: point-based and area-based. The point-based approach is widely applied in the image processing literature, and explores local interest points in images (i.e. where large changes occur in color intensity); whereas a new area-based approach combines domain knowledge with Watershed segmentation to partition the images into different spatial-temporal segments from which domain specific features, such as wide moving jam patterns, are extracted. The results show that the Watershed segmentation separates the traffic (congestion) patterns into more meaningful and separable classes, comparable to those that have been proposed in the literature. Since there is no ground-truth set of labels, the quantitative assessment tests how well both methods are able to separate the respective feature spaces they construct for the (large) database of traffic patterns. We argue that the more crisp this separation is; the better the labelling has turned out. For this quantitative comparison we train a multinomial classifier that maps unseen patterns to the labels discovered by each of the two labeling approaches. The most important result is that the classifier using the area-based feature vector achieves the highest average levels of confidence in its decisions to classify patterns, implying a highly separable feature vector space. We argue this is good news! Not only does the combination of image processing (Watershed) and domain knowledge (traffic flow characteristics) lead to meaningful labels that can be automatically retrieved from large databases of data; this method also leads to a more efficient separation of the resulting feature space. Our next endeavor is to further refine and use this method to develop a search engine for the (rapidly growing) 200 TB historical database of traffic data hosted by the Dutch National Datawarehouse (NDW).

Zusammenfassung Einleitung Eine aktuelle Umfrage unter Ärzten in Weiterbildung zum Facharzt für Plastische und Ästhetische Chirurgie und Klinikleitern zeigt ein großes Interesse an einer hochwertigen mikrochirurgischen Weiterbildung. Leider gefährden ökonomischer Druck sowie forensische Bedenken diese Bemühungen zunehmend und machen eine Verlagerung des Trainings außerhalb des OPs nötig. Zur Förderung der mikrochirurgischen Weiterbildung bietet die Deutschsprachige Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) eine Akademie an, um Kollegen ein breites mikrochirurgisches Spektrum zu bieten und den fachlichen Austausch zu stärken. In dieser Arbeit stellen wir das Kurskonzept und eine erste Evaluation vor. Methodik Seit 2015 wurde jährlich durch die DAM eine praxisorientierte Weiterbildungsakademie mit Gastoperateuren zu allen Schwerpunktbereichen der Mikrochirurgie an der BG-Klinik Ludwigshafen veranstaltet. Pro Tag wurden jeweils mindestens 3 mikrochirurgische Eingriffe in den Fachgebieten Brust-, Nerven-, Knochen/Hand-Extremitäten- und Lymphgefäßrekonstruktion parallel durchgeführt und begleitet von Fachvorträgen. Die Teilnehmer wurden gebeten, anonym ihre Erwartungen zu dem Kurskonzept zu definieren sowie den Kurs und seine Inhalte zu evaluieren. Ergebnisse Das Format und die Ziele der Akademie werden dargestellt. Im zweiten Schritt erfolgte die Evaluation, an der sich 79 % der Teilnehmer beteiligten. 90 % der Teilnehmer waren aus einem Haus der Maximalversorgung oder Universitätsklinik, wobei 57 % der Abteilungen weniger als 5 mikrochirurgische Eingriffe pro Woche durchführten. Alle Teilnehmer sahen die Mikrochirurgie als Teil ihres Arbeitsspektrums und das größte Interesse bestand für die Extremitäten- (90 %) und die mikrochirurgische Rekonstruktion der Hand (80 %). Alle Teilnehmer würden den Kurs weiterempfehlen, empfohlen wurde eine Verbesserung der intraoperativen Video-Übertragung. Diskussion Diese Arbeit zeigt, dass praxisorientierte Akademien am Beispiel der Mikrochirurgie ein hochaktuelles Lernformat sind, um den Limitationen der chirurgischen Aus- und Weiterbildung erfolgreich entgegenzutreten. Insbesondere der enge Austausch mit den Experten wurde als wertvoll erachtet, um ein Netzwerk innerhalb der deutschsprachigen Mikrochirurgie aufzubauen. Die Akademie verfolgt das Ziel, eine junge Generation von Mikrochirurgen dauerhaft und nachhaltig zu begeistern und ein professionelles Netzwerk aufzubauen und weiterzuentwickeln.

Background: Preeclampsia is a recognized cause of maternal and perinatal morbidity and mortality. Some biomarkers such as uric acid are increased in the presence of the disease. This could serve as a marker of severity and provide a basis for making management decisions. This study sought to determine the association between elevated serum uric acid and adverse pregnancy outcomes in preeclampsia.Methods: A prospective case-control study was carried out on consenting preeclamptic (95) and normotensive (95) pregnant women in their third trimester of pregnancy. Blood samples were taken for serum uric acid estimation at recruitment and delivery. Their Socio-demographic information was collected through a structured proforma. Data were analyzed using Statistical package for social sciences (SPSS) version 23. A p

Incorporation of more sophisticated human factors (HF) in mathematical models for driving behavior has become an increasingly popular and important research direction in the last few years. Such models enable us to simulate under which conditions perception errors and risk-taking lead to interactions that result in unsafe traffic conditions and ultimately accidents. In this paper, we present a generic multi-level microscopic traffic modelling and simulation framework that supports this important line of research. In this framework, the driving task is modeled in a multi-layered fashion. At the highest level, we have idealized (collision-free) models for car following and other driving tasks. These models typically contain HF parameters that exogenously “govern the human factor”, such as reaction time, sensitivities to stimuli, desired speed, etc. At the lowest level, we define HF variables (task demand and capacity, awareness) with which we maintain what the information processing costs are of performing driving tasks as well as non-driving related tasks such as distractions. We model these costs using so-called fundamental diagrams of task demand. In between, we define functions that govern the dynamics of the high-level HF parameters with these HF variables as inputs. When total task demand increases beyond task capacity, first awareness may deteriorate, where we use Endsley's three-level awareness construct to differentiate between effects on perception, comprehension, anticipation and reaction time. Secondly, drivers may adapt their response in line with Fullers risk allostasis theory to reduce risk to acceptable levels. This framework can be viewed as a meta model, that provides the analyst possibilities to combine and mix a wide variety of microscopic models for driving behavior at different levels of sophistication, depending on which HF are studied, and which phenomena need to be reproduced. We illustrate the framework with a distraction (rubbernecking) case. Our results show that the framework results in endogenous mechanisms for inter- and intra-driver differences in driving behavior and can generate multiple plausible HF mechanisms to explain the same observable traffic phenomena and congestion patterns that arise due to the distraction. We believe our framework can serve as a valuable tool in testing hypotheses related to the effects of HF on traffic efficiency and traffic safety in a systematic way for both the traffic flow and HF community.

Background: Modern surgery demands high-quality and reproducibility. Due to new working directives, resident duty hours have been restricted and evidence exists that pure on-the-job training provides insufficient exposure. We hypothesize that supplemental simulations in animal models provide a realistic training to augment clinical experiences. This study reviews surgical training models, their costs and survey results illustrating academic acceptance. Methods: Animal models were identified by literature research. Costs were analyzed from multiple German and Austrian training programs. A survey on their acceptance was conducted among faculty and medical students. Results: 915 articles were analyzed, thereof 91 studies described in-vivo animal training models, predominantly for laparoscopy (30%) and microsurgery (24%). Cost-analysis revealed single-training costs between 307€ and 5861€ depending on model and discipline. Survey results illustrated that 69% of the participants had no experience, but 66% would attend training under experienced supervision. Perceived public acceptance was rated intermediate by medical staff and students (4.26; 1 – low, 10 high). Conclusion: Training in animals is well-established and was rated worth attending in a majority of a representative cohort to acquire key surgical skills, in light of reduced clinical exposure. Animal models may therefore supplement the training of tomorrow’s surgeons to overcome limited hands-on experience until virtual simulations can provide such educational tools.

BackgroundThe unprecedented demand and consequent global shortage of N95 respirators during the COVID-19 pandemic have left frontline workers vulnerable to infection. To potentially expand the supply, we validated a rapidly applicable low-cost decontamination protocol in compliance with regulatory standards to enable the safe reuse of personalized, disposable N95-respirators.MethodsFour common models of N95-respirators were disinfected for 60 minutes at 70°C either at 0% or 50% relative humidity (RH). Effective inactivation of SARS-CoV-2 and E. coli was evaluated in inoculated masks. The N95 filter integrity was examined with scanning electron microscopy. The protective function of disinfected N95 respirators was tested against US NIOSH standards for particle filtration efficiency, breathing resistance and respirator fit.ResultsA single heat treatment inactivated both SARS-CoV-2 (undetectable, detection limit: 100 TCID50/ml) and E. coli (0 colonies at 50%RH) in all four respirator models. Even N95-respirators that underwent ten decontamination cycles maintained their integrity and met US-governmental criteria for approval regarding fit, filtration efficiency and breathing resistance. Scanning electron microscopy demonstrated maintained N95 fiber diameter compared to baseline.InterpretationThermal disinfection enables large-scale, low cost decontamination of existing N95 respirators using commonly sourced equipment during the COVID-19 pandemic. This process could be used in hospitals and long term care facilities and also provides a feasible approach to expand the N95 supply in low- and middle-income regions.

Item does not contain fulltext As automated vehicles become increasingly common on the road, the call for an appropriate preparation for its drivers is becoming more urgent. Expert opinions and insights have been acquired via a focus group discussion with eleven Dutch driving examiners to assist in inventorying what types of preparations are needed. The concept of meaningful human control (MHC) as an integral part of the discussion lead to consensual findings regarding ADAS functionality and the drivers’ tasks, as well as discussion topics on driver training and levels of automation. It was concluded to have more research into human factors to safeguard proper control over automated vehicles. 2020 Forum on Integrated and Sustainable Transportation Systems (FISTS) (Delft, the Netherlands. 3-5 Nov. 2020)

Contains fulltext : 226739.pdf (Publisher’s version ) (Open Access) The future adoption of automated vehicles poses many challenges, with one of the more important being the preservation of control over vehicles that are no longer (fully) operated by drivers. There is consensus that vehicles should not perform actions that are unacceptable to humans. In this paper, we introduce the concept of Meaningful Human Control (MHC) as a function of a framework of the Automated Driving System (ADS). This framework is constructed through the core components that make up the ADS, primarily considered within the categories of the vehicle and driver. Identification of these components and the chain of control allow traceability of MHC to be performed, and aids vehicle manufacturers, software developers, other vehicle component designers, and vehicle- and driver licensing authorities to address many challenges related to the design and preservation of human control in automated vehicles. Operationalisation of MHC is discussed in the paper including a suggested approach that should aid understanding and the application of the concept. Four application examples are given and recommendations are made in regard to vehicle design, human machine interaction, transition of control, driver training, vehicle approval, and other topics. The framework and presented concept also allow researchers to identify areas to perform more explicit and relevant research and develop models that can be applied to perform projections of future impacts. 29 p.

Zusammenfassung Einleitung Die korrekte Diagnose und Lokalisation von peripheren Nervenläsionen ist essentiell für die Wahl der richtigen Therapie in der peripheren Nervenchirurgie. Vor allem Substanzdefekte müssen erkannt werden um eine frühe Wiederherstellung zu ermöglichen und Langzeitschäden zu verhindern. Neueste Entwicklungen in der MR-Neurographie können detaillierte Informationen über Morphologie und zukünftig möglicherweise sogar die Funktionalität eines Nervs in Relation zu umgebenden Strukturen liefern. In dieser Fallserie stellen wir Kasuistiken vor, die signifikant von einer erweiterten Diagnostik per MR-Neurographie profitierten. Methodik Wir zeigen den klinischen Verlauf von 5 exemplarischen Fällen, die sich mit traumatischen Nervenläsion vorstellten und mittels ergänzender MR-Neurographie einem konklusiven Therapiekonzept zugeführt wurden. Das Ausmaß der Schädigung sowie die Nervenintegrität wurden mittels speziell hochauflösender MR-Sequenzen evaluiert und mit den klinischen, z. T. intraoperativen, neurophysiologischen sowie sonographischen Befunden korreliert. Ergebnisse In zwei Fällen konnte trotz pathologischer Elektroneurographie und nicht eindeutigen Sonographiebefunden aufgrund der in der MR-Diagnostik erwiesenen Nervenintegrität erfolgreich eine konservative Therapie durchgeführt werden. In drei Fällen ermöglichte die MR-Neurographie die präzise Bestimmung von Art und Lokalisation der Nervenläsionen, sodass anschließend eine zielgerichtete Nervenrekonstruktion erfolgen konnte. Diskussion Obwohl noch keine systematischen klinischen Analysen vorliegen, konnten unsere Ergebnisse zeigen, dass die MR-Neurographie traumatische periphere Nervenläsionen korrekt diagnostizieren und lokalisieren kann. Hierdurch ermöglicht die MR-Neurographie eine verbesserte Diagnostik und somit Therapieplanung in der Nervenchirurgie. Das Risikoprofil ist identisch zu konventionellen MR-Untersuchungen, jedoch ist die Implementierung von notwendiger Hard- und Software sowie klinisch-radiologischer Expertise (noch) nicht flächendeckend verfügbar. Schlussfolgerung Die MR-Neurographie liefert entscheidende Informationen über die Art der Nervenläsion und kann somit die Notwendigkeit einer Operation sowie die passende OP-Strategie identifizieren.

The practice of abdominal massage dates to years ago and associated with foetal and maternal morbidity and mortality when undertaken by untrained traditional birth attendants in our setting. We present a 30-year old G3P2+0 with uterine rupture and intra-uterine foetal death following abdominal massage. She was resuscitated and had emergency exploratory laparotomy and repair of uterine rupture.

Background: Gynaecological malignancies continue to be an important public health problem globally and are among the leading causes of morbidity and cancer-related deaths worldwide. In developing countries there is poor awareness and late presentation, and specialized cancer treatment centers are few, necessitating the gynaecologists at the tertiary hospitals to render surgical care for some cancer patients. The objective of the study was to determine the prevalence, indications, and surgical outcome of hysterectomy for primary gynaecological malignancies and assess the associated factors.Methods: This was a retrospective review of hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on age, parity, indication, length of surgery, blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using Statistical package for social sciences (SPSS) version 20.Results: Of 1240 major gynaecological surgeries, 26 were hysterectomies for malignant conditions giving a prevalence of 2.1%. Commonest indication was Endometrial cancer 16 (61.5%), followed by cervical cancer 3 (11.5%) and ovarian malignancy 3 (11.5%). There was a significant relationship between age (p=0.027) with the indications for hysterectomy. Commonest complication was anaemia 6 (23.1%) and wound sepsis 5 (19.2%). Anaemia was significantly associated with duration of surgery (p=0.004) and estimated blood loss (p=0.005).Conclusions: The prevalence of 2.1% for a non-cancer center is a fair contribution to efforts at caring for cancer patients. All surgeries were simple TAH±BSO and more than half were done for endometrial cancer. Further training of cancer surgeons and establishment of a Cancer Centre in the State is needed.

Uterine inversion is a rare clinical entity with challenging diagnosis and management. Reports of successfully managed cases contribute to knowledge and aid future management of cases among practitioners. We report a case of a 46 year old para-3 with protrusion of a mass from her vagina and vaginal bleeding of 7 days duration. She was managed as a case of chronic uterine inversion. She was resuscitated and had vaginal myomectomy, Haultin’s procedure and subsequently total abdominal hysterectomy due to ischaemic necrosis of parts of the uterus.

We present an experimental investigation into light trapping within isotextured wafers. Measurements of reflectance and transmittance are performed on Si wafers both before and after the deposition of thin films on their surfaces. The wafers have a variety of surface morphologies that were created by varying the isotexture etch duration. We find that, unlike external reflectance, light trapping in isotextured wafers depends only weakly on the isotexture etch time (for practical etch durations). We also find that the light trapping induced by isotexture is similar to that induced by random pyramids. Moreover, we conclude that the spherical-cap model, which is extended to account for internal rays within the isotexture, can be applied to predict the transmittance and escape reflectance and, hence, the light trapping in isotextured wafers. By way of quantification, the model predicts the AM1.5g generation current to within ±1% and the reflectance and transmittance to within ±2% absolute for λ < 1100 nm (and to within ±4% for λ < 1200 nm for most samples). With an established light-trapping model, photovoltaic researchers can more accurately predict the behavior of isotextured solar cells for various antireflection coatings, encapsulants, and light sources.

Understanding people’s coping strategies in response to the 2016 drought that hit Cebu province deserves a revisit. Toward this end, this paper discusses people’s coping strategies in conjunction with their perception on this climatic event. It is argued in this paper that any intervention plans for implementation to mitigate the impact of natural disasters should be placed in the context of the people’s socio-cultural milieu. By using twenty-eight (28) transcripts of the focus group discussions and in-depth interviews from the respondents in the different municipalities in the province of Cebu, the coping strategies of communities were founded in their local knowledge founded on their perceptions of the 2016 drought. In conclusion, people’s knowledge on this specific climatic event is experiential and their coping strategies, drawn out from experience, were primarily developed to live compatibly and harmoniously with nature and secondly, to improve adaptive capacities to natural uncertainties.

Intimate partner violence (IPV) is a worldwide social issue perpetrated by intimate male partners against their wives. Studies on IPV have generated accurate comparative information since the 1993 World Conference on Human Rights and the Declaration on the Elimination of Violence Against Women to guide strategy and track progress in attempts to comprehend the IPV issues. In many attempts to understand violence against women, the social construction of IPV was not well documented in the literature. This article aims to explore IPV survivors’ social construction of IPV by analyzing the experiential narratives of IPV survivors. To address the objective, this article used the phenomenological approach by examining the lived experiences of 15 IPV survivors. Our study finds that IPV made IPV survivors empowered, and with this social construction, survivors were able to overcome violence perpetrated by their intimate partners. The findings further proved that giving preferential attention to the needs of IPV victims could lead to victim empowerment, a factor needed in the elimination of violence against women and children in all forms. It is suggested for any intervention activities to (a) ultimately address the empowerment of individuals and (b) respond to the needs of individuals because what may work for one victim may not work for another.

Background: Contraceptive discontinuation and switching to less effective methods, often leads to unintended pregnancies and reduces the impact of family planning programs. To understand what drives contraceptive use behavior, it is important to identify factors that influence discontinuation and switching. This study sought to determine the discontinuation rates, reasons for discontinuation or switching, and assess associated factors among women in Port Harcourt.Methods: A retrospective descriptive study, of women 15-48 years who accepted a modern method, over a five-year period from 1st January 2014 to 31st December 2018 was carried out. Information on age, parity, education, contraceptive use intention, method and duration of use, reason for discontinuation, and method switching, were extracted from their hospital records. Coded data were entered into Excel spreadsheet and exported to SPSS version 20 for statistical analysis at significance level of P

Exploring the relation between the student-identified academic performance indicatorsand the academic performance of studentsis the main objective of this study. It was established that the instructional, family, and school organization support variables were indicators in their performance. It was argued in this paper that teachers, to improve the academic performance (AP) of students, have to focus on the improvement of the academic performance indicators (API) for the APIand AP are directly correlated.

Summary Many road authorities work with static values for road capacities, while it has been proven that capacity is not a fixed quantity. At the same time, there is an increasing need for accurate stochastic input for traffic models, such as the variation in road capacity. In this paper, a methodological framework with a conceptual model for practical stochastic capacity estimation is presented, and a quantification of motorway capacity variation is given for the influence of day-type specific variations in capacity values. The results of the analysis show that there is a reduction in motorway breakdown capacity of 4% on weekend days in comparison with workdays. Furthermore, a capacity decrease of 8% was found for the discharge capacity in comparison with workdays. The analysis further shows that the breakdown capacity on holidays is not significantly lower than on workdays. Discharge capacity and capacity drops are also derived in each case. The results show that the capacity is significantly different depending on the type of day. A quantification of these differences is given in the form of a Weibull capacity estimation fit for each type-of-day scenario. Further consideration of the implications and applications of the framework is also given. Copyright © 2015 John Wiley & Sons, Ltd.

A parameterization of light trapping in wafer-based solar cells is presented. The parameterization contains three free variables to represent the quality of the light trapping, all of which are independent of wavelength and cell thickness. The variables can be determined by fitting the equation to experimental and simulated absorption curves, or they can be determined analytically from theoretical light-trapping approximations. The parameterization can be used to predict a solar cell's absorption as a function of wavelength and cell thickness, from which the generation current can be calculated for any incident spectrum.

We believe Dr. Ponsford’s question[1][1] may be of interest to other CMAJ readers and thus would like to share our perspective on the domestic use of N95 respirator heat treatment. We tested thermal disinfection in 4 common N95 respirator models (8110s, 9105s, 8210, and 1860s; All 3M). After 10

The authors regret that a contributing author was missing from the list of authors. The complete list of authors should be: “S.C. Calvert, B. van Arem, & J. W. C. van Lint”. All are with Delft University of Technology, Department of Transport & Planning, The Netherlands updated as above. The authors would like to apologise for any inconvenience caused.