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Background Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear. Objective To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS. Methods A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations. Results Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions. Conclusions Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.

Es soll untersucht werden, ob sich die Straßenraummerkmale Straßenbahnschienen, Sharrows und parallel parkende Autos sowie injunktive und deskriptive Normen auf die Positionswahl Radfahrender auswirken. Do tram tracks, sharrows and parallel parked cars, as well as injunctive and descriptive norms affect bicyclists' positional choice?

Purpose VMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique. Material and methods First, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of ± 5 mm. Results In phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is −1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2 min and 3.1 min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and −0.6 min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn’t increase plan robustness. Conclusion VMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.

Autonomous vehicles (AV) and advanced driver-assistance systems (ADAS) offer multiple safety benefits for drivers and road agencies. However, maintaining the lateral position of an AV or a vehicle with ADAS within a lane is a challenge, especially in adverse weather conditions when lane markings are occluded. For significant penetration of AV without compromising safety, vehicle-to-infrastructure sensing capabilities are necessary, especially during severe weather conditions. This research proposes a method to create a continuous electromagnetic (EM) signature on the roadway, using materials compatible with existing paving materials and construction methods. Laboratory testing of the proposed concept was performed on notched concrete-slab specimens and concrete prisms containing EM materials. An induction-based eddy-current sensor and magnetometers were implemented to detect the EM signature. The detected signals were compared to evaluate the effects of sensor height above the concrete surface, type of EM materials, EM-material volume, material shape, and volume of EM concrete prisms. A layer of up to 2 in. (5.1 cm) of water, ice, snow, or sand was placed between the sensor and the concrete slab to represent adverse weather conditions. Results showed that factors such as sensor height, EM-material volume, EM dosage, types of the EM material, and shape of the EM material in the prism were significant attenuators of the EM signal and must be engineered properly. Presence of adverse surface conditions had a negligible effect, as compared to normal conditions, indicating robustness of the presented method. This study proposes a promising method to complement existing sensors’ limitations in AVs and ADAS for effective lane-keeping during normal and adverse weather conditions with the help of vehicle-to-pavement interaction.

Tracked vehicles are expected to be used for factory inspection such as in petrochemical refinery, in which the robot needs to navigate in narrow spaces. During the narrow space navigation, the robot needs to adjust its position in lateral direction. However, it is a difficult problem to realize lateral motion of tracked vehicles for factory inspection, because mechanical complexity is increased if the additional actuator is installed. In this paper, the authors propose a lateral skidding motion of tracked vehicles using wall reaction force. The proposed method convert the direction of driving force by actively colliding the wall with passive wheels, and realize the lateral motion without attaching the additional actuator. Experimental results show that the lateral skidding motion is realized on two types of floor material. In addition, the time for lateral positioning with manual operation was 20 % reduced when the proposed method was used. The use of external force is one solution to change the motion direction in narrow spaces.

Extraluminal bronchial blocker placement has become a well-accepted approach to one-lung ventilation in young children. In some cases, technical issues with placement may require alternative approaches to correct bronchial blocker positioning. The primary aim of this study was to review the authors' experience with using endobronchial intubation to facilitate extraluminal bronchial blocker placement in young children.Single-center case series of pediatric patients undergoing thoracic surgery and one-lung ventilation using a bronchial blocker.Tertiary academic medical center.Pediatric patientsthree years of age undergoing thoracic surgery and one-lung ventilation who underwent bronchial blocker placement using endobronchial intubation to facilitate blocker placement. In all patients, the bronchial blocker was inserted through a selectively mainstemmed endotracheal tube to facilitate blocker positioning.No interventions were performed.Fifteen patients were identified after a query of the local electronic health record. There were five right-sided and ten left-sided placements in this cohort. Bronchial blocker placement was successful in 14 of 15 patients using endobronchial intubation to facilitate bronchial blocker placement. In one patient, the bronchial blocker was discovered in the nonsurgical bronchus, following placement with this technique. The bronchial blocker was repositioned manually into the desired mainstem bronchus prior to lateral positioning.Mainstem intubation can be used to facilitate bronchial blocker placement in young children and represents an alternative approach to extraluminal bronchial blocker placement.

Background Compared to an equivalent sized polyvinyl chloride (PVC) double-lumen tube (DLT), a silicone DLT has a shorter endobronchial segment. The aim of this study was to compare the incidence of clinically significant displacement of left-sided PVC and silicone DLTs after a positional change to a lateral position from a supine position and determine its effect on the need for DLT repositioning for successful lung separation in patients undergoing thoracic surgery. Methods One hundred eight adult patients requiring one-lung ventilation were randomly divided into group P (PVC DLT, n = 54) and group S (Silicone DLT, n = 54). The position of the DLT was observed before and after lateral positioning to assess the effect of the position change. The incidence of clinically significant displacement (> 10 mm) of DLT was compared between the groups. Results DLTs were clinically significantly displaced in group P (17/48, 35.4%) and group S (18/52, 34.6%) after lateral positioning (P = 0.933). A proximal displacement (31.3% [group P] and 25.0% [group S]) was more common than distal displacement (4.2% [group P] and 9.6% [group S]), with no significant intergroup difference (P = 0.494). After lateral positioning, critical malposition of DLT with bronchial herniation to the right main bronchus was 8.3% (group P) and 7.9% (group S, P = 0.906). Conclusions Left-sided PVC and silicone DLTs produced comparable incidences of clinically significant displacement and, consequently, required similar rates of repositioning for successful lung separation after lateral positioning.

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

For now, many hospitals that require nurses to move patients by hand from stretchers to a hospital bed, so a design of stretcher with auxiliary functions of lateral positioning and transferring for immobilized patients, which is a mechanical mechanism consisted of rigid rods, joints and sliders, was designed to help the nurses to move patients between beds and reduce their workload. Driven by motors, the rigid rods can be rotated, stretched or shortened so that the entire stretcher bed board can archive to a proper posture and position. In this paper, the following objectives will be achieved: (i) Create a schematic of the mechanism and describe the principles and functions (ii) the calculation of inverse kinematics, forward kinematics, dynamics (including energy), and PD control in the mechanism (iii) The motion process of simulating the mechanism using MATLAB (iv) Using MATLAB to create the plots of angle, torque, and position state (v) Using SolidWorks to construct the prototype and to implement the motion simulation of the mechanism (vi) Describe the practical application and future Extensions of this mechanism.

GOALS The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy. BACKGROUND Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus. STUDY Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint. RESULTS A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI

Overall on-road driving skill is a cumulated acquisition of driving skills learned during training period and furthered tempered with post-licensing driving exposure on the roads. Training serves to develop a person’s basic driving skills to operate safely on the roads at first, while subsequent on-road driving hones the driving skills further. Inactivity from on-road driving can result in deterioration of driving skills. Particularly for the case of inactivity immediately following licensure, which is not uncommon in Singapore, the learned skills can degrade rapidly. This research aims to examine the effect of driving inactivity on the learned driving skill, i.e. lateral positioning control, specifically for young-inexperienced drivers. A series of experiments were conducted on a driving simulator for different subject groups involving active driver, novice driver (freshly-licensed driver), inactive driver (never ever drive upon licensure), and no licence subjects. The participants drove through a stretch of expressway under free-flow conditions, and lane positioning control was monitored. It is found that without on-road driving exposure, driving skills like maintenance of lane positioning control in terms of lane wandering and lane encroachment may deteriorate after some periods of inactivity, i.e. 3 months. The deterioration varies at different rate, with faster deterioration for more complex tasks. The skills level can regress close to un-trained level for complex driving tasks. The findings also suggest that on-road driving exposure is needed to not only retain but also to improve the lane positioning control skills.

The aim of this study was to investigate the predictive value of the Multidimensional Driving Style Inventory (MDSI) for driving behaviour in a driving simulator, in terms of speeding, braking, steering, lateral positioning and maintaining distance to a preceding vehicle. Eighty-eight participants, mainly from the Netherlands and Belgium, filled in the MDSI and drove in a simulator for thirty minutes. Different driving behaviours, including complying with the maximum speed, lateral position and the distance to preceding vehicles, were recorded. The objective data retrieved from the simulator were compared with scores resulting from the questionnaire data. The analysis revealed modest correlations between the self-reported driving styles and the driving behaviour in the driving simulator, similar to those reported in the literature. It is concluded that the current study supports the use of the MDSI as a diagnostic tool for screening participants with different driving styles for simulator studies.

Objective: To evaluate the effect of right lateral positioning in comparison with supine positioning on tracheal aspirate pepsin levels as a marker of aspiration of gastric contents in ventilated p...

Objective The semisitting position (SSP) and lateral position (LP) in vestibular schwannoma (VS) surgery each have advantages and disadvantages, and which position is superior overall is debatable. Our objective was to determine the optimal position for surgical treatment of VSs with a diameter ≥3 cm. Methods We retrospectively evaluated consecutive patients with a large VS treated between January 2010 and July 2020. Patients were grouped by surgical position and analyzed. Results We enrolled 259 patients (LP group, n = 156; SSP group, n = 103). The resection extent was not significantly different between the SSP (gross-total resection [GTR], n = 89 [88.1%], near-total resection [NTR], n = 10 [9.9%], subtotal resection [STR], n = 2 [2.0%]) and LP (GTR, n = 125 [80.1%]; NTR, n = 24 [15.4%]; STR, n = 7 [4.5%]) groups. The rate of GTR with facial nerve (FN) functional preservation was higher in the SSP group than in the LP group (P = 0.014) at eight days after the operation. However, during follow-up (SSP group median, 31.5 months; LP group median, 19.5 months), there was no significant between-group difference in FN functional preservation. Two patients in the SSP group required conversion to the LP due to severe intraoperative venous air embolism (VAE). Conclusion Compared with the LP, the SSP did not produce significantly better FN outcomes in patients with a large VS. The duration of surgery was significantly longer in SSP cases than in LP cases. Given the risk of VAE associated with the SSP, the selection of the optimal surgical position should be made with caution on an individual basis.

Fish passage conditions over spillways are important for the operations of hydroelectric dams because spillways are usually considered as a common alternative passage route to divert fish from the turbines. The objectives of this study were to determine the relative potential of fish injury during spillway passage both before and after the installation of baffle blocks at Boundary Dam, and to provide validation data for a model being used to predict total dissolved gas levels. Sensor Fish were deployed through a release system mounted on the face of the dam in the forebay. Three treatments, based on the lateral position on the spillway, were evaluated for both the baseline and post-modification evaluations: Left Middle, Right Middle, and Right. No significant acceleration events were detected in the forebay, gate, or transition regions for any release location; events were only observed on the chute and in the tailrace. Baseline acceleration events observed in the chute region were all classified as strikes, whereas post-modification events included strike and shear on the chute. While the addition of baffle blocks increased the number of severe events observed on the spillway chute, overall fewer events were observed in the tailrace post-modification. Analysis of lateral positioning of passage indicated that the Right Middle treatment was potentially less injurious to fish based on relative frequency of severe events at each location. The construction of baffle blocks on the spillway visibly changed the flow regime. Prior to installation the flow jet was relatively thin, impacting the tailrace as a coherent stream that plunged deeply, possibly contributing to total dissolved gas production. Following baffle block construction, the discharge jet was more fragmented, potentially disrupting the plunge depth and decreasing the time that bubbles would be at depth in the plunge pool. The results in this study support the expected performance of the modified spillway chute: the addition of the baffle blocks generally lessened the depth and impact of entry. This study provides information that can be used to help design and operate spillways for improving fish passage conditions.

Accurate and real-time lateral positioning is the key to path tracking control of unmanned roller compactor. In order to ensure the accuracy and real-time of lateral positioning, a lateral positioning method based on visual feature extraction is proposed. Firstly, the camera calibration was carried out to obtain its internal parameters and external parameters. Then the image processing method was used to detect and fit the ground markings in the working area. Finally, in order to achieve the lateral positioning, the visual positioning model was used to calculate the distance between the look-ahead point in the moving direction of the roller compactor and the left and right ground markings. The experimental results show that the average absolute error of static positioning is 0.04 meters, the average relative error is 2.31%, the average absolute error of dynamic experiment is 0.06 meters, the average relative error is 3.51%, and the average processing speed of the algorithm reaches 70 frames/second. It fully meets the needs of positioning measurement accuracy and real-time in engineering applications. In addition, the method is less subject to the interference of electromagnetic signal and requires less hardware cost.

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no longer suitable for extracorporeal shockwave lithotripsy. The key to success depends on the urologist’s choice of instruments, preoperative and intraoperative access planning, patience, perseverance, skill and training. Percutaneous renal access is a crucial early step that may ultimately influence outcomes of PCNL in terms of overall stone-free rate and complications. Several techniques for access and tract dilatation are described in this chapter. Prone, supine or lateral positioning during renal access have inherent advantages and disadvantages. Similarly, various adjunct imaging modalities and instrumentation are available to increase success and decrease the risk of complications. Nonetheless, the most practical and effective approach still depends heavily on stone burden and renal anatomy, available instrumentation and equipment, and the surgeon’s expertise and level of training.

Monitoring the underground pipeline to prevent the illegal intrusion is a quite important work for civil infrastructure security management. The distributed fiber optic sensing technology nowadays has been widely used in the monitoring. Meanwhile, it also suffers from a relatively high false alarm rate. To tackle the difficult problem of false alarms, the paper develops a short range lateral positioning method of vibration source based on ultra-weak fiber Bragg grating vibration sensing array. Two parallel fiber optic cables are required to be deployed at the both sides of the pipeline. The positioning algorithm establishes a least square misfit function between the predicted and observed travel time difference based on the double-cable data. By systematically searching through the possible lateral distance in a selected range, an optimal distance can be identified according to the minimal misfit value. The tests on synthetic and field data validate the effectiveness of the proposed method.

Roadside vegetation provides a myriad of environmental and psychological benefits to drivers. While research has shown that natural landscapes cause less stress and frustration to the driver among other benefits, the same vegetation may potentially increase the severity of run-off-the-road crashes. The aim of this study was to evaluate the extent to which clear zone width and roadside vegetation density influence operating speeds and lateral positioning to determine whether the roadside environment has any effect on drivers’ attention to their speed. A within subject driving simulator experiment tested six combinations of clear zone widths and roadside vegetation densities. Participants’ driving performance was measured throughout the virtual drive. Along tangents and curves to the left, participants slowed down and drove closer to the centerline when trees were near the edge of the road. Similar to the results reported in Calvi (2015), no statistically significant differences in operating speeds were observed with change in vegetation density. The analysis of drivers’ eye movements indicated that the roadside configuration did not affect participants’ attention to their operating speed, however, the number of glances was highly correlated to the time spent in the virtual drive. The results provide evidence to suggest that, while the increased roadside vegetation density does not necessarily result in reduced driver speeds or deviated lateral positioning, the manipulation of the roadside clear zone width does provide tangible benefits to safe driver behavior. These research findings should be considered in the design of roadside elements, accounting for overstated benefits to roadside vegetation.

A continuous-gradient approach of material evaporation is employed to fabricate nanostructures with varying geometric parameters, such as thickness, lateral positioning, and orientation on a single substrate. The method developed for mask lithography allows continuous tuning of the physical properties of a sample. The technique is highly valuable in simplifying the overall optimization process for constructing metasurfaces.

One-lung ventilation is known to alter the physiology and result in a discrepancy between end-tidal CO 2 (ETCO 2 ) and arterial blood CO 2 partial pressure despite protective mechanisms like hypoxic pulmonary vasoconstriction. Shunts in an emphysematous patient, lateral positioning and capnothorax may aggravate the discrepancy. We present here an incredible discrepancy of 40 mmHg which led us to question the very utility of ETCO 2 monitoring in this subset of patients and consider alternative techniques.

Case The case reported involves a patient who developed an unexplained decrease in hemoglobin after acetabular fracture surgery in the prone position. Repeat abdominal computed tomography was remarkable for a massive subcapsular spleen hematoma secondary to rib fracture impingement, which required splenectomy. Conclusion The spleen can be injured by a fracture rib during prone positioning for fixation of an acetabular fracture. Prone surgical positioning may cause iatrogenic intra-abdominal organ injury in patients with displaced lower rib fractures. Lateral positioning should be considered for acetabular surgery in patients with rib fractures.

BIBM 2018, IEEE International Conference on Bioinformatics and Biomedicine, Madrid, ESPAGNE, 03-/12/2018 - 06/12/2018; Machine learning (ML) technics have been recently used to detect emotion and predict crash severity. This research work aims at assessing different classifications and machine learning technics in predicting the alcohol consumption and associated functional states. 28 young drivers were tested for a 45 min drive with a blood alcohol concentration (BAC) of 0.0, 0.2 and 0.5g/m. Subjective functional states were analysed using Thayer's scale and NASA-TLX. The physiological parameters (electroencephalogram, electrodermal and cardiac activity) and driver simulators parameters (speed, lateral positioning and wheel steering) were acquired during the three alcohol sessions. Data were analysed on 10s temporal windows without superposition nor gap. Two analyses using classification and ML technics were used: to determine both capacity of the algorithms to detect alcohol consumption (BAC level) and functional states (effort, performance and alertness) from NASA and Thayer's scales. Different algorithms were trained using 10 folds cross validation technics using Weka (University of Waikato, NZ). Using both vehicle and physiological data was beneficial for BAC prediction and ROC area of the top three algorithms were found between 0.62 and 0.72 with higher results for Random Forest (RF) algorithms. In functional states prediction, results were similar for all effort, performance and alertness predictions with ROC area reaching 0.75 for RF. Once algorithm setting optimized, performances for BAC prediction reached 0.73 while were, lower than for functional states prediction with ROC area of 0.91 when pairing data. Such results could help in the strategy for detecting alcohol consumption in drivers.

In this paper, we utilize bulk acoustic waves to control the position of microparticles inside droplets in two-phase microfluidic systems and demonstrate a method to enrich the microparticles. In droplet microfluidics, different unit operations are combined and integrated on-chip to miniaturize complex biochemical assays. We present a droplet unit operation capable of controlling the position of microparticles during a trident shaped droplet split. An acoustic standing wave field is generated in the microchannel, and the acoustic forces direct the encapsulated microparticles to the center of the droplets. The method is generic, requires no labeling of the microparticles, and is operated in a noncontact fashion. It was possible to achieve 2+-fold enrichment of polystyrene beads (5 μm in diameter) in the center daughter droplet with an average recovery of 89% of the beads. Red blood cells were also successfully manipulated inside droplets. These results show the possibility to use acoustophoresis in two-phase systems to enrich microparticles and open up the possibility for new droplet-based assays that are not performed today.

A mechanics based model to describe the lateral positioning of a thin, tensioned, translating tape over a tilted roller is introduced, based on the assumption that the transport velocity of the tape should match the surface velocity of the roller when there is sufficient traction. It is shown that this condition requires the slope of the neutral axis of the tape and the slope of the centerline of the tilted roller to be the same over the wrapped segment. An extension of this model is discussed including the possibility of circumferential and lateral sliding, depending on the velocity difference between the tape and the roller. The new model is incorporated into a generalized model of a tape path that consists of numerous rollers as well as the appropriate boundary conditions for the take-up and supply reel dynamics. The nonlinear equation of motion is solved numerically, and the steady state solution is found by an implicit time stepping algorithm. An experimental setup with one tilting roller, two or three nearly ideally oriented rollers and two reels is used for verification of the model. The effects of roller tilt angle, tape wrap angle, and the lengths of the free-tape spans upstream and downstream of the tilted roller on the steady state lateral tape position are investigated experimentally and by simulations. The experiments show that the circumferential position of the wrap on the upstream side of a tilted roller has the strongest effect on pushing the tape in the lateral direction. The total wrap angle around the roller has a smaller effect. It was also shown that the tape segments upstream and downstream of the tilted roller interact, and the combined effect results in a different overall lateral tape response in steady state.

The objective of this research was to develop recommendations for bicycle lane width for various roadway and traffic characteristics. An observational field study involved installing temporary lane line markings to delineate bicycle lanes of varying width at midblock locations and then observing the lateral positioning of bicyclists and motorists within the roadway cross section. The final database from the field study included data for 4,965 bicyclists, 3,163 passing vehicles, and 994 parked vehicles. The primary findings of the study showed that a buffered bike lane provided distinct advantages over simply widening a bike lane and that as traffic volumes and truck percentages increased, bicyclists moved away from vehicles in the travel lane and positioned themselves closer to parked vehicles or the curb. General design guidance is provided along with recommended parking lane, buffer, bike lane, and travel lane widths most applicable to urban and suburban two-lane undivided roadways with constrained roadway width.

Cardiac air embolism should be suspected in any neonate with acute unexplained cardiovascular collapse or worsening oxygenation. We present here five cases that presented with the above symptoms. A comprehensive evaluation including targeted neonatal echocardiography and near-infrared spectroscopy helped confirm the diagnosis and assess the hemodynamic state. Management was supportive including left lateral positioning, chest compressions, and cardiovascular medications to treat pulmonary hypertension and systemic hypotension.

Purpose The purpose of this study was to quantify the effect that table height, patient size, and localizer acquisition order may have on AEC prescribed dose. Method and materials Three phantoms were used for this study: the Mercury Phantom, acrylic sheets, and an anthropomorphic phantom. A lateral (LAT) and a posterior-anterior (PA) localizer was acquired for each phantom at different table heights on a MDCT scanner (GE Discovery CT750 HD). AEC scan acquisitions were prescribed for each combination of phantom, localizer orientation, and table height ±4 cm with the center position; the displayed CTDIvol was recorded. Based on the institutional dose monitoring program, the relationship between change in CTDIvol and change in table height were studied for LAT and AP localizers for clinical exams. Results For all phantom scans based on the PA localizer, the percent change in ranged between −18% and 42% for table heights 4 cm below and above proper centering; while for the LAT localizer, the percent change in CTDIvol from ideal were no greater than 12% different for ±4 cm differences in table height. Change in CTDIvol and change in table height displayed a strong linear relationship for AP localizer exams (P = 0.002), and weak correlation for LAT localizer exams (P = 0.12). Conclusions Since uncertainty in vertical patient positioning is inherently greater than lateral positioning, the LAT localizer should be utilized to precisely and reproducibly deliver the intended amount of radiation prescribed by CT protocols.

Highway related crashes are considered as one of most concerned types of problems in the modern world. Run-Off-Road (ROR) crashes could be identified as the most critical among highway related crashes. Previous research studies on Traffic Engineering has found that the road side elements will have a positive influence toward ROR crashes. Hence, the study explores the relationship of roadside elements with drivers' speed selection and lateral position. In this research study, the effect of road side vegetation and utility poles on drivers' speed selection and lateral positioning was evaluated. A straight roadway section and horizontal curve roadway section with varying road side vegetation were selected to get the required data for the study. Fifty vehicle were observed at each location to get the speeds and lateral positions. Collected data was analyzed using Multiple Regression Analysis technique to generate models to find drivers' speed selection and lateral positioning of vehicle on road. Study found that in lightly vegetated roadways, subjects drove speedier and drove much near the edge of the road. At the point when the scene changes into more vegetated, subjects drove much slower and drove near to the center of the road. The models demonstrate that the impact of road side vegetation way much higher in curved roads areas than straight segments. Therefore, it is recommended to post a speed limit sign and proper monitoring system at each critical curved roadway section in the country.

Surgical positioning is accompanied by numerous anesthetic considerations, particularly its potential effects on the cardiovascular, respiratory, and nervous systems. Clinical studies have shown that lateral positioning does not affect hemodynamics; however, with the addition of trunk flexion, there is a decrease in cardiac output, which may be secondary to caval compression. In this report, we describe a unique case of hypotension that arose in a patient positioned only in the right lateral decubitus position with flexion and that was exacerbated by an abnormally narrow inferior vena cava.

Lying ears are defined as ears that protrude less from the head, and in frontal view, are characterized by lateral positioning of antihelical contour relative to the helical rim. These aesthetically displeasing ears require correction in accord with the goals of otoplasty stated by McDowell. The authors present a case of lying ears treated by correcting the conchomastoid angle using Z-plasty, resection of posterior auricular muscle, and correction of the conchoscaphal angle by releasing cartilage using 2 full-thickness incisions and grafting of a conchal cartilage spacer. By combining these techniques, the authors efficiently corrected lying ears and produced aesthetically pleasing results.

Prompt recognition and management of hypotension resulting from aortocaval compression syndrome are essential to optimize the maternal and fetal outcomes. Management involves increasing leftward uterine displacement and sometimes full lateral positioning, although lateral position during cesarean delivery is typically considered to be impractical. We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position. Performing cesarean delivery in the lateral position is virtually unreported, and this unique strategy prevented further symptoms of aortocaval compression and enabled safe delivery.

Wild capuchin monkeys (Sapajus libidinosus) at Serra da Capivara National Park, Brazil, regularly use stone tools to break open cashew nuts (Anacardium spp.). Here we examine 2 approaches used by the capuchins to position the kidney-shaped cashew nuts on an anvil before striking with a stone tool. Lateral positioning involves placing the nut on its flatter, more stable side, therefore requiring less attention from the monkey during placement. However, the less stable and never previously described arched position, in which the nut is balanced with its curved side uppermost, requires less force to crack the outer shell. We observed cashew nut cracking in a field experimental setting. Only 6 of 20 adults, of both sexes, were observed to deliberately place cashew nuts in an arched position, which may indicate that the technique requires time and experience to learn. We also found that use of the arched position with dry nuts, but not fresh, required, in 63% of the time, an initial processing to remove one of the cashew nut lobes, creating a more stable base for the arch. This relatively rare behaviour appears to have a complex ontogeny, but further studies are required to establish the extent to which social learning is involved.

The Foresighted Driver Model (FDM) is a microscopic driver model which is based on the idea that a driver balances risk with utility. This paper deals with the modeling of advanced driving maneuvers for the FDM with a special focus on lateral positioning scenarios, such as lane changes in highway traffic. When driving at high speeds, tactical preparation for a safe lane change is of high importance. In this context, the paper presents maneuvers that allow for lane changes to be planned well in advance and carefully made without the restraint of requiring immediate action. Furthermore, the paper presents a continuous lateral control which allows driving on arbitrary paths other than the centerline, depending on the current traffic situation. Since more complex lateral maneuvers require more detailed considerations of the environment, an approach is presented to model the lane and the environmental influences. This paves the way for a modeling of variables such as lane markings, roadblocks, hard shoulders and more. Simulations illustrate how the introduced maneuvers allow successful preparation for upcoming lane changes and how traffic obstructions can be bypassed without performing a lane change but by using the continuous lateral control.

The correct position of double-lumen tubes (DLTs) is customarily confirmed after tracheal intubation by bronchoscopy with the patient supine on a headrest. However, displacement of DLTs usually occurs during lateral positioning because of neck extension. This study was undertaken to determine whether displacement of DLTs could be minimized during lateral positioning if DLTs were positioned without a headrest.One hundred patients scheduled for thoracic surgery were randomized into two groups (n = 50 each). After tracheal intubation using a headrest, adjustment of DLT position was performed according to group assignment, i.e., either with the headrest in place or without the headrest. Using a bronchoscope, distances from the tracheal opening to the main carina and from the bronchial opening to the left bronchial carina were measured in both the supine and lateral positions.Displacement of DLTs [mean (standard deviation)] during lateral positioning was greater in the headrest group than in the no-headrest group [12.3 (6.5) mm vs 6.8 (5.5) mm, respectively, in the trachea; 11.6 (6.7) mm vs 6.0 (4.6) mm, respectively, in the bronchus; P0.001]. The incidence of significant displacement, defined as10 mm from initial correct position, was greater in the headrest group than in the no-headrest group (64% vs 28%, respectively, in the trachea; 58% vs 20%, respectively, in the bronchus; P0.001).Displacement of DLTs during lateral positioning appears to be caused primarily by extension of the neck. Correct adjustment of DLT position without a headrest in the supine position is an easy and effective method to minimize DLT displacement during lateral positioning.

In order to verify a quick launching system for rockets with small and medium sizes, an engineering vehicle localization and navigation sub-system is presented in this article. The structure of the launcher includes the front board and two cylindrical landmarks on both sides. When the vehicle gets close to the launcher, two 2D laser scanners on the vehicle detect the launcher reliably. And an extend Kalman filter is used to estimate the vehicle’s pose relative to the launcher. The localization and navigation results show that the lateral positioning error is smaller than 1cm so that the vehicle could align with the launcher accurately.

Background Video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer is being performed at an increasing number of institutions. In our institute, at first, we had performed VATS-E in the left lateral position without pneumothorax. But, we introduced VATS-E in the prone position with pneumothorax, because of difficulty of visual development for a surgical site by assistant. This study aimed to compare the two methods and to clarify the advantage in the prone position. Methods Thirty-one patients who underwent VATS-E at the Department of Gastroenterological Surgery, Kagawa University, from August 2013 to January 2018 were divided into two groups by the patient position. For the first 17 patients, we used the left lateral position (Group L); for the next 14 patients, we used the prone position (Group P). We compared the short-term outcomes in these two approaches. Results There were no significant differences in the most operative factors; duration of the thoracoscopic esophagectomy (354 min. in Group L and 309 min. in Group P, P = 0.153), operative hemorrhage (421 ml in Group L and 228ml in Group P, P = 0.054), infusion volume (8.8 ml/kg/hr. in Group L and 8.2ml/kg/hr. in Group P, P = 0.415), urinary volume (2.3 ml/kg/hr. in Group L and 1.7ml/kg/hr. in Group P, P = 0.202). However, C-reactive protein (CRP) level in post-operative day 3 (17.2 in Group L and 13.8 in Group P, P = 0.046) and procalcitonin (PCT) level in post-operative day 3 (1.8 in Group L and 0.3 in Group P, P = 0.049) was significantly lesser in Group P. And, Period until ambulation (4.0 days in Group L and 1.3 days in Group P, P Conclusion In conclusion, VATS-E in the prone position is lesser invasive and faster recovery than in the left lateral position. Disclosure All authors have declared no conflicts of interest.