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Introduction: Concerns exist that a potential mechanism for harm from upright activity (sitting, standing, and walking) early after an acute ischaemic stroke could be the reduction of cerebral perfusion during this critical phase. We aimed to estimate the effects of upright positions (sitting and standing) on cerebral hemodynamics within 48 h and later, 3–7 days post-stroke, in patients with strokes with and without occlusive disease and in controls. Methods: We investigated MCAv using transcranial Doppler in 0° head position, then at 30°, 70°, 90° sitting, and 90° standing, at <48 h post-stroke, and later at 3–7 days post-stroke. Mixed-effect linear regression modeling was used to estimate differences in MCAv between the 0° and other positions and to compare MCAv changes across groups. Results: A total of 42 stroke participants (anterior and posterior circulation) (13 with occlusive disease, 29 without) and 22 controls were recruited. Affected hemisphere MCAv decreased in strokes with occlusive disease (<48 h post-stroke): from 0° to 90° sitting (−9.9 cm/s, 95% CI[−16.4, −3.4]) and from 0° to 90° standing (−7.1 cm/s, 95%CI[−14.3, −0.01]). Affected hemisphere MCAv also decreased in strokes without occlusive disease: from 0° to 90° sitting (−3.3 cm/s, 95%CI[−5.6, −1.1]) and from 0° to 90° standing (−3.6 cm/s, 95%CI [−5.9, −1.3]) (p-value interaction stroke with vs. without occlusive disease = 0.07). A decrease in MCAv when upright was also observed in controls: from 0° to 90° sitting (−3.8 cm/s, 95%CI[−6.0, −1.63]) and from 0° to 90° standing (−3 cm/s, 95%CI[−5.2, −0.81]) (p-value interaction stroke vs. controls = 0.85). Subgroup analysis of anterior circulation stroke showed similar patterns of change in MCAv in the affected hemisphere, with a significant interaction between those with occlusive disease (n = 11) and those without (n = 26) (p = 0.02). Changes in MCAv from 0° to upright at <48 h post-stroke were similar to 3–7 days. No association between changes in MCAv at <48 h and the 30-day modified Rankin Scale was found. Discussion: Moving to more upright positions <2 days post-stroke does reduce MCAv in the affected hemisphere; however, these changes were not significantly different for stroke participants (anterior and posterior circulation) with and without occlusive disease, nor for controls. The decrease in MCAv in anterior circulation stroke with occlusive disease significantly differed from without occlusive disease. However, the sample size was small, and more research is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Aim: To access efficacy and safety of the upright proton therapy for the skull-base chordomas and chondrosarcomas. Materials and methods: The study encompasses single-center experience of proton therapy in chordomas (CA) and chondrosarcomas (CSA) of skull-base localization. We evaluate overall survival, local control and toxicity. Tumor response was assessed in accordance with RANO criteria. Treatment-related toxicity was evaluated with the help of CTCAE v 5.0 scale. Results: Proton therapy in the upright position was utilized for 51pts (patients) with CA-CSA (40 pts with chordoma and 11pts with chondrosarcoma) at the A. Tsyb Medical Radiological Research Center in 2016–2023. Median tumor volume constituted 30 cm3 (IQR (interquartile range) 15–41 cm3). Median total dose was 70 GyRBE. Median number of fractions was 35. Overall survival (OS) at 1-, 2- and 3-year rates reached 98.0 %, 88.6 % and 82.7 %, respectively. Median follow-up time was 36 months. The 1-, 2- and 3-year local control (LC) rates constituted, respectively, 98 %, 78.6 % and 66.3 %. Prior surgery showed statistically significant association with better prognosis (p = 0.023). Brainstem-to-tumor dose coverage compromise became the major pattern of LC failure (p = 0.03). The late radiation toxicity reactions included temporal lobe necrosis grade 2 in 2 pts, xerostomia grade 1 in 1pt, radiation cataract grade 2 in 1pt and persistent headache grade 2 in 4 pts. Severe late toxicity reactions were observed in 2 cases (4 %): 1 myelitis grade 3 and brainstem damage grade 5 in 1pt. Conclusion: Local control was achieved in the majority of patients receiving the scanning-beam upright proton therapy for skull-base CA-CSA. The LC rates after a surgery-radiotherapy combination treatment were higher compared with irradiation alone. Pattern of failure is mostly brainstem-tumor dose compromise. The high OS and LC rates were accompanied by low toxicity incidence. Even in complex case of the skull base CA-CSA upright proton therapy shows promising clinical outcomes.

IntroductionConcerns exist that a potential mechanism for harm from upright activity (sitting, standing, and walking) early after an acute ischaemic stroke could be the reduction of cerebral perfusion during this critical phase. We aimed to estimate the effects of upright positions (sitting and standing) on cerebral hemodynamics within 48 h and later, 3–7 days post-stroke, in patients with strokes with and without occlusive disease and in controls.MethodsWe investigated MCAv using transcranial Doppler in 0° head position, then at 30°, 70°, 90° sitting, and 90° standing, at

Aim: This study presents an analysis (efficacy and toxicity) of outcomes in patients with esthesioneuroblastoma after pencil beam proton therapy with a fixed beamline in the upright position. Background: Esthesioneuroblastoma (ENB) is an extremely rare tumor of sinonasal area located in critical proximity to vital structures. Proton therapy (PT) is often considered the optimal radiation treatment for head-and-neck tumors, although of limited availability. Upright PT delivered using fixed pencil beamline and rotating chair is a fairly promising option. Methods: This is a single-center experience describing the outcomes of PT in 14 patients with ENB treated between January 2016 and October 2022; half of the cases had a history of previous irradiation. The therapy was applied using a fixed pencil beamline with 6D-chair for positioning. The median dose was 63 GyRBE (total range 48-70 GyRBE; based on 1.1 RBE multiplier for protons) with 2.0 GyRBE per fraction. The mean gross tumor volume was 109.5 cm3 (17.1-257.7 cm3). Patient demography, pathology, treatment parameters and toxicity data were analyzed. Radiation-induced reactions were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. Results: The median follow-up time was 28 months. The 1- and 2-year locoregional control rates constituted 100% and 88.9%, respectively; the median duration of local control was 52 months. The 1- and 2-year progression-free survival (PFS) rates constituted 92.9% and 75.0%, respectively; the median PFS duration was 52 months. The 1- and 2-year overall survival (OS) rates constituted 92.9% and 84.4%, respectively. Two patients died of noncancer-related causes (coronavirus-induced pneumonia) and 1 patient died of tumor progression. All patients tolerated PT well without any treatment gaps. Serious late toxicity reactions included glaucoma in 1 patient and cataract in 2 patients, in over half a year since irradiation. Conclusion: PT with upright design of the unit affords promising outcomes in terms of disease control and toxicity rates in ENB, a sinonasal tumor of complicated localization. [ABSTRACT FROM AUTHOR]

INTRODUCTION The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic. METHODS This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used. RESULTS When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was =12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033). CONCLUSIONS Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group. [ABSTRACT FROM AUTHOR]

Objective Design Methods Results Conclusions Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To explore the possible barriers and facilitators to implementing the Upright Positions in the Second Stage of Labour (UPSSL) programme in Chinese healthcare settings.A mixed‐method convergent design with the guidance of Consolidated Framework for Implementation Research (CFIR).An online survey study and semi‐structured interviews were conducted between March and May 2023. Healthcare professionals were recruited from four hospitals in Shijiazhuang, China. One hundred and thirty‐one participants completed the survey study, and 23 of them were interviewed individually. Descriptive statistics evaluated the possible barriers and facilitators of implementing the UPSSL programme within the CFIR framework quantitatively. Guided by the CFIR framework, qualitative data were analysed using directed content analysis to summarize healthcare professionals' perspectives on barriers and facilitators of the UPSSL programme.Multiple intersectional barriers and facilitators were identified from the survey and semi‐interviews. Healthcare professionals believed that the UPSSL programme has a scientific evidence base, systematic contents, and possible benefits for women. However, various barriers existed at individual, system, and organizational levels. Major barriers included healthcare professionals and women's safety concerns towards the use of upright positions during childbirth, the healthcare professionals' unfamiliarity with assisting an upright position birth, poor adaptability of the programme protocol, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting.To facilitate the implementation of the UPSSL programme in China, tailored antenatal education on upright positions, especially addressing safety‐related issues, should be provided to pregnant women, their families, or peers to enhance their understanding of and familiarity with such positions. Healthcare professionals should also be offered adequate training opportunities and necessary facilities. Furthermore, national‐level policy changes might be required to address midwifery workforce shortages. Additionally, further research is warranted to select, adapt, and test effective implementation strategies for programme adoption. What problem did the study address? The adoption of upright positions during the second stage of labour could promote better maternal and neonatal outcomes and a positive childbirth experience. However, the adoption of upright positions during the second stage of labour is suboptimal in healthcare settings in China. Barriers and facilitators of implementing upright positions during childbirth are unclear. What were the main findings? A range of barriers and facilitators within the CFIR framework to promote upright positions during childbirth from healthcare professionals' perspectives were identified, and the major barriers included safety concerns towards and unfamiliarity with an upright position birth, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting. Where and on whom will the research have an impact? This study will enable a better understanding of the barriers and facilitators to promoting upright positions in the second stage of labour in China. The smooth and effective implementation of the UPSSL programme could help to promote better maternal and neonatal outcomes and improve women's childbirth experiences. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Good Reporting of A Mixed Methods Study (GRAMMS) guidelines.In this study, healthcare professionals were involved in refining the topic guides and survey questions. Additionally, findings from the interviews were returned to them for comments and corrections. [ABSTRACT FROM AUTHOR]

AimThis study presents an analysis (efficacy and toxicity) of outcomes in patients with esthesioneuroblastoma after pencil beam proton therapy with a fixed beamline in the upright position.BackgroundEsthesioneuroblastoma (ENB) is an extremely rare tumor of sinonasal area located in critical proximity to vital structures. Proton therapy (PT) is often considered the optimal radiation treatment for head-and-neck tumors, although of limited availability. Upright PT delivered using fixed pencil beamline and rotating chair is a fairly promising option.MethodsThis is a single-center experience describing the outcomes of PT in 14 patients with ENB treated between January 2016 and October 2022; half of the cases had a history of previous irradiation. The therapy was applied using a fixed pencil beamline with 6D-chair for positioning. The median dose was 63 GyRBE (total range 48–70 GyRBE; based on 1.1 RBE multiplier for protons) with 2.0 GyRBE per fraction. The mean gross tumor volume was 109.5 cm3 (17.1–257.7 cm3). Patient demography, pathology, treatment parameters and toxicity data were analyzed. Radiation-induced reactions were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v 4.0.ResultsThe median follow-up time was 28 months. The 1- and 2-year locoregional control rates constituted 100% and 88.9%, respectively; the median duration of local control was 52 months. The 1- and 2-year progression-free survival (PFS) rates constituted 92.9% and 75.0%, respectively; the median PFS duration was 52 months. The 1- and 2-year overall survival (OS) rates constituted 92.9% and 84.4%, respectively. Two patients died of non-cancer-related causes (coronavirus-induced pneumonia) and 1 patient died of tumor progression. All patients tolerated PT well without any treatment gaps. Serious late toxicity reactions included glaucoma in 1 patient and cataract in 2 patients, in over half a year since irradiation.ConclusionPT with upright design of the unit affords promising outcomes in terms of disease control and toxicity rates in ENB, a sinonasal tumor of complicated localization.

Background: Delivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs.Material and Methods: This article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants.Results: On a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10.Conclusion: Learning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to develop a Practice Programme for Upright Positions in the Second Stage of Labour to provide a reference for midwifery professionals in the standardized implementation of upright positions in clinical practice. Background: The adoption of upright positions in the second stage of labour is recommended by many international organizations, but upright positions have not been widely used and their implementation varies greatly across studies. Methods: The Practice Programme for Upright Positions in the Second Stage of Labour was developed under the guidance of the Medical Research Council framework for developing and evaluating complex interventions and the World Health Organization handbook for guideline development. Four stages were conducted: (1) establishing the intervention development group, (2) identifying a theoretical basis and forming a content framework, (3) evidence retrieval and synthesis and (4) refining and modelling the practice programme. Results: The content framework of the Practice Programme for Upright Positions in the Second Stage of Labour was formed based on the literature review, semi‐structured interviews and expert consultation, including indications and contraindications, implementation methods, observations, potential risks and precautions. According to each item, we conducted a series of systematic reviews, and summarized the available best evidence from clinical guidelines, systematic reviews and original studies. Eventually, the Practice Programme for Upright Positions in the Second Stage of Labour was developed, integrating the findings of the iterative evidence reviews and revised by stakeholders. Conclusions: This study first reported the development process of the Practice Programme for Upright Positions in the Second Stage of Labour, characterized by evidence‐based, iteratively processed and highly rigorous. The implications may guide researchers to embed the intervention normatively into clinical practice for improving maternal and infant outcomes. Implications for Nursing Management: The Practice Programme for Upright Positions in the Second Stage of Labour could facilitatesystematic management of labour positions and guide midwives in the successful implementation of upright positions. [ABSTRACT FROM AUTHOR]

Introduction: Maternal and child health is an important public health issue, especially in developing countries like India. Maternal and child health services help to determine maternal and neonatal morbidity and mortality in a country. The second stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth. Midwives play a pivotal role in managing maternal positions during the second stage of labor. However, there is limited evidence to support an ideal maternal position during the second stage of labor. Methodology: All studies that explored the effects of positioning during the second stage of labor were retrieved. Only four major databases, Google Scholar, ResearchGate, PubMed, and Shodhganga, were searched. The keywords used for search included the second stage of labor, maternal position, upright position, left lateral position, squatting position, and maternal outcomes. The search criteria included studies published from 2008 to 2021. Out of 154 research articles, only 14 studies were included for the review process. Results: The positions such as maternal upright, lateral position, squatting position, and sitting position are beneficial for the maternal and neonatal outcome. The mean length of the second stage of labor was shorter in squatting primiparas and multiparas than in semirecumbent women, whereas lithotomy and supine positions during labor are associated with poor maternal and fetal outcomes. Conclusion: The selected positions during the second stage of labor have shown positive outcomes for the pregnant and her child. The findings should be introduced in midwifery education programs and in clinical practice as a method to improve the care of women during the second stage of labor.

Objective: To stimulate obstetric centers to start training in breech counseling and selection and performing vaginal breech deliveries. Methods: The different steps that were needed to roll out a breech program, are described: the "walking" epidural (PIEB protocol), the breech consultation with a structured counseling tool, and training of the whole team (gynecologists, midwives, anesthesiologists, and pediatricians). We describe below the results of 111 women who were counseled at the breech consultation, in the period May 2019 to August 2021. Results: In all, 86.5% of patients (n= 96) with a singleton term breech met the criteria for a vaginal breech delivery; 77% of this group (n= 74) accepted a planned vaginal breech delivery. Of this group, 54% (n=40) had a successful vaginal breech delivery, 27% (n=20) ended up in a secondary cesarean section, and 19% (n=14) had a planned cesarean section. Conclusion: We were able to roll out a successful breech program, including vaginal breech delivery, in a safe way. The breech consultation is the most essential part of the process. Training of the whole team is mandatory. The results of the first 2 years are encouraging to continue this program. [ABSTRACT FROM AUTHOR]

Background: Maternal position during delivery can affect the physiology of labour and the mechanics of childbirth., Objective: The study aimed to evaluate the impact of an upright position during the first stage of labour on maternal outcomes., Methods: This parallel group randomised control trial was conducted from April to June 2020 among 60 women (30 each in the experimental and control groups) admitted to the selected hospital in Punjab, India. Women who entered the active stage of labour naturally with a single live foetus in cephalic presentation, aged 18-45 years, and with normal body mass index were randomly assigned either to the experimental or control group using a concealed envelope method. Women in the experimental group were informed and encouraged to adopt the upright position, while those in the control group received the standard routine care during the first stage of labour. The effectiveness of upright positions during the first stage of labour was assessed in terms of duration of the first, second, and third stages of labour, mode of delivery, and perineal lacerations. Outcome assessors were blinded to the intervention. The differences in the groups were evaluated by mean, median, frequency, percentage, Chi-square, and t-test., Results: The results of 60 women were analysed. Women in the experimental group experienced a significant reduction in the incidence of instrumental delivery (p =0.005), perineal laceration (p =0.001), and duration of the first stage (p =0.0001) and third stage (p =0.0001) of labour compared to those in the control group. No harm was reported across the study groups., Conclusion: This study urges nurses and midwives to recommend the use of upright positions during the first stage of labour to reduce the duration of labour and incidence of perineal laceration among women., Clinical Trial Registration Number: CTRI/2022/04/041740., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Facial surgeries are usually performed with the patient in the supine position; however, it is crucial to predict postoperative results in the upright position. This study aimed to clarify the posture-related morphological changes in the facial soft tissue regarding age and sex, using physical measurements to obtain results in specific linear metric measurements of standard facial features. One hundred healthy volunteers were divided into four groups based on age and sex (25 young men, 25 young women, 25 old men, 25 old women). For all participants, 18 measuring points were marked on the skin along with 18 paired linear measurements, and the angle was measured using a digital sliding caliper and angle meter in both upright and supine positions. In all four groups, the intercanthal width (en-en), binocular width (ex-ex), length of the eye fissure (en-ex), length of the nasal bridge (n-prn), width of the nose (al-al), height of the lower face (sn-gn), vermilion height of the lower lip (sto-li), height of the lower lip (sto-sl), width of the philtrum (cphi-cphi), width of the mouth (ch-ch), and nasolabial angle (NLA) were significantly larger in the supine position than in the upright position. The increase was larger in the older age groups than in the younger age groups. Moreover, the increase was larger in old men than in old women. During facial surgery involving these areas, surgeons should consider the patient's age and sex and understand what facial figuration change would occur depending on posture and change their preoperative design or make minor adjustments during operation in the supine position to increase patient satisfaction. [ABSTRACT FROM AUTHOR]

To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women.

Background/aims: The World Health Organization encourages women in labour to ambulate and assume upright positions shown to be associated with favourable childbirth outcomes. However, the literature shows that most women in developed and developing countries, including Malawi, give birth in the supine position. There is a lack of research on factors that influence choice of birthing positions among women in Malawi. This study aimed to identify these factors. Methods: A face-to-face descriptive survey was conducted on 373 low-risk postnatal women in Malawi. Bivariate and multivariate analyses were used to determine association between sociodemographic characteristics and choice of labour and birthing position, as well as to identify predictive factors. Results: Walking during labour was significantly associated with age (P=0.018) and monthly family income (P=0.012). During birth, women who had received some degree of education were more likely to use the supine position than those who had not (93% vs 78%; P=0.011). However, women with a higher level of income were less likely to use the supine position than women with low income (82% vs 93%; P=0.005). Conclusions: Age, income and education influence Malawian women's choices for labour and birthing position. There is a need for Malawian women to be informed about and encouraged to use different labour and birthing positions, regardless of their socioeconomic and demographic status, to promote positions that improve maternal and neonatal outcomes. Childbirth education sessions or classes during antenatal care should include information on different birthing positions. [ABSTRACT FROM AUTHOR]

Aim: To access efficacy and safety of the upright proton therapy for the skull-base chordomas and chondrosarcomas., Materials and Methods: The study encompasses single-center experience of proton therapy in chordomas (CA) and chondrosarcomas (CSA) of skull-base localization. We evaluate overall survival, local control and toxicity. Tumor response was assessed in accordance with RANO criteria. Treatment-related toxicity was evaluated with the help of CTCAE v 5.0 scale., Results: Proton therapy in the upright position was utilized for 51pts (patients) with CA-CSA (40 pts with chordoma and 11pts with chondrosarcoma) at the A. Tsyb Medical Radiological Research Center in 2016-2023. Median tumor volume constituted 30 cm 3 (IQR (interquartile range) 15-41 cm 3 ). Median total dose was 70 Gy RBE . Median number of fractions was 35. Overall survival (OS) at 1-, 2- and 3-year rates reached 98.0 %, 88.6 % and 82.7 %, respectively. Median follow-up time was 36 months. The 1-, 2- and 3-year local control (LC) rates constituted, respectively, 98 %, 78.6 % and 66.3 %. Prior surgery showed statistically significant association with better prognosis (p = 0.023). Brainstem-to-tumor dose coverage compromise became the major pattern of LC failure (p = 0.03). The late radiation toxicity reactions included temporal lobe necrosis grade 2 in 2 pts, xerostomia grade 1 in 1pt, radiation cataract grade 2 in 1pt and persistent headache grade 2 in 4 pts. Severe late toxicity reactions were observed in 2 cases (4 %): 1 myelitis grade 3 and brainstem damage grade 5 in 1pt., Conclusion: Local control was achieved in the majority of patients receiving the scanning-beam upright proton therapy for skull-base CA-CSA. The LC rates after a surgery-radiotherapy combination treatment were higher compared with irradiation alone. Pattern of failure is mostly brainstem-tumor dose compromise. The high OS and LC rates were accompanied by low toxicity incidence. Even in complex case of the skull base CA-CSA upright proton therapy shows promising clinical outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Visually induced circular vection (CV) has been the subject of a wide range of functional brain and behavioral research. Participants in MRI or PET studies on CV were mostly in a supine viewing position, while participants in behavioral studies on CV were mostly in an upright viewing position. This study examines the effects of viewing positions (upright and supine) on roll CV reported by 16 participants while watching random dots (92 × 60 degrees field-of-view) rotating at different angular velocities (2, 4, 8, 16, 32, 64 deg/s) for 30 s. Viewing positions affected roll CV durations differently depending on the stimulation velocities. At slower velocities (2, 4, and 8 deg/s), participants exhibited significantly longer roll CV sensations when they were sitting in an upright position as opposed to lying in a supine position. The onset of roll CV was also significantly earlier with participants in an upright position despite similar roll CV intensities in both viewing positions. Significant two-way interactions between effects of viewing positions and dot rotating velocities for some conditions were noted. Consistency between current findings and the hypothesis predicting a weaker roll CV in upright positions based upon perceived gravity by the otolith organs is discussed.

Reaction Wheel Inverted Pendulum (RWIP) is a nonlinear system as Single Input Multiple Output (SIMO). In order to control pendulum of RWIP at the upright position, reaction wheel must be controlled appropriately. In this paper, authors propose Linear Quadratic Regulator (LQR) algorithm and Fuzzy Logic Controller (FLC) for controlling RWIP. Results from the simulation are tested on Matlab/Simulink Tool. Then, authors implement the plant on real model. LQR and FLC can control pendulum of RWIP which holds on upright position when system is affected by external force.

Aims: To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour. Background: Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent. Design: A meta‐analysis of randomized controlled trials. Data sources: The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019. Review methods: We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta‐analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour. Results: Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59–0.93), shortened the active pushing phase (mean difference [MD] = −8.16 min, 95% CI −16.29 to −0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14–0.87) and episiotomy (RR = 0.52, 95% CI 0.29–0.92), but significantly increased the rate of second‐degree perineal trauma (RR = 1.45, 95% CI 1.10–1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage. Conclusions: Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence. Impact: This meta‐analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma. [ABSTRACT FROM AUTHOR]

The effects of upright postures on the cerebral circulation early post-ischemic stroke are not fully understood. We conducted a systematic review and meta-analysis to investigate the effects of head positioning on cerebral haemodynamics assessed by imaging methods post-ischemic stroke. Of the 21 studies included (n = 529), 15 used transcranial Doppler. Others used near-infrared, diffuse correlation spectroscopy and nuclear medicine modalities. Most tested head positions between 0° and 45°. Seventeen studies reported changes in CBF parameters (increase at lying-flat or decrease at more upright) in the ischaemic hemisphere with position change. However, great variability was found and risk of bias was high in many studies. Pooled data of two studies ≤24 h (n = 28) showed a mean increase in cerebral blood flow (CBF) velocity of 8.5 cm/s in the ischaemic middle cerebral artery (95%CI,−2.2–19.3) from 30° to 0°. The increase found ≤48 h (n = 50) was of 2.3 cm/s (95%CI,−4.6–9.2), while ≤7 days (n = 38) was of 8.4 cm/s (95%CI, 1.8–15). Few very early studies (≤2 days) tested head positions greater than 30° and were unable to provide information about the response of acute stroke patients to upright postures (sitting, standing). These postures are part of current clinical practice and knowledge on their effects on cerebral haemodynamics is required. [ABSTRACT FROM AUTHOR]

Acrobot is a robotic system with some under actuated degree. In order to control Acrobot at the upright position, designers have to create appropriate algorithms. In this paper, authors propose Linear Quadratic Regulator (LQR) algorithm for controlling over the plant. Through dynamic equation analysis of Acrobot Robotic System, linearization is used for around balance point. Besides, authors also apply the genetic algorithm to optimize LQR. Results from the simulation are shown on Matlab/Simulink Tool. LQR controller can control the plant which holds on balance state when system is transient a few seconds.

Upright positions in the second stage of labour are recommended by many international organizations. However, they have not been widely used worldwide, especially in China. One of the important factors is the absence of a practice programme based on the best available evidence. We thus developed a Practice Programme for Upright Positions in the Second Stage of Labour following the UK Medical Research Council framework. Under the guidance of the programme, whether the use of upright positions can improve the maternal birth experience is a question of great concern. This study aimed to explore the birth experience of Chinese women who adopted upright positions in the second stage of labour. This qualitative descriptive study was conducted as part of an implementation study that developed an evidence-based intervention and used strategies to integrate the evidence-based intervention into routine obstetric clinical practice. The maternity department of a tertiary comprehensive hospital in Hebei Province, China. Semi-structured interviews with twelve eligible women who adopted upright positions in the second stage of labour were conducted between March and April 2022. Qualitative data were analyzed by using conventional content analysis. The average age of included women was 26.5 ± 3.5 years, and ten of them were primiparous women. Eight women adopted epidural analgesia during labour to relieve labour pain. All women gave birth in at least one type of upright position in the passive second stage of labour and adopted the semi-recumbent position in the active second stage of labour. Through conventional content analysis, we found that the use of upright positions in the second stage of labour could possibly promote an overall positive birth experience. Women giving birth in upright positions generally perceived they were more involved in their birthing process, and had greater physical and mental capacity to cope with childbirth. Women have a positive birth experience when using upright positions in the second stage of labour. This study suggests upright positions could improve women's birth experience and have the potential to be widely applied in clinical practice. [ABSTRACT FROM AUTHOR]

Bipedal walking is a composite task requiring integration of many control circuitries in the brain and spinal cord. The present study was carried out to verify whether an increase in blood lactate, such as that associated with a high intensity exercise, is able to significantly modify the qualitative and/or quantitative aspects of human walking. Eighteen healthy physically male participants, aged between 20 and 24 years (M = 21.8, SD = 1.22), were recruited for the study. For this purpose, the experimental protocol included the measure of blood lactate levels with the aim of assessing possible relations between lactate blood values and different aspect of walking after an exhaustive exercise. An exhaustive exercise was associated with a strong increase of blood lactate levels and produced a significant worsening in the ability to maintain the bipodalic upright posture as well as the fluidity of walking. Our results suggest that exhausting bouts impose greater challenges on postural control.

Reaction Wheel Inverted Pendulum (RWIP) is a nonlinear system as Single Input Multiple Output (SIMO). In order to control pendulum of RWIP at the upright position, reaction wheel must be controlled appropriately. In this paper, authors propose Linear Quadratic Regulator (LQR) algorithm and Fuzzy Logic Controller (FLC) for controlling RWIP. Results from the simulation are tested on Matlab/Simulink Tool. Then, authors implement the plant on real model. LQR and FLC can control pendulum of RWIP which holds on upright position when system is affected by external force. [ABSTRACT FROM AUTHOR]

Women who use upright positions and are mobile during labor have shorter labors, less intervention, fewer cesarean births, and report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. The evidence for supporting physiologic childbearing for optimal birth fails to disrupt intervention intensive hospital practices that deny 60% of women mobility in labor despite calls by maternity care organizations to not restrict mobility for low risk women in spontaneous labor. [ABSTRACT FROM AUTHOR]

Rearing, i.e., standing on the hind limbs in an upright posture, is part of a rat's innate exploratory motor program. Here, we examined in developing rats whether rearing is critical for the pup's capability to form spatial representations based on distal environmental cues. Pups (male) were tested at PD18, i.e., the first day they typically exhibit stable rearing, on a spatial habituation paradigm comprising a Familiarization session (with the pup exposed to an arena with a specific configuration of distal cues) followed, 3 h later, by a Test session where the pups were either re-exposed to the identical distal cue configuration (NoChange) or a changed configuration (DistalChange). In Experiment 1, rearing activity (rearing events, duration) decreased from Familiarization to Test in the NoChange pups but, remained elevated in the DistalChange group indicating that these pups recognized the distal novelty. Recognition of distal novelty was associated with increased c-Fos expression in hippocampal and medial prefrontal cortex (mPFC) areas, compared with NoChange pups. Analysis of GAD67+ cells suggested a parallel increase in excitation and inhibition specifically in prelimbic mPFC networks in response to distal cue changes. In Experiment 2, the pups were mechanically prevented from rearing while still seeing the distal cues during Familiarization. Rearing activity in the Test session of these pups did not differ between groups that were or were not exposed to a changed distal cue configuration at Test. The findings evidence a critical role of rearing for the emergence of allocentric representations integrating distal space during early development. • Standing in upright position is critical for the development of allocentric spatial mapping. • Persisting spatial representations are formed on PD18, i.e., the first day rat pups exhibit consolidated rearing. • Hippocampal and medial prefrontal cortex areas are activated when novelty is recognized in the distal environment. • Mechanically suppressing rearing prevents formation of distal spatial representations in rat pups. [ABSTRACT FROM AUTHOR]

Background: There is limited research into the effects of the birth environment on birth outcomes., Aim: To investigate the effect of a hospital birthing room designed to encourage mobility, self-determination and uptake of upright maternal positions in labour on the rate of vaginal births., Methods: The multicentre randomised controlled trial Be-Up, conducted from April 2018 to May 2021 in 22 hospitals in Germany, included 3719 pregnant women with a singleton pregnancy in cephalic position at term. In the intervention birthing room, the bed was removed or covered in a corner of the room and materials were provided to promote upright maternal positions, physical mobility and self-determination. No changes were made in the control birthing room. The primary outcome was probability of vaginal births; secondary outcomes were episiotomy, perineal tears degree 3 and 4, epidural anaesthesia, "critical outcome of newborns at term", and maternal self-determination (LAS)., Analysis: intention-to-treat., Findings: The rate of vaginal births was 89.1 % (95 % CI 87.5-90.4%; n = 1836) in the intervention group and 88.5 % (95 % CI 87.0-89.9 %; n = 1863) in the control group. The risk difference in the probability of vaginal birth was + 0.54 % (95 % CI - 1.49 % to 2.57 %), the odds ratio was 1.06 (95 % CI 0.86-1.30). Neither the secondary endpoints nor serious adverse events showed significant differences. Regardless of group assignment, there was a significant association between upright maternal body position and maternal self-determination., Conclusion: The increased vaginal birth rates in both comparison groups can be explained by the high motivation of the women and the staff., Competing Interests: Conflict of interest We declare that we have no competing interests, apart from the following activities related to the content of the manuscript: Elke Mattern was Chair of the German Society for Midwifery Science (DGHWi) without remuneration until February 2022. Rainhild Schäfers was involved in the leadership of the guideline development group Guideline 015-083 "Vaginal birth at term" free of charge., (Copyright © 2023. Published by Elsevier Ltd.)

Acrobot is a robotic system with some under actuated degree. In order to control Acrobot at the upright position, designers have to create appropriate algorithms. In this paper, authors propose Linear Quadratic Regulator (LQR) algorithm for controlling over the plant. Through dynamic equation analysis of Acrobot Robotic System, linearization is used for around balance point. Besides, authors also apply the genetic algorithm to optimize LQR. Results from the simulation are shown on Matlab/Simulink Tool. LQR controller can control the plant which holds on balance state when system is transient a few seconds. [ABSTRACT FROM AUTHOR]

Intravenous injection is the most feared medical procedure and gives rise to an experience of mild to severe pain in children. Unrestrained pain has a negative effect on the child. Pain management in the form of a convenient sitting position is needed by children who undergo intravenous injection procedures. This study aims to determine the effect of parental holding and an upright position on children’s pain during intravenous injection procedures. The study used the Randomized Clinical Trial method involving 34 respondents, aged 1–4 years, who were included in the intervention and control group. The result of a Mann-WhitneyUtest analysis showed a significant difference in the pain score between the intervention and control groups (pvalue = .000; α = .05). The parental holding and upright position can be applied as a nonpharmacological pain management strategy for children who undergo intravenous injection procedures. [ABSTRACT FROM PUBLISHER]

Upright positions in the second stage of labour are recommended by many labour and birth guidelines, but they have not been widely used in China and the implementation varies greatly. Given this, we developed a Practice Programme for Upright Positions in the Second Stage of Labour (UPSSL Programme). Whether the UPSSL Programme can be translated into action in the local context is a crucial issue that needs to be further explored. This study aimed to explore barriers and facilitators to the implementation of the UPSSL Programme in the Chinese context to facilitate the integration of evidence and routine clinical practice. A descriptive qualitative design was adopted. The study was conducted in the maternity unit of a tertiary general hospital in China. A purposeful sampling was used to recruit midwives, obstetricians and their leaders. Data were collected through semi-structured face-to-face interviews. The Consolidated Framework for Implementation Research was used to guide the development of interview guide and the analysis of qualitative data. The study was reported following the Standards for Reporting Qualitative Research. Twelve eligible participants were interviewed, including eight midwives, two obstetricians, the head nurse of the delivery room, and the head of the maternity unit. Eight barriers and 10 facilitators were identified by using the directed content analysis. The barriers to implementing the UPSSL Programme were professionals' concerns about the potential risks of the programme (relative advantage), higher complexity (complexity), placement method of upright positions presented without pictures (design quality & packaging), staff shortage (cost), limited understanding of parturients' needs (patient needs & resources), lack of a training protocol for professionals (available resources), professionals' limited knowledge and skills in the programme (knowledge & beliefs about the intervention), and lack of confidence in the successful implementation of the programme (self-efficacy). Participants expressed several barriers and facilitators to implementing the UPSSL Programme in clinical practice in the Chinese context. The findings provide a reference for the development of targeted implementation strategies that could promote the integration of evidence and routine clinical practice, and thus facilitate the normative application and promotion of upright positions in China. [ABSTRACT FROM AUTHOR]

Neuroimaging researchers tacitly assume that body-position scantily affects neural activity. However, whereas participants in most psychological experiments sit upright, many modern neuroimaging techniques (e.g., fMRI) require participants to lie supine. Sparse findings from electroencephalography and positron emission tomography suggest that body position influences cognitive processes and neural activity. Here we leverage multi-postural magnetoencephalography (MEG) to further unravel how physical stance alters baseline brain activity. We present resting-state MEG data from 12 healthy participants in three orthostatic conditions (i.e., lying supine, reclined at 45°, and sitting upright). Our findings demonstrate that upright, compared to reclined or supine, posture increases left-hemisphere high-frequency oscillatory activity over common speech areas. This proof-of-concept experiment establishes the feasibility of using MEG to examine the influence of posture on brain dynamics. We highlight the advantages and methodological challenges inherent to this approach and lay the foundation for future studies to further investigate this important, albeit little-acknowledged, procedural caveat. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to evaluate the role of the maternal position at the time of delivery on the onset of de novo symptoms of urinary incontinence (UI) in the post-partum period. Methods: This prospective study evaluated the data of consecutive women undergoing labour and delivery, between January 2014 and July 2014. We included only women with a singleton pregnancy undergoing vaginal delivery. During the study period, patients chose to deliver in the position that they considered the most comfortable. The onset of UI was evaluated according to the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-sf). Results: Overall, 716 primiparous women were included in the study. Sixty women refused the 12-week post-partum interview (8.4%). Women were divided in two groups: 296 women (45.1%) who chose an upright position during delivery (group 1) and 360 women (54.9%) who chose a supine position (group 2). Group 1 had a significantly lower episiotomy rate, but a higher rate of greater than second degree perineal tears. In group 1 we found a significantly lower rate of de novo UI (40.5% vs 48.9%, p = 0.03) and in particular of stress urinary incontinence. Via multivariate analysis, birth position was the only factor correlating with the occurrence of urinary incontinence in the post-partum period (OR: 1.52; 95%CI: 1.06, 2.18; p = 0.02). Conclusions: Upright positions at delivery are related to a lower episiotomy rate and a higher rate of greater than second degree perineal tears. Supine positions are an independent risk factor for the onset of de novo UI. [ABSTRACT FROM AUTHOR]

Background The heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70 years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined. Methods Twenty-five females and twenty-six males, 70 years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested. Findings The heel of most of the participants is positioned at a 60°–69° or 90°–99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal. Interpretation The relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores. [ABSTRACT FROM AUTHOR]

Background : Mother's position during labor has been a major concern for faster, easier and more tolerable birth. In fact, position change during labor be introduced ad a solution for dystopia, prolonged labor and labor arrest. Furthermore, pregnancy outcome including the health of fetus and neonate is affected by upright delivery position. Objective : To determine the effect of sitting position on the duration of 2nd stage of labor and neonatal apgar score. Design : This was a randomized controlled clinical trial. Samples: 100 women were selected consecutively and assigned randomly to one of trail or control group(50 in each). Results : The duration of 2nd stage of labor was significantly lower in case versus comparative group )p= 0.01). The statistical significance wasn't found for the 1st and 5 minutes after birth apgar score in comparison between 2 groups. Discussion : Although, sitting position was found shorten the 2nd stage of labor in this study, it is suggested that mothers be given the chance to choose own position of delivery.

Abstract: Women in western countries generally lie semi-recumbent during first stage of labour, when perhaps it is more natural to move around. Consequently carers are unaware of what constitutes instinctive behaviours and their outcomes. With this in mind, a structured narrative review of the literature identified what prior research has shown about the impact of maternal movement upon length of first stage; results are ambiguous, with 11 studies reporting no alteration to length and 7 reporting shortening. These studies fail to adequately detail time spent mobilising and what in fact constituted walking, squatting, upright, lying lateral, supine or semi-recumbent, and their direct effects upon progress of first stage. Advancements in knowledge are required to progress understanding about maternal activity during labour and its outcomes. [Copyright &y& Elsevier]

Abstract: Objectives: to evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women''s bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. Design: quasi-experimental study. Setting: medical centre in Taichung, Taiwan. Participants: 66 women giving birth at the hospital, with 33 primigravidas assigned to each group. Interventions: during the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing. Outcome measures: pain scores were recorded at two evaluation time points: at 10cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores. Findings: the women in the experimental group had a lower pain index (5.67 versus 7.15, p=0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p<0.001), a shorter duration of the second stage of labour (91.0 versus 145.97, p=0.02) and more positive labour experiences (39.88 versus 29.64, p<0.001) compared with the control group. There was no significant difference in the Apgar score for newborn infants during either the first minute (7.70 versus 7.73, p=0.72) or the fifth minute (8.91 versus 8.94, p=0.64). Key conclusions: the pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience. Implications for practice: pushing interventions can yield increased satisfaction levels for women giving birth. [Copyright &y& Elsevier]

The aim of this study was to test the hypothesis that, in comparison with standard postures, aero posture (AP) would modify the coordination of lower limb muscles during pedalling and consequently would influence the pedal force production. Twelve triathletes were asked to pedal at an intensity near the ventilatory threshold (VT+Δ20%) and at an intenisty corresponding to the respiratory compensation point (RCP). For each intensity, subjects were tested under three positions: (1) upright posture (UP), (2) dropped posture (DP), and (3) AP. Gas exchanges, surface electromyography and pedal effective force were continuously recorded. No significant difference was found for the gas-exchange variables among the three positions. Data illustrate a significant increase [ gluteus maximus (GMax), vastus medialis (VM)] and decrease [ rectus femoris (RF)] in electromyography (EMG) activity level in AP compared with UP at RCP. A significant shift forward of the EMG patterns (i.e. later onset of activation) was observed for RF (at VT+Δ20% and RCP), GMax, VL, and VM (at RCP) in AP compared with UP. These EMG changes are closely related to alteration of force profile in AP (higher downstroke positive peak force, lower upstroke negative peak force, and later occurrence of these peaks along the crank cycle). [ABSTRACT FROM AUTHOR]