Influence of Landscape Design on Driving Behavior Based on Slope Illusion

In a continuous downhill section of a mountain highway, factors such as road alignment, roadside environment, and other visual characteristics will impact the slope illusion drivers experience and engage in unsafe driving behaviors. To improve the negative consequences of slope illusion and driving safety in continuous downhill sections, the effects of plant spacing, height, roadside distance, and color on driving behavior were all studied by simulating the plant landscape in a virtual environment. A driving simulator and UC-win/road software were used to conduct an indoor driving simulation experiment, and parameters such as speed and lateral position offset were used as the evaluation indices of driving stability to reflect the driver’s speed perception ability with subjective equivalent speeds. The results show that a plant landscape with appropriate plant spacing, height, roadside separation, and color is conducive to improving driving stability. Furthermore, a landscape with a height of 3 m, spacing of 10 m, roadside spacing of 0.75 m, and appropriate color matching can enhance the slope perception ability and speed perception ability of drivers, which is conducive to improving the driving safety of continuous downhill sections.

“Attention! A Door Could Open.”—Introducing Awareness Messages for Cyclists to Safely Evade Potential Hazards

Numerous statistics show that cyclists are often involved in road traffic accidents, often with serious outcomes. One potential hazard of cycling, especially in cities, is “dooring”—passing parked vehicles that still have occupants inside. These occupants could open the vehicle door unexpectedly in the cyclist’s path—requiring a quick evasive response by the cyclist to avoid a collision. Dooring can be very poorly anticipated; as a possible solution, we propose in this work a system that notifies the cyclist of opening doors based on a networked intelligent transportation infrastructure. In a user study with a bicycle simulator (N = 24), we examined the effects of three user interface designs compared to a baseline (no notifications) on cycling behavior (speed and lateral position), perceived safety, and ease of use. Awareness messages (either visual message, visual message + auditory icon, or visual + voice message) were displayed on a smart bicycle helmet at different times before passing a parked, still-occupied vehicle. Our participants found the notifications of potential hazards very easy to understand and appealing and felt that the alerts could help them navigate traffic more safely. Those concepts that (additionally) used auditory icons or voice messages were preferred. In addition, the lateral distance increased significantly when a potentially opening door was indicated. In these situations, cyclists were able to safely pass the parked vehicle without braking. In summary, we are convinced that notification systems, such as the one presented here, are an important component for increasing road safety, especially for vulnerable road users.

Analysis of osteoblast, osteoclast levels and radiographic patterns in the healing process of bone fractures (preliminary research)

Objectives: The healing process of a bone fracture goes through many phases. The hard callus phase was critical where the original structure was conducted. The hard callus growth depends on osteoblasts and osteoclasts active, and this condition can be analyzed on the radiograph. This study aimed to examine the analysis of bone fracture healing between osteoblasts and osteoclast numbers and radiographic patterns. Materials and Methods: The study used 12 male Wistar rats with an incomplete fracture in the right femur made by a dental tapered bur with 0.3 mm in length and 0.2 mm in depth. Digital radiographic examinations were carried out on days 0, 5, 10, 17, and 25 after fracturing in a lateral position. Furthermore, a radiographic analysis was performed using Image-J to obtain changes in the value of length and depth in the healing area. The research was conducted to find the radiopaque and radiolucent patterns and the number of osteoblasts and osteoclasts. Results: This study resulted in a change in the radiograph pattern. Callus formation resulted in fracture areas with a smaller distance from day 0 to day 25. The bone healing process begins with granulation tissue formation, followed by the gradual replacement of the connective tissue and bone. This process is comparable to the increase in osteoblasts up to day 25, which blocks bone resorption. Osteoclasts regulate bone resorption, and their number increases after 10 and 17 days to replace bone formation. Osteoclasts decline after 25 days because osteoblasts inhibit them, which control bone formation. Conclusion: The conclusions were obtained there are changes in the radiograph pattern. The radiopaque increased while the radiolucent decreased; the osteoclast pattern tended to be stable and lowered while the osteoblasts increased during the fracture healing process. The correlation of all the factors is very closely related.

Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT

Introduction: This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. Material and methods: A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. Discussion: There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.

Comparison of the Hypotension in Lateral Verses Sitting Positions during Induction of Spinal Anaesthesia for Caesarean Section

Objective: To compare the hypotension in lateral verses sitting positions during induction of spinal anaesthesia for caesarean section. Study Design: This is a Randomized control trial (RCT) study. Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of health sciences Karachi, from December 2018 to June 2019. Materials and Methods: All women age 18 to 45 underwent elective caesarian section having ASA I and II, singleton pregnancy on ultrasound with parity ≤3 were enrolled. Patients were randomized to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S) through lottery methods. Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they was placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured with the help of Non-invasive BP apparatus. BP was recorded at baseline then every 5 min till 30 minutes by anesthetist who was unaware of parturient group. Any single or more reading of SBP of <90 mmHg was considered as Hypotension. Results: Mean age of the patients in lateral group was 31.49 ±10.87 years and mean age of the patients in sitting group was 31.80 ±10.77 years (p-value 0.869). Majority of the patients 35 (62.5%) with hypotension were presented with sitting position. Chi square test was applied and statistically significant difference was observed between groups (p-value 0.012). Conclusion: We concluded that less frequency of hypotension was observed when spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position.

An Isolated Dextrogastria Simulating Diaphragmatic Rupture in a Post-Traumatic Context

We report a case of isolated dextrogastria discovered in imaging a 34-years-old woman who was in the emergency department for vomiting and fluctuating right chest pain following a road accident. It was a collusion between 2 motorcycles, the patient being a rear passenger, performing a whiplash mechanism with a brief initial loss of consciousness. The day after the accident, she complained of left cervical swelling, painful with dysphagia to solids. Physical examination revealed bilateral palpebral oedema. There was a decrease in right vesicular murmurs with symmetrical tympanism towards the base of the lung. The rest of the examination was normal. The chest x-ray showed digestive loops above the liver that appeared to be located in the right intra-thoracic, suggesting in this context a diaphragmatic rupture. The OGDT and the thoraco-abdominal CT made possible to correct the diagnosis of type II dextrogastria by showing the stomach and part of the colon located on the right, above the liver, under the diaphragmatic dome which is disembowelled, pushing back the lung homolateral up. There was also a deviation of the ipsilateral thoracic esophagus in continuity with the stomach. The liver, in the right quasi-lateral position, is forced downward, extending to the lower edge of the ipsilateral flank. The other viscera kept their usual topographies. KEY WORDS: Dextrogastria, Isolated dextrogastria, Chest pain, Dysphagia.

369 Mono-orifice mitral valve after transcatehter repair with mitraclip system

A 70 years old male with non-ischaemic dilated cardiomyopathy (left ventricular end-diastolic volume, LVEDV, 200 mL), reduced left ventricular ejection fraction (LVEF, 30%) and worsening dyspnoea was screened for transcatheter repair of severe mitral regurgitation (MR). Baseline echocardiogram showed marked symmetrical bi-leaflet tethering with a symmetrical central jet. Etiology was predominantly functional with organic features including partial flail scallop (A1) and a ruptured second order chorda (Figure 1A). Pre-operative strategy was to deploy a single MitraClip NT in the central position. After correct deployment of the first clip, we observed a remarkable reduction of regurgitant jets in the lateral position accompanied by a complete holosystolic lack of leaflet coaptation in the medial orifice which caused significant residual regurgitation. (Figure 1B) MitraClip deployment in the commissural position is associated with technical challenges, including limited maneuvering, risk of chordae rupture and inability to retrieve the device if entangled. (1) Therefore, after careful crossing of the medial neo-orifice and rapid positioning a second MitraClip NT was implanted medial to the first device in the commissural position (Figure 2). As a result, the medial orifice was obliterated resulting in an atypical mono-orifice morphology which resembles a commissural edge-to-edge plasty. Anterograde flow was normal (G med 2.5 mmHg) and the trivial residual jet of MR was lateral to the two clips implanted. At 1-year follow-up the patient was asymptomatic (NYHA functional class I) with a stable mild MR and no change in anterograde gradients; positive remodelling of the left ventricle (LVEDP: −48 ml) and increased LVEF (+8%) were observed. 369 Figure 1.