Management Center Research Articles

Oncological microdissection testicular sperm extraction (Onco-microTESE) outcomes for fertility preservation of patients with testicular cancer with azoospermia or severe oligoasthenoteratozoospermia.

To determine the success rate of oncological microdissection testicular sperm extraction (onco-microTESE) in patients with testicular cancer (TC) with azoospermia and severe oligoasthenoteratozoospermia (OAT; <1 million/mL sperm) and to explore any factors that may predict success. Case series of outcomes from all consecutive patients (42 testes in 38 patients) that presented or were referred to a single specialist tertiary referral centre for fertility management in the context of TC with severe OAT or azoospermia between August 2015 and August 2022. Biochemical, radiological, and histological parameters were collected for all patients. All patients underwent onco-microTESE (simultaneous radical inguinal orchidectomy with ex vivo microTESE of the affected testis). Those with unsuccessful surgical sperm retrieval (SSR) from the affected testis underwent contemporaneous contralateral microTESE, if no contraindication was present. The primary outcome was successful SSR from the affected testicle sufficient for assisted reproductive techniques. Secondary outcomes included contralateral microTESE success, the time from referral to procedure, and the total successful fertility preservation rate. Initial onco-microTESE was successful in 19 of 31 patients (61%) with azoospermia. Contralateral microTESE was successful in a further two of eight patients with azoospermia with failed onco-microTESE. Overall, 22/31 patients with azoospermia (71%) had successful fertility preservation in this series. In addition, six of seven patients with severe OAT had further sperm harvested by onco-microTESE to maximise their fertility preservation. All surgery was performed within median (interquartile range) of 7 (5-13) days from presentation. Onco-microTESE represents an effective method of fertility preservation for sub-fertile patients with TC without delaying oncological treatment. Knowledge of the fertility status at first presentation is essential to allow for such additional options for optimal fertility preservation in TC.

A Framework for Distributed Orchestration of Cyber-Physical Systems: An Energy Trading Case Study

The increasing number of active energy consumers, also known as energy prosumers, is dramatically changing the electricity system. New products and services that adopt the concept of dynamic pricing are available to the market, where demand and price forecasting are applied to determine schedule loads and prices. Throughout this manuscript, a novel framework for energy trading among prosumers is introduced. Rather than solving the problem in a centralized manner, the proposed orchestrator relies on a distributed game theory to determine optimal bids. Experimental results validate the efficiency of proposed solution, since it achieves average energy cost reduction of 2×, as compared to the associated cost from the main grid. Additionally, the hardware implementation of the introduced framework onto a low-cost embedded device achieves near real-time operation with comparable performance to state-of-the-art computational intensive solvers.

BS O06 - Management of Leaks post Bariatric Surgery: Recent Experience from a Tertiary Bariatric Surgery Referral Unit

Abstract Background Bariatric surgery has been consistently demonstrated to provide effective long-term sustained weight loss and remission of several life-threatening conditions. The most common bariatric procedures undertaken globally include laparoscopic sleeve gastrectomy (SG) and gastric bypass2. These procedures are safe and have low associated mortality rates [0.05% SG, 0.09% single anastomosis gastric bypass (SAGB) and Roux-en-Y (RNYGB)]3. However, complications including staple line and anastomotic leaks can occur in up to 3% of patients and are associated with significant morbidity, thus requiring prompt identification and treatment4. Our study aims to analyse management of these leaks and establish an algorithm for our centre. Method This was a retrospective study of consecutive patients who experienced post-bariatric surgery leak between 2018 to 2024, in a regional tertiary bariatric surgery referral unit in the UK, serving a population of 5 million. The study included patients who underwent bariatric surgery in the UK or abroad (SG, RNYGB and SAGB), both primary and revision cases, and were subsequently diagnosed with post-operative leak. Patients were initially managed in our facility or referred to our centre for ongoing management of leak from other centres. Demographics, time to presentation, hospital length of stay (LOS), diagnostic investigations performed, and management approaches were analysed. Results 22 patients (8 bypasses, 14 sleeves) were included. Mean time to presentation from index surgery was 19.6 days and mean LOS was 43.6 days. Initial management included conservative (3), endo-vacuum therapy (EVT) (4), stent (1), surgical (14) [9 laparoscopy and 5 laparotomy]. Surgical management comprised 7 T-tube insertions, 1 Foley catheter, 2 primary repairs, 2 EVTs, 1 washout and drain, and 1 stoma formation. Three patients required no further intervention, six needed different management approaches and three required re-operations. 7 patients were readmitted following discharge. Resolution of leak was achieved in all cases. There was no 90-day mortality. Conclusion Management of postoperative leak following bariatric surgery is a complex issue, requiring early identification, adequate drainage and control of sepsis, and maintenance of nutrition. Successful management requires a proactive and aggressive approach, including early clinical suspicion. Access to a range of interventions to support a dynamic approach to management is critical. The sequence and choice of management of leaks should be individualised according to each patient’s clinical presentation and investigation findings. A combination of different management approaches is often required for successful treatment of leak. Multicentre studies are needed to move closer to a consensus on managing bariatric leaks.

EGS SO20 - Management &amp; outcomes from oesophageal perforations at a tertiary centre

Abstract Background Oesophageal perforations, whilst rare, are a challenging surgical emergency. Traditionally associated with high morbidity and mortality, outcomes have progressively improved over the past 25 years, likely due to advances in medical care and specialised management in high volume tertiary centres. This study examines the management strategies and outcomes from oesophageal perforations at our tertiary unit. Method A retrospective cohort analysis was conducted on consecutive emergency cases of thoracic and junctional oesophageal perforations from January 2019 to June 2024. Data on patient demographics, baseline characteristics, management strategies and clinical outcomes were extracted from the patient’s electronic records. Kaplan-Meier survival curves were generated using the management approach and the extent of perforation as the predictive variables. Results 51 patients (mean age 47 years, 66% male) were treated for oesophageal perforations. The predominant aetiology was spontaneous (80%, n=41). Contained perforations were identified in 57% (n=29) of patients based on imaging, endoscopic, or operative findings. Conservative management was applied in 57% (n=29) of cases. Among those requiring intervention, 11 (58%) underwent surgery, while the remainder underwent endoscopical via vacuum therapy (32%, n=6) or stenting (11%, n=2). The mean in-hospital stay was 11 days (IQR 7-29). The 30-day mortality rate was 18% (n=9). Survival analysis revealed improved survival probabilities with contained perforations and non-surgical management strategies (p=0.023 and 0.001 respectively). Conclusion Our results demonstrate that the outcomes from oesophageal perforations continue to improve, reflecting ongoing advancements in therapeutic management. Furthermore, whilst surgery was once the mainstay, there appears to be a safe, increasing shift towards more conservative and endoscopic management.

Pengembangan Sumber Daya Manusia pada Produktivitas Kerja di Puskesmas

All individuals who operate actively and professionally in the health sector are considered health human resources, regardless of whether they have earned formal health education or not. The purpose of this study is to ascertain the Health Center's HR management implementation strategy. This study employed a descriptive qualitative methodology. Purposive sampling, nonprobability sampling, or a sampling strategy based on particular criteria were used to choose the study participants. Documentation, interviews, and observation are some of the data collection techniques. The study's findings show that the HR development management communication components and the recommendations for the Health Center HR development policy have been successfully applied. Even with the improvement in quality, there are still a number of barriers preventing resources from being used efficiently.

Lipoprotein-associated phospholipase A2 and its possible association with COPD development: a case-control study.

The association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with various cardiovascular events has been well-established. However, the exploration of its potential involvement in Chronic obstructive pulmonary disease (COPD) is currently limited. Therefore, our study aims to examine the relationship between Lp-PLA2 and pulmonary conditions, including emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction, to provide further evidence of a possible association with COPD development. Using data from the Southwest Hospital Health Management Center, spanning January 2013 to July 2024, we analyze relationship of serum Lp-PLA2 levels with diffuse pulmonary emphysema and pulmonary functions. In univariate analysis, group differences were assessed with t-tests for numerical variables and Chi-square tests for categorical data. Variables found to be statistically significant (two-sided P < 0.05) in univariate analysis were subsequently included as covariates in multivariate analysis, performed using a binary logistic regression model. Odds ratios and 95% confidence intervals were calculated to assess the differences. We established 2 case-control populations: the Imaging population (1056 subjects, mean age 57.666 ± 8.700 years old, 89.9% male) selected from 24,670 initial records, and the Pulmonary Function population (279 subjects, mean age 52.082 ± 11.473 years old, 71.4% male) selected from 1868 initial records. Univariate analysis revealed that serum Lp-PLA2 levels were significantly higher in patients with diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction compared to those without (454.682 ± 141.382U/L vs. 423.330 ± 140.658U/L, P < 0.001; 475.059 ± 157.181U/L vs. 420.824 ± 142.119U/L, P = 0.006; 475.31 ± 148.980U/L vs. 439.036 ± 157.977U/L, P = 0.049, respectively). Multivariate analysis further showed higher Lp-PLA2 levels were associated with increased risks of diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction. Using Lp-PLA2 ≤ 300 U/L as reference, odds ratios for the aforementioned conditions showed a gradually increasing trend with every 100U/L increase in Lp-PLA2 levels. Our preliminary study suggests that Lp-PLA2 is independently associated with diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction, which are commonly seen in COPD development. These findings indicated a possible association between Lp-PLA2 and COPD, though further validation is needed in a large cohort of COPD patients.

Navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region)

Objective. To assess navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region). Materials and methods. Navigation literacy of primary health care personnel was assessed among all heads of medical and obstetric centers in Orenburg region (n = 58). For this purpose, a single-stage continuous online survey was conducted using a combined questionnaire developed by the Central Research Institute for Healthcare Organization and Informatization of the Ministry of Heath of the Russian Federation. Results. The level of navigation literacy among the heads of the medical and obstetric centers of Orenburg region in 65.7 % of cases was excellent and sufficient. In the list of navigation skills, the heads of the medical and obstetric centers noted difficulties in the implementation of: issues of medical insurance (48.3 %), legal aspects of medical care and protection of patients' rights (27.5-48.3 %), healthcare reform (36.2 %). It was found out that from 63.7 % to 91.4 % of the heads of the medical and obstetric centers are aware of the ongoing state measures in the field of public health. The majority of the respondents (60.0 %) noted that they search for necessary information for professional purposes using digital tools. However, every third respondent (32.7 %) mentioned the difficulties in finding it on legislative issues, interpreting the quality and safety of food products according to their product labeling (27.6 %), solving problems related to mental health and well-being (18.9 %). These data demonstrate the need to improve navigation literacy of medical and obstetric centers managers in the digital environment. Conclusions. The modern multilevel and multicomponent healthcare system is associated with the need to improve the navigation literacy of medical personnel. The data obtained determined the main directions for improving navigation literacy of the heads of medical and obstetric centers.

The European Works Council and the Coverage of Expert Costs

In a recent case of the Austrian Supreme Court (OGH 29.8.2023, 8 ObA 28/23k), a European Works Council sought legal advice and wanted the costs to be covered by the central management of a group of undertakings. This request was denied on the ground that the European Works Council could also have obtained the same advice free of charge from a representative body. The Supreme Court ruled that the central management must also bear the expert costs in these cases and thus clarified that the European Works Council is not obliged to choose services that are free of charge. Case: Austrian Supreme Court ( Oberster Gerichtshof – OGH) of 29.8.2023, 8 ObA 28/23k, ECLI:AT:OGH0002:2023:008OBA00028.23 K.0829.000.

Abstract 4137869: Ross Procedure for Correction of Congenitally Unicuspid Aortic Valve: A Paradigm Shift?

Case 1: A 54-yr-old man reported exertional dyspnea for 3 months, with a systolic murmur on exam. TTE noted severe aortic stenosis, moderate insufficiency and possible bicuspid valve morphology. Coronary angiogram showed no obstructive disease. CT chest showed a 5-cm ascending aortic aneurysm. CT surgery evaluation was sought, and patient had a Ross procedure with aortic hemiarch repair. Intra-operative TEE confirmed a congenitally unicommissural, unicuspid aortic valve (UAV). A 7-month follow-up TTE showed a normal aortic and pulmonic prosthetic gradient. Case 2: A 46-yr-old lady reported progressive exercise intolerance, with a systolic murmur and faint S2 noted on exam. TTE showed severe aortic stenosis. MR angiogram showed a unicuspid valve and a mildly dilated aortic root. The patient was evaluated by CT surgery and underwent Ross procedure. TTE 4 years later showed a normal aortic and a moderately elevated pulmonic prosthetic gradient. Patient continues to exercise without limitations. Discussion: UAV is a rare entity with an incidence of 0.02%. It has a bimodal distribution, in infants and adults, with the unicommissural type more common in adults. Due to rapid progression of valvular disease, the mean age at diagnosis is 42 years. Concurrent aortic dilatation is present in 48% patients. Management of UAV is a matter of ongoing investigation. Classically, young patients with aortic valve disease underwent mechanical AVR. Ross procedure was under-utilized due to concerns about the surgical complexity and potential need for re-operation of the aortic and pulmonic grafts. However, recent studies show promising results. Patients with UAV have lower reoperation rates after a Ross procedure compared to a repair alone. Furthermore, a Ross procedure confers mortality benefit over mechanical AVR with no significant difference in immediate perioperative complications and mortality, although, this needs further investigation in a UAV cohort. Our cases support the feasibility of a Ross procedure for UAV, in providing a durable solution while avoiding anticoagulation in young patients. As Ross procedure is performed in limited centers, patients with UAV should be referred to such centers for definitive management.

QLTI-19. PEDIATRIC NEURO-ONCOLOGISTS NAVIGATING AN ADULT WORLD: A TALE OF TWO CENTERS

Abstract BACKGROUND Adolescent and Young Adult Neuro-Oncology(AYA-NO) patients are a distinct cohort with an overlap of tumors found in childhood and adulthood. For adult patients with pediatric-type Central Nervous System tumors, optimal work-flow to manage these patients is unclear. METHODS We examine the work-flow of pediatric neuro-oncologists starting AYA-NO clinics within two high volume adult institutions: the University of Miami(Florida, USA) and the Princess Margaret Cancer Centre(Toronto, Canada). RESULTS Over 18 months, the AYA-NO clinics managed 167 patients total with several key differences emerging in both institutions between the pediatric and adult work-flows. Adult providers commonly have neurology backgrounds, while pediatric providers mostly have hematology/oncology backgrounds. In pediatrics, providers typically meet the patient inpatient before pathology results, adult providers meet their patients in outpatient settings once histopathology results are available. Outpatient management in pediatric oncology centers typically includes labs, infusion centers, provider rooms, and social workers in one area while adults, due to the larger volume, have these services on separate units. Chemotherapy related differences included the primary provider for inpatient admissions and the emphasis of adult institutions on outpatient administration when feasible. Psychosocial factors such as the variety of caregivers, increased opportunity for patient autonomy in decision-making, and the increased fragmentation in care magnifies the importance of providers forming a strong rapport with AYA-NO patients. End of life care is vastly different including the inability for adult patients to receive palliative treatment in hospice care and the availability medically-assisted death. CONCLUSION Pediatric neuro-oncologists building AYA-NO workflows within adult settings can provide unique expertise for AYA-NO patients with pediatric-type tumors. Growing AYA-NO clinics can benefit from allocating AYA CNS specific resources such as chemotherapy/targeted therapy provider education, a dedicated hospital/clinic space, chemotherapy nursing, a care coordinator, and a social worker with experience treating this patient population.

Industrial Specialization in China: Effects of Central Tools Governing Subnational Agency

Abstract We examine how the central government's management of subnational governments' agency influences the smartness of the latter's industrial specialization choices. Based on smart industrial specialization theory and agency theory, we hypothesize how two central government tools governing subnational governments' agency – facilitating their organizational efficacy and promoting their officials to higher ranks – explain recent industrial specialization choices by China's 31 provincial governments. We find that provincial governments with greater organizational efficacy, measured by access to better-resourced local state-owned enterprises in focal industries, make smarter specialization policies. In addition, we show that provincial governments with greater numbers of officials previously promoted to the central government make, contrary to conventional wisdom, potentially less smart specialization policies. Our research extends smart specialization theory by explaining that central government tools governing subnational agency problems can have knock-on effects making subnational governments' industrial specialization choices smart or unsmart.

Knowledge, Attitude, and Practice of Healthcare Providers Towards Preventive Chemotherapy Neglected Tropical Diseases in the Forécariah Health District, Guinea, 2022

Background: Neglected tropical diseases (NTDs) are a diverse group of twenty diseases that occur in tropical and subtropical regions that particularly affect vulnerable and often marginalised populations. Five of these are classified as “preventive chemotherapy” (PC) diseases such as trachoma, onchocerciasis, geo-helminthiasis, lymphatic filariasis, and schistosomiasis. This study aimed to describe the knowledge, attitudes, and practices of healthcare providers in the Forecariah health district with respect to PC-NTDs in Guinea in 2022. Methods: A descriptive cross-sectional study was conducted from 7 to 22 November 2022 among healthcare providers in the health district of Forécariah in Guinea. Data on participants’ socio-demographic characteristics and knowledge of and attitudes and practices regarding PC-NTDs were collected using an electronic (KoboToolbox) semi-structured questionnaire and analysed using descriptive statistics. Results: Among the 86 healthcare providers who participated in this study, nurses (44.2%) and young adults aged between 25 and 49 years (81.4%) were mostly represented. The majority of respondents declared having already heard about onchocerciasis (70.7%) and lymphatic filariasis (60.0%) but only the minority declared having already heard about geo-helminthiasis (30.7%), schistosomiasis (21.3%), and trachoma (9.3%). Only a few respondents knew how to prevent PC-NTDs (onchocerciasis 26.7%, lymphatic filariasis 26.7%, geo-helminthiasis 29.3%, and schistosomiasis 17.3%). Many healthcare providers reported they would refer cases of onchocerciasis (50.6%), lymphatic filariasis (58.7%), and schistosomiasis (46.7%) to a management centre. Conclusions: This study highlights the varying levels of knowledge, attitudes, and practices among healthcare providers in dealing with PC-NTDs, suggesting areas for improvement in training and resource allocation.

Microplastic Contamination in Landfill Leachate and Surface Water: Assessment of Wastewater Treatment Efficiency at the Nonthaburi Waste Management Center, Thailand

Microplastics (MPs), plastic particles smaller than 5 mm, have emerged as a significant environmental concern, particularly as contaminants originating from landfills. Landfills can serve as a major source of MPs, potentially releasing them into surface water through leachate. This study aims to investigate the contamination of MPs in leachate and surface water, as well as to evaluate the efficiency of landfill wastewater treatment in removing these particles. The research was conducted at the Waste Management Center of the Nonthaburi Provincial Administrative Organization, Thailand, with samples collected in June 2023. Sampling included two leachate sources, influent and effluent from the treatment system and surface water. The abundance and characteristics of MPs in each sample were analyzed. Results indicated a significant presence of MPs in leachate, with an average concentration of 173.98 pieces/L, while concentrations in influent, effluent and surface water were 38.40 pieces/L, 10.80 pieces/L and 11.33 pieces/L, respectively. MPs in all samples were predominantly in the size range of 16-100 µm, corresponding to 71.28-93.75% of the total particles. Polypropylene was the dominant polymer in leachate (69.66%) and effluent (48.94%), whereas acrylate copolymer (96.53%) and polytetrafluoroethylene (44.12%) were the major types found in influent and surface water, respectively. The wastewater treatment system of the landfill demonstrated an overall removal efficiency of 71.88% for MPs in leachate. These findings highlight the extent of MP contamination in landfill environments and the importance of improving treatment processes to mitigate their release into surrounding ecosystems.

Exploring the Psychological Mechanism of How the Multidimensional Service Quality of Fitness Centers Affects Consumer Satisfaction and Loyalty Depending on the Level of Exercise Involvement

This study aimed to examine the influence of core services and the physical servicescape and social servicescape on consumer satisfaction and loyalty via perceived price fairness, flow experience, and rapport in fitness centers. Additionally, the present study explored how exercise involvement moderates the relationship between perceived price fairness, flow experience, rapport, and consumer satisfaction. For these purposes, targeting adults using fitness centers in South Korea, a total of 763 participants were sampled based on a cross-sectional design and used for data analyses involving confirmatory factor analysis for measurement validation and latent moderated structural equation modeling for hypothesis testing. The results showed that the core services, physical servicescape, and social servicescape enhance perceived price fairness, flow experiences, and rapport between staff and consumers, respectively. The study findings also indicated that exercise involvement significantly moderates the effect of price fairness and flow experience on satisfaction but not rapport. These insights offer practical and theoretical implications for fitness center management, emphasizing the importance of tailored service strategies in retaining loyal customers.

Analisis Motivasi Kerja, Lingkungan Kerja, dan Produktivitas Kerja Pegawai Pada Pusat Pengelolaan Pendapatan Daerah Wilayah Karawang

This research aims to find out and understand the results of the analysis of work motivation, work environment and employee work productivity at the Regional Revenue Management Center for the Karawang Region. The location of this research is the Regional Revenue Management Center for the Karawang Region. This research method uses a qualitative descriptive approach, expressed through word selection, sentence construction, detailed narrative and visual representation. Data collection techniques using interviews, observation and documentation. The results of research on work motivation provided at the Regional Revenue Management Center for the Karawang Region are quite good. The working environment at the Regional Revenue Management Center in the Karawang Region is still less comfortable for working employees, because several facilities were found to be not very functional. The work productivity of employees at the Regional Revenue Management Center for the Karawang Region can be seen from work efficiency, always trying to provide fast and precise services to the community, but increasing work productivity has not been achieved or is not yet optimal. In this way, of course, to increase employee work productivity at the Karawang Region Regional Revenue Management Center, it is necessary to pay attention to work motivation, especially the work environment so that it can leave a deep impression on employees, which will produce better results for employees.

Successful management of complete heart block in checkpoint inhibitor induced myocarditis by left bundle branch area pacing: a case report

Abstract Background Optimal management of checkpoint inhibitor-induced complete heart block is unknown. Previous reports showed relatively high incidence of pacing failure due to the co-existing myocarditis. Case summary A 71-year-old male with a prior history of stage IV metastatic squamous cell lung cancer presents was admitted for dyspnoea and hypotension 10 days after checkpoint inhibitor treatment using pembrolizumab. He was found to have myocarditis, third-degree AV block, severe left ventricular systolic dysfunction with EF 35%, and required pressure support. A dual chamber pacemaker using left bundle branch area pacing (LBBAP) was urgently placed that immediately improved his haemodynamics. Both the cathode and anode were able to capture the ventricle at different pacing outputs. The patient was taken off all intravenous pressors and successfully transferred to a larger centre for further management of the myocarditis with no further arrhythmia or hypotension. Discussion In conclusion, because of the unique ability to capture a large amount of myocardium from both the tip and ring electrodes as well as the ability to deliver cardiac resynchronization therapy, LBBAP may be the preferred pacing strategy in patients who develop complete heart block due to checkpoint inhibitor-induced myocarditis.

Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer

BackgroundThe use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality. MethodsData was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)). ResultsOverall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, p < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15–1.32], p < 0.001). DiscussionThe overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient’s condition.

Enhancing Road Safety with Smart Infrastructure: Development and Implementation of Advanced Zebra Crossings and Speed Breaking

Abstract: This study addresses a critical issue in road safety by proposing innovative solutions to mitigate accidents caused by speeding and reckless driving, particularly in high-risk areas such as highways, hospitals, and schools. With road traffic accidents accounting for approximately 1.3 million fatalities annually, along with 20 to 50 million injuries or disabilities, the inefficacy of traditional traffic control systems is a growing concern. Factors such as poor visibility, adverse weather, and driver distractions further compromise the effectiveness of conventional signs and signals. This research introduces a "smart zebra crossing" system that integrates ultrasonic sensors and embedded LED lights to provide real-time alerts to both drivers and pedestrians, thereby enhancing visibility and safety, especially under low-light conditions. Additionally, a "smart speed breaking" system is proposed, which dynamically adjusts its height based on vehicle speed, detected through ultrasonic sensors, prompting drivers to decelerate when necessary. Both systems are linked to a central traffic management network, facilitating real-time adjustments in speed limits and providing alerts to connected vehicles. The integration of these technologies represents a significant advancement in road safety, offering an adaptive, intelligent solution for improving traffic management and reducing the risk of accidents, particularly in vulnerable zones.

A Cloud Infrastructure for Health Monitoring in Emergency Response Scenarios.

Wearable devices have a significant impact on society, and recent advancements in modern sensor technologies are opening up new possibilities for healthcare applications. Continuous vital sign monitoring using Internet of Things solutions can be a crucial tool for emergency management, reducing risks in rescue operations and ensuring the safety of workers. The massive amounts of data, high network traffic, and computational demands of a typical monitoring application can be challenging to manage with traditional infrastructure. Cloud computing provides a solution with its built-in resilience and elasticity capabilities. This study presents a Cloud-based monitoring architecture for remote vital sign tracking of paramedics and medical workers through the use of a mobile wearable device. The system monitors vital signs such as electrocardiograms and breathing patterns during work sessions, and it is able to manage real-time alarm events to a personnel management center. In this study, 900 paramedics and emergency workers were monitored using wearable devices over a period of 12 months. Data from these devices were collected, processed via Cloud infrastructure, and analyzed to assess the system's reliability and scalability. The results showed a significant improvement in worker safety and operational efficiency. This study demonstrates the potential of Cloud-based systems and Internet of Things devices in enhancing emergency response efforts.

Skeletal phenotypes in postmenopausal women affected by primary hyperparathyroidism.

The current primary hyperparathyroidism (PHPT) presents as a mild disease. We explored skeletal phenotypes in postmenopausal women affected by PHPT, focusing on fracture prevalence. PHPT women were retrospectively evaluated at four Italian centers for osteoporosis management (two centers in Milan, n = 244; Cuneo, n = 128; Pisa, n = 131). Data collected from clinical records were analyzed by hierarchical clusterization. Considering the whole PHPT series [n = 503, aged 67.0 (61.0-74.0) years], 90% had low bone mineral density (BMD) and approximately 30% reported at least one fracture. Vertebral fractures were associated with older age and lower hypophosphatemia, while women with appendicular fractures were younger with less severe hypophosphatemia. Fractures were predicted by lumbar T-score. By using a clustering approach, we identified four different skeletal phenotypes (cluster, C): C1 (n = 53) and C2 (n = 172) included women with lumbar and femur neck osteopenia, with low prevalence of fractures (11.3%). Osteoporotic PHPT women were grouped into C3 (n = 142) and C4 (n = 136); all women in C4 experienced fractures, were older, and were more frequently affected with cardiovascular diseases. In contrast, women included in C3 never experienced fractures and had a lower body mass index (BMI), though they were characterized by severe reduction in BMD at both lumbar and femur sites. Ionized and total calcium, phosphate, 25hydroxyvitamin D levels, kidney function, and stone prevalence (range, 26.4%-29.0%) were similar among clusters C1, C2, and C4, while unfractured women in C3 showed slightly higher ionized hypercalcemia, lower hypophosphatemia, and higher hypercalciuria with a trend to more frequently develop kidney stones (38.7%) than women in the remaining clusters. Skeletal involvement in women with PHPT presented heterogeneous phenotypes with different prevalence of fractures. Fractures were not related to PHPT severity, suggesting that other factors besides PHPT, such as age, BMI, and lumbar and femur BMD, should be considered in the evaluation of bone involvement in postmenopausal women with PHPT.