Avoiding instabilities in short gap car-followings with connected autonomous vehicles

The image of driverless vehicles cruising on highways has been coming closer to reality over the last years thanks to the constant investigations in the technologies used in Connected and Automated Vehicles (CAV). Platooning of CAVs has been the focal point of investigations due to the potential benefits that can be reaped from the proper implementation of platoons on highways. One of the challenges facing the successful operation of platoons is the bullwhip phenomenon that causes propagating perturbations in platoons hindering its stability. The present study focuses on eliminating or reducing the bullwhip effect suffered by vehicles in a platoon. The aforementioned platoon algorithm will be governed by the formula of the Desired Space Gap (DSG) as followers will have to maintain a gap equal to the DSG to follow the leader. This algorithm managed to successfully carry out any increase or decrease in velocity of the platoon however, in the case of braking it has proved to be extremely unstable and suffers from effect of the bullwhip phenomenon. The average cumulative gap was used as a solution to trigger an instant response from all vehicles down the platoon to the actions of the leader as it was observed that vehicles in the end of the platoon tend to approach the leaders at high velocities because they only start decreasing their velocities once the vehicle ahead of them decelerates rather than the leader. This solution has been effective in significantly reducing the bullwhip effect on some vehicles in the platoon only, mainly the ones at the end of the platoon. Furthermore, this solution has given positive results only in cases of great changes in velocity

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Relative bioavailability of terbutaline to the lung following inhalation, using urinary excretion

The urinary salbutamol pharmacokinetic to determine relative lung and systemic bioavailability has been extended to terbutaline. Mean(SD) urinary terbutaline 0.5h post inhalation, in 12 volunteers, with (IC) and without (I) oral charcoal and oral (O) dosing was 7.4(2.2), 6.5(2.1) and 0.2(0.2)µg. I and IC were similar and both significantly greater than O (p < 0.001). Urinary 24h terbutaline post I was similar to IC + O. The method was linear and reproducible similar to that of the urinary salbutamol method. The urinary salbutamol pharmacokinetic method post inhalation applies to terbutaline. Terbutaline study doses can replace routine salbutamol during these studies when patients are studied

Prevalence of Congenital Heart Diseases in Children with Congenital Hypothyroidism

The aim of the work was to assess the prevalence of cardiac anomalies in primary congenital hypothyroidism (PCH) patients. Fifty patients with PCH recruited after diagnosis by ultrasonography or scintigraphy (64% Dysgenesis, 36% Dyshormonogenesis). The prevalence of cardiac anomalies was 18%, with renal anomalies being 8%. There was no significant difference in the longitudinal follow-up of growth and sexual maturation between a hypothyroid with and without anomalies. Statistically significant difference was found with replacement therapy of both groups. Hence, echocardiography should be done to screen this birth defect as soon as possible so as to prevent or delay the possible complications. [Arch Clin Exp Surg 2013; 2(2.000): 85-91

Is vancomycin monitoring of real value in pediatric cancer patients?

Vancomycin is not nephrotoxic by itself but many patients using it with other nephrotoxic agents show nephrotoxicity to some extent. Whether to monitor or not to monitor vancomycin needs further study. The aim of the present study was to investigate the significance of monitoring vancomycin serum levels in pediatric patients treated from different malignancies. 150 newly diagnosed pediatric patients, with various types of malignancy treated with different nephrotoxic agents including vancomycin, were recruited in the study. All patients had normal renal functions at the start of the study and were divided into three groups; Group I included 50 (21 females) patients received vancomycin without monitoring (VWOM group); Group II included 50 (19 females) patients received vancomycin with monitoring (VWM group); Group III (Control group) included 50 (23 females) patients received vancomycin-free antimicrobial agents (VF group). Vancomycin trough level was determined only for VWM group. The effectiveness of monitoring was estimated by the ability to achieve more rapid response, decrease hospital stay and nephrotoxicity and its effect on total dose of vancomycin. There was a significant decrease in nephrotoxicity in VWM and VF groups, 9 subjects (18%), compared to 15 subjects (30%) in VWOM group (p=0.016). The time needed to show a response achievement was significantly decreased in VWM group compared to VWOM group with mean (SD) of 6.5 (2.5) and 8.7 (3.6) days, respectively (p=0.015). That led to shorter hospital stay in VWM group compared to VWOM group with mean (SD) of 10.1 (3.4) and 12.4 (4.2) days, respectively (p=0.003). Monitoring vancomycin level was important in the examined high risk groups of pediatric cancer patients studied. [Med-Science 2018; 7(1.000): 54-57

Effect of camel milk on lipid profile among patients with diabetes: a systematic review, meta-analysis, and meta-regression of randomized controlled trials

Abstract The effects of camel milk (CM) intake on lipid profile among patients with diabetes remain controversial. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to calculate the effect size of CM intake on blood lipids among patients with type 1 (T1D) and type 2 (T2D) diabetes. We searched nine databases from inception until December 31, 2022, to identify relevant RCTs. Effect sizes for total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) were calculated and expressed using mean differences (MD) and confidence intervals (CI). Of 4,054 retrieved articles, 10 RCTs (a total of 347 participants aged 8–70 years, 60.5% male) were eligible for inclusion. The pooled results from a random-effects model showed statistically significant decreases in TC (MD − 21.69, 95% CI: 41.05, − 2.33; p = 0.03; I 2=99%), TG (MD − 19.79, 95% CI: −36.16, − 3.42; p=0.02, I 2=99%), and LDL (MD −11.92, CI: −20.57, −3.26; p = 0.007, I 2=88%), and a significant increase in HDL (MD 10.37, 95% CI, 1.90, 18.84; p=0.02, I 2=95%) in patients with diabetes supplemented with CM compared with usual care alone. Subgroup analysis revealed that only long-term interventions (> 6 months) elicited a significant reduction in TC levels and TG levels. Consumption of fresh CM by patients with diabetes resulted in significant reductions in TC, TG, and LDL levels, while showing a significant increase in HDL levels. Patients with T1D elicited a more beneficial effect in lowering TC, LDL, and TG levels and in increasing HDL levels than their corresponding partners with T2D. In conclusion, long-term consumption of CM for patients with diabetes, especially those with T1D, could be a useful adjuvant therapy to improve lipid profile alongside prescribed medications. However, the high heterogeneity in the included studies suggests that more RCTs with larger sample sizes and longer intervention durations are required to improve the robustness of the available evidence

Ramadan intermittent fasting is associated with ameliorated inflammatory markers and improved plasma sphingolipids/ceramides in subjects with obesity: lipidomics analysis

Abstract Intermittent fasting (IF) is associated with enormous metabolic alterations that underpin its diverse health effects. Changes in lipid metabolism, particularly ceramides, and other sphingolipids, are among the most notable of these alterations. This study investigated the lipidomic alterations associated with 29–30 days of Ramadan diurnal intermittent fasting (RIF) in metabolically healthy overweight and obese subjects. A prospective cohort of 57 overweight and obese adults (70% males, 38.4 ± 11.2 years), with an age range of 18–58 years was observed prior to and at the conclusion of Ramadan. At both time points, anthropometric, biochemical (lipid profile, glycemic, and inflammatory markers), and dietary intake measurements were taken. Using liquid chromatography-mass spectrometry, a lipidomic analysis of ceramides and other sphingolipids was conducted. Using paired sample t-tests, pre- and post-Ramadan anthropometric, biochemical, and dietary values were compared. RIF was associated with improved levels of lipid profile compartments and inflammatory markers. In addition, RIF was associated with a decrease in plasma sphingosine and sphinganine, which was accompanied by a decrease in sphingosine 1-phosphate and sphinganine 1-phosphate. In addition, RIF was associated with decreased C17, C22, and C24 sphingomyelin, but not C14, C16, C18, C20, and C24:1 sphingomyelin, as well as C20, C22, C24, and C24:1 dihydrosphingomyelin, but not C16 and C18 dihydrosphingomyelin. This study demonstrates that RIF is associated with improvements in plasma sphingosine, sphinganine sphingomyelin, and dihydrosphingomyelin lipid species, as well as improved lipid profile and inflammatory markers, which may confer short-term protection against cardiometabolic problems in patients with overweight/obesity