Strategies to identify muscle fatigue from SEMG during cycling

Detection, quantification and analysis of muscle fatigue are crucial in occupational/rehabilitation and sporting settings. Sports organizations, such as the Australian Institute of Sports (AIS), currently monitor fatigue by a battery of tests including invasive techniques that require taking blood samples and/or muscle biopsies, the latter of which is highly invasive, painful, time consuming and expensive. SEMG (surface electromyography) is non-invasive monitoring of muscle activation and is an indication of localized muscle fatigue based on the observed shift of the power spectral density of the SEMG. The success of SEMG based techniques is currently limited to isometric contraction and is not acceptable to the human movement community. The paper proposes and tests a simple signal processing technique to identify the onset of muscle fatigue during cyclic activities of muscles, such as VL and VM, during cycling. Based on experiments conducted with 7 participants, using power output as a measure of fatigue, the technique is able to identify muscle fatigue with 98% significance

Prevalence of Vitamin B12 Deficiency in Patients with type 2 Diabetes Mellitus on Metformin

Background: Type 2 diabetes mellitus (T2DM) is a common public health problem in metabolism. Metformin is the oral hypoglycemic agent used as a first line together with life style modification in type 2 diabetes patients worldwide. Continuous metformin therapy increases the risk of vitamin B12 insufficiency, and its medical consequences in T2DM patients. Objective: To detect the prevalence of serum vitamin B12 deficiency in T2DM who has been treated with metformin in Erbil Province. Patients and Methods: The study involved 200 cases (100 patients and 100 controls) that met the study's basic criteria. A completed questionnaire, and a blood test for serum vitamin B12 levels were performed. A deficiency of vitamin B12 is defined as <160 pg/mL in serum vitamin B12. Results: Deficiency of serum vitamin B12 was found in 48% of patients (n=48), while HbA1c levels had no impact on this finding. In T2DM level of serum vitamin B12 that has been on metformin at a dose of ≤ 1 gm/ day shows a significant difference with those patients with no history of metformin use. Conclusion: Low levels of serum vitamin B12  came as a result of the overdosing of metformin for long period of treatment

Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.

BACKGROUND: The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions. METHODS: The Context and Implementation of Complex Interventions (CICI) framework was developed in an iterative manner and underwent extensive application. An initial framework based on a scoping review was tested in rapid assessments, revealing inconsistencies with respect to the underlying concepts. Thus, pragmatic utility concept analysis was undertaken to advance the concepts of context and implementation. Based on these findings, the framework was revised and applied in several systematic reviews, one health technology assessment (HTA) and one applicability assessment of very different complex interventions. Lessons learnt from these applications and from peer review were incorporated, resulting in the CICI framework. RESULTS: The CICI framework comprises three dimensions-context, implementation and setting-which interact with one another and with the intervention dimension. Context comprises seven domains (i.e., geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, political); implementation consists of five domains (i.e., implementation theory, process, strategies, agents and outcomes); setting refers to the specific physical location, in which the intervention is put into practise. The intervention and the way it is implemented in a given setting and context can occur on a micro, meso and macro level. Tools to operationalise the framework comprise a checklist, data extraction tools for qualitative and quantitative reviews and a consultation guide for applicability assessments. CONCLUSIONS: The CICI framework addresses and graphically presents context, implementation and setting in an integrated way. It aims at simplifying and structuring complexity in order to advance our understanding of whether and how interventions work. The framework can be applied in systematic reviews and HTA as well as primary research and facilitate communication among teams of researchers and with various stakeholders

Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data

Drivers need sufficient passing sight distance (PSD) to pass slower vehicles with safety. This distance can help to improve traffic operation on two-way, two-lane highways. Existing models propose different values of PSD because of different assumptions. In only some cases were these models based on field data of passing maneuvers. This research proposed the design of a methodology to observe passing maneuvers on existing highways with the help of six video cameras installed at a fixed point next to passing sections. The use of more cameras allows complete registration of trajectories along the entire passing zone, with uniform image resolution. The methodology was applied to register a sample of 234 maneuvers on four passing zones. Trajectories of 58 maneuvers were completely described and analyzed with specific restitution software. Results were compared with those from existing PSD models. The distances traveled proposed by the AASHTO model on the left lane were (a) similar to average observed distances when the passed vehicle was one truck and (b) between 50 and 100 m higher when one passenger car was passed. Higher differences, greater than 100 m, were found between measured data and the PSD model (published previously), especially at high design speeds. The observed average speed difference between passing and impeding vehicles was significantly higher than that in any model. Variables with the strongest influence on the time and distance traveled on the opposing lane were the type and speed of the passed vehicle and the length of the passing zone. Left-lane time and distance increase with this length.Llorca Garcia, C.; García García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record. 2262:42-51. doi:10.3141/2262-05S42512262Farah, H., Bekhor, S., & Polus, A. (2009). Risk evaluation by modeling of passing behavior on two-lane rural highways. Accident Analysis & Prevention, 41(4), 887-894. doi:10.1016/j.aap.2009.05.006Rilett, L. R., Hutchinson, B. G., & Whitney, M. (1990). Mechanics of the passing maneuver and the impact of large trucks. Transportation Research Part A: General, 24(2), 121-128. doi:10.1016/0191-2607(90)90019-3Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Harwood, D. W., Gilmore, D. K., & Richard, K. R. (2010). Criteria for Passing Sight Distance for Roadway Design and Marking. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 36-46. doi:10.3141/2195-0

The Fundamental Diagram of Pedestrian Movement Revisited

The empirical relation between density and velocity of pedestrian movement is not completely analyzed, particularly with regard to the `microscopic' causes which determine the relation at medium and high densities. The simplest system for the investigation of this dependency is the normal movement of pedestrians along a line (single-file movement). This article presents experimental results for this system under laboratory conditions and discusses the following observations: The data show a linear relation between the velocity and the inverse of the density, which can be regarded as the required length of one pedestrian to move. Furthermore we compare the results for the single-file movement with literature data for the movement in a plane. This comparison shows an unexpected conformance between the fundamental diagrams, indicating that lateral interference has negligible influence on the velocity-density relation at the density domain $1 m^{-2}<\rho<5 m^{-2}$. In addition we test a procedure for automatic recording of pedestrian flow characteristics. We present preliminary results on measurement range and accuracy of this method.Comment: 13 pages, 9 figure

New consistency index based on inertial operating speed

The occurrence of road crashes depends on several factors, with design consistency (i.e., conformance of highway geometry to drivers' expectations) being one of the most important. A new consistency model for evaluating the performance of tangent-to-curve transitions on two-lane rural roads was developed. This model was based on the inertial consistency index (ICI) defined for each transition. The ICI was calculated at the beginning point of the curve as the difference between the average operating speed on the previous 1-km road segment (inertial operating speed) and the actual operating speed at this point. For the calibration of the ICI and its thresholds, 88 road segments, which included 1,686 tangent-to-curve transitions, were studied. The relationship between those results and the crash rate associated with each transition was analyzed. The results showed that the higher the ICI was, the higher the crash rate; thus, the probability of accidents increased. Similar results were obtained from the study of the relationship between the ICI and the weighted average crash rate of the corresponding group of transitions. A graphical and statistical analysis established that road consistency might be considered good when the ICI was lower than 10 km/h, poor when the ICI was higher than 20 km/h, and fair otherwise. A validation process that considered 20 road segments was performed. The ICI values obtained were highly correlated to the number of crashes that had occurred at the analyzed transitions. Thus, the ICI and its consistency thresholds resulted in a new approach for evaluation of consistency.The authors thank the Center for Studies and Experimentation of Public Works of the Spanish Ministry of Public Works, which partially subsidized the data collection, for obtaining the empirical operating speed profiles used in the validation process. The authors also thank the General Directorate of Public Works of the Infrastructure and Transportation Department of the Valencian government, the Valencian Province Council, and the General Directorate of Traffic of the Ministry of the Interior of the Government of Spain for their cooperation in data gathering.García García, A.; Llopis Castelló, D.; Camacho Torregrosa, FJ.; Pérez Zuriaga, AM. (2013). New consistency index based on inertial operating speed. Transportation Research Record. (2391):105-112. doi:10.3141/2391-10S1051122391Ng, J. C. ., & Sayed, T. (2004). Effect of geometric design consistency on road safety. Canadian Journal of Civil Engineering, 31(2), 218-227. doi:10.1139/l03-090Gibreel, G. M., Easa, S. M., Hassan, Y., & El-Dimeery, I. A. (1999). State of the Art of Highway Geometric Design Consistency. Journal of Transportation Engineering, 125(4), 305-313. doi:10.1061/(asce)0733-947x(1999)125:4(305)Hassan, Y. (2004). Highway Design Consistency: Refining the State of Knowledge and Practice. Transportation Research Record: Journal of the Transportation Research Board, 1881(1), 63-71. doi:10.3141/1881-08Polus, A., & Mattar-Habib, C. (2004). New Consistency Model for Rural Highways and Its Relationship to Safety. Journal of Transportation Engineering, 130(3), 286-293. doi:10.1061/(asce)0733-947x(2004)130:3(286)Cafiso, S., Di Graziano, A., Di Silvestro, G., La Cava, G., & Persaud, B. (2010). Development of comprehensive accident models for two-lane rural highways using exposure, geometry, consistency and context variables. Accident Analysis & Prevention, 42(4), 1072-1079. doi:10.1016/j.aap.2009.12.015Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-0

Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing

The paper presents an application of a reliability analysis for evaluating the risk associated with passing sight distance (PSD) standards in terms of the expected probability of noncompliance. Calculation of PSD is required to determine where drivers can safely execute passing maneuvers. Traditional PSD standards are based on deterministic, theoretical models, which are calibrated with conservative percentile values for uncertain design inputs to account for uncertainty. The PSD standards do not provide information about the risk of deviation from them. Reliability analysis is a technique that is based on limit state design and that accounts for the propagation of variability from input random parameters to the design outputs. A total of 1,098 passing maneuvers were observed on several two-lane highways in Spain; two data collection methodologies were used: external observations and an instrumented vehicle. The most significant factors affecting PSD were impeding-vehicle speed, passing-vehicle acceleration, and head-ways between impeding and passing vehicles. A uniform acceleration model described the passing-vehicle trajectory. The characterized input parameters and the passing model were used to perform a reliability analysis. The results showed the probability of noncompliance in different scenarios, defined as the proportion of cases in which the required PSD would exceed the available sight distance. American and Spanish PSD standards were evaluated. Geometric design standards presented a probability of noncompliance of about 0.15, whereas some marking standards had a probability of noncompliance exceeding 0.85. These standards may be associated with higher risk levels if they are followed by drivers. As well, PSD risk levels were not consistent for different design speeds, since they underestimated operating speed at some locationsThis paper was developed as a result of a mobility study at the University of British Columbia funded by the Erasmus Mundus Program of the European Commission under the Transatlantic Partnership for Excellence in Engineering project. The authors thank the Spanish Ministry of Economy and Competitiveness, which subsidized the research project, and the Spanish Directorate General of Traffic, Spanish Ministry of Public Works, Valencia Regional Department of Transport, and Valencia province road department for their collaboration during the field study.Llorca Garcia, C.; Moreno Chou, AT.; Sayed, T.; García García, A. (2014). Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing. Transportation research record. 2404:18-26. doi:10.3141/2404-03S18262404Ismail, K., & Sayed, T. (2009). Risk-based framework for accommodating uncertainty in highway geometric design. Canadian Journal of Civil Engineering, 36(5), 743-753. doi:10.1139/l08-146Ismail, K., & Sayed, T. (2010). Risk-Based Highway Design. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 3-13. doi:10.3141/2195-01Richl, L., & Sayed, T. (2006). Evaluating the Safety Risk of Narrow Medians Using Reliability Analysis. Journal of Transportation Engineering, 132(5), 366-375. doi:10.1061/(asce)0733-947x(2006)132:5(366)Harwood, D. W., Gilmore, D. K., & Richard, K. R. (2010). Criteria for Passing Sight Distance for Roadway Design and Marking. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 36-46. doi:10.3141/2195-05Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Llorca, C., & García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record: Journal of the Transportation Research Board, 2262(1), 42-51. doi:10.3141/2262-05Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Llorca, C., Moreno, A. T., García, A., & Pérez-Zuriaga, A. M. (2013). Daytime and Nighttime Passing Maneuvers on a Two-Lane Rural Road in Spain. Transportation Research Record: Journal of the Transportation Research Board, 2358(1), 3-11. doi:10.3141/2358-01Easa, S. M. (1993). Reliability‐Based Design of Intergreen Interval at Traffic Signals. Journal of Transportation Engineering, 119(2), 255-271. doi:10.1061/(asce)0733-947x(1993)119:2(255)Selvanathan, E. A., & Selvanathan, S. (1994). The demand for transport and communication in the United Kingdom and Australia. Transportation Research Part B: Methodological, 28(1), 1-9. doi:10.1016/0191-2615(94)90027-2Easa, S. M. (2000). Reliability Approach to Intersection Sight Distance Design. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 42-52. doi:10.3141/1701-06Ibrahim, S. E.-B., & Sayed, T. (2011). Developing safety performance functions incorporating reliability-based risk measures. Accident Analysis & Prevention, 43(6), 2153-2159. doi:10.1016/j.aap.2011.06.006Khoury, J. E., & Hobeika, A. G. (2007). Assessing the Risk in the Design of Passing Sight Distances. Journal of Transportation Engineering, 133(6), 370-377. doi:10.1061/(asce)0733-947x(2007)133:6(370)Khoury, J. E., & Hobeika, A. G. (2012). Integrated Stochastic Approach for Risk and Service Estimation: Passing Sight Distance Application. Journal of Transportation Engineering, 138(5), 571-579. doi:10.1061/(asce)te.1943-5436.0000366Kim, S., & Choi, J. (2013). Effects of preceding geometric conditions on operating speed consistency of multilane highways. Canadian Journal of Civil Engineering, 40(6), 528-536. doi:10.1139/cjce-2012-005

Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study

Gemcitabine and oxaliplatin (GEMOX) are active as first-line therapy against advanced pancreatic cancer. This study aims to evaluate the activity and tolerability of this combination in patients refractory to standard gemcitabine (GEM). A total of 33 patients (median age of 57) were included with locally advanced and metastatic evaluable diseases, who had progressed during or following GEM therapy. The GEMOX regimen consisted of 1000 mg m−2 of GEM at a 100-min infusion on day 1, followed on day 2 by 100 mg m−2 of oxaliplatin at a 2-h infusion; a cycle that was given every 2 weeks. All patients received at least one cycle of GEMOX (median 5; range 1–29). Response by 31 evaluable patients was as follows: PR: 7/31(22.6%), s.d. ⩾8 weeks: 11/31(35.5%), s.d. <8 weeks: 1/31(3.2%), PD: 12/31(38.7%). Median duration of response and TTP were 4.5 and 4.2 months, respectively. Median survival was 6 months (range 0.5–21). Clinical benefit response was observed in 17/31 patients (54.8%). Grade III/IV non-neurologic toxicities occurred in 12/33 patients (36.3%), and grade I, II, and III neuropathy in 17(51%), 3(9%), and 4(12%) patients, respectively. GEMOX is a well-tolerated, active regimen that may provide a benefit to patients with advanced pancreatic cancer after progression following standard gemcitabine treatment

Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation