Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados / Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials

Este estudio tuvo como objetivo evaluar la efectividad del entrenamiento muscular pélvico temprano para reducir los síntomas de incontinencia urinaria, mejorar la calidad de vida, función sexual y aumentar la fuerza de suelo pélvico en pacientes posprostatectomía radical. Se realizó una búsqueda en 8 bases de datos hasta el 26 de octubre de 2022, se evaluó la calidad metodológica y el riesgo de sesgo de 14 estudios incluidos (n=1236), se calculó la evidencia y el metaanálisis. El entrenamiento redujo significativamente los síntomas de incontinencia urinaria en comparación con un grupo control (DME=−2,80; IC 95%=−5,21 a −0,39; p=0,02), con heterogeneidad significativa (I2=83%; p=<0,0001) y evidencia moderada. Además, presentó evidencia moderada para mejorar la calidad de vida, y muy baja para mejorar la función sexual y fuerza de suelo pélvico. Estos resultados deben ser observados con precaución debido a la heterogeneidad significativa de los estudios analizados. (AU)

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=−2.80, 95% CI=−5.21 to −0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed. (AU)

[Translated article] Mechanical properties variations of immature bone in the earliest stages of development.

INTRODUCTION: Bone as a material varies its composition and mechanical properties throughout life. Although these variations are better understood in adulthood, there is little experimental information on the variation of these properties in early stages of development. The objective of this study is to analyze the mechanical behavior and chemical properties of cortical bone tissue from two animal species in these earliest stages. MATERIAL AND METHODOLOGY: Twenty specimens of cortical bone were manufactured from bovine and ovine species that were in different stages of development (feeding exclusively on breast milk, in the transition period to feed or pasture, and young animals but on a solid food diet). The specimens were subjected to tensile tests, recorded with a high-speed camera to obtain deformation maps. Measurements of the tensile force until the specimen broke were also carried out. A fractographic study was carried out with a scanning electron microscope to analyze the fracture surface and an analysis of the amount of calcium in each of the specimens using X-ray dispersion spectroscopy. RESULTS: A statistically significant and positive correlation was found between the elastic modulus of the specimens and their calcium content. A trend towards more rigid behavior with age was observed. CONCLUSIONS: Young bone tissue tends to stiffen with age as the calcium content increases with an increase in elastic modulus.

[Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]. / Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados.

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.

Mechanical properties variations of immature bone in the earliest stages of development. / Variación de las propiedades mecánicas del hueso inmaduro en las etapas más tempranas del desarrollo.

INTRODUCTION: Bone as a material varies its composition and mechanical properties throughout life. Although these variations are better understood in adulthood, there is little experimental information on the variation of these properties in early stages of development. The objective of this study is to analyze the mechanical behavior and chemical properties of cortical bone tissue from two animal species in these earliest stages. MATERIAL AND METHODOLOGY: Twenty specimens of cortical bone were manufactured from bovine and ovine species that were in different stages of development (feeding exclusively on breast milk, in the transition period to feed or pasture, and young animals but on a solid food diet). The specimens were subjected to tensile tests, recorded with a high-speed camera to obtain deformation maps. Measurements of the tensile force until the specimen broke were also carried out. A fractographic study was carried out with a scanning electron microscope to analyze the fracture surface and an analysis of the amount of calcium in each of the specimens using X-ray dispersion spectroscopy. RESULTS: A statistically significant and positive correlation was found between the elastic modulus of the specimens and their calcium content. A trend towards more rigid behavior with age was observed. CONCLUSIONS: Young bone tissue tends to stiffen with age as the calcium content increases with an increase in elastic modulus.

Evaluation of AIS3+ car occupant injuries using deterministic and probabilistic methods in frontal crashes.

Computational modelling was used to assess the capability of a deterministic and a probabilistic method to predict the incidence of AIS3+ injuries in passenger car occupants by comparing the predictions of the methods to the actual injuries observed in real-world crashes. The likelihood of sustaining an injury was first calculated using a computer model for a selected set of injury criteria in different impact conditions based on real-world crashes; AIS3+ injuries were then predicted using each method separately. Regardless of the method, the number of serious injuries was over-predicted. It was also noted that the used injury criteria suggested the occurrence of specific injuries that were not observed in the real world. Although both methods are susceptible to be adapted to improve their predictions, the question of the suitability of using some of the most commonly accepted injury criteria used with crash test dummies for injury assessment with human body models deserves further research.

Role of HDAC6-STAT3 in immunomodulatory pathways in Colorectal cancer cells.

Colorectal cancer (CRC) is one of the most common malignant neoplasms and the second leading cause of death from tumors worldwide. Therefore, there is a great need to study new therapeutical strategies, such as effective immunotherapies against these malignancies. Unfortunately, many CRC patients do not respond to current standard immunotherapies, making it necessary to search for adjuvant treatments. Histone deacetylase 6 (HDAC6) is involved in several processes, including immune response and tumor progression. Specifically, it has been observed that HDAC6 is required to activate the Signal Transducer and Activator of Transcription 3 (STAT3), a transcription factor involved in immunogenicity, by activating different genes in these pathways, such as PD-L1. Over-expression of immunosuppressive pathways in cancer cells deregulates T-cell activation. Therefore, we focused on the pharmacological inhibition of HDAC6 in CRC cells because of its potential as an adjuvant to avoid immunotolerance in immunotherapy. We investigated whether HDAC6 inhibitors (HDAC6is), such as Nexturastat A (NextA), affected STAT3 activation in CRC cells. First, we found that NextA is less cytotoxic than the non-selective HDACis panobinostat. Then, NextA modified STAT3 and decreased the mRNA and protein expression levels of PD-L1. Importantly, transcriptomic analysis showed that NextA treatment affected the expression of critical genes involved in immunomodulatory pathways in CRC malignancies. These results suggest that treatments with NextA reduce the functionality of STAT3 in CRC cells, impacting the expression of immunomodulatory genes involved in the inflammatory and immune responses. Therefore, targeting HDAC6 may represent an interesting adjuvant strategy in combination with immunotherapy.

Optimising adjacent membrane segmentation and parameterisation in multicellular aggregates by piecewise active contours.

In fluorescence microscopy imaging, the segmentation of adjacent cell membranes within cell aggregates, multicellular samples, tissue, organs, or whole organisms remains a challenging task. The lipid bilayer is a very thin membrane when compared to the wavelength of photons in the visual spectra. Fluorescent molecules or proteins used for labelling membranes provide a limited signal intensity, and light scattering in combination with sample dynamics during in vivo imaging lead to poor or ambivalent signal patterns that hinder precise localisation of the membrane sheets. In the proximity of cells, membranes approach and distance each other. Here, the presence of membrane protrusions such as blebs; filopodia and lamellipodia; microvilli; or membrane vesicle trafficking, lead to a plurality of signal patterns, and the accurate localisation of two adjacent membranes becomes difficult. Several computational methods for membrane segmentation have been introduced. However, few of them specifically consider the accurate detection of adjacent membranes. In this article we present ALPACA (ALgorithm for Piecewise Adjacent Contour Adjustment), a novel method based on 2D piecewise parametric active contours that allows: (i) a definition of proximity for adjacent contours, (ii) a precise detection of adjacent, nonadjacent, and overlapping contour sections, (iii) the definition of a polyline for an optimised shared contour within adjacent sections and (iv) a solution for connecting adjacent and nonadjacent sections under the constraint of preserving the inherent cell morphology. We show that ALPACA leads to a precise quantification of adjacent and nonadjacent membrane zones in regular hexagons and live image sequences of cells of the parapineal organ during zebrafish embryo development. The algorithm detects and corrects adjacent, nonadjacent, and overlapping contour sections within a selected adjacency distance d, calculates shared contour sections for neighbouring cells with minimum alterations of the contour characteristics, and presents piecewise active contour solutions, preserving the contour shape and the overall cell morphology. ALPACA quantifies adjacent contours and can improve the meshing of 3D surfaces, the determination of forces, or tracking of contours in combination with previously published algorithms. We discuss pitfalls, strengths, and limits of our approach, and present a guideline to take the best decision for varying experimental conditions for in vivo microscopy.

Centrifugal dewatering performance in plastic films recycling.

Dewatering of plastic films is a highly energy-consuming recycling operation that largely affects the quality of the recycled product. Despite the importance of good drying, this operation has not been studied at laboratory or pilot plant scale. In this work, the mechanical dewatering of blown film grade high density polyethylene has been assessed by using a laboratory centrifuge. It is suggested that a plastic cake is formed under the centrifugal forces similar to the sludge cake after the filtration process. The water is retained within the plastic cake due to three phenomena: free water within the cake pores and voids, water maintained by capillarity (superficial and pendular) and water trapped due to the tortuosity of the plastic mass. The total moisture is a sum of an equilibrium moisture and a transient moisture. The equilibrium moisture depends on the centrifugal force (G) but it is independent of time. Conversely, the transient moisture is reliant on both the G-force and the centrifugation time. The experimental results showed that an optimum side length exists. The moisture content is minimized when the flake side lies between 1 and 2 cm. Finally, it has been found that the moisture content is a function of the plastic surface. Hence, the specific moisture content (the mass of water per total plastic surface) should be calculated to compare films with uneven thickness or made of different materials. In sum, the outcomes of this study may be fundamental for the further and more extensive research into the plastic films dewatering processes.

Systemic Treatment of Moderate to Severe Psoriasis in Pediatric Patients in Galicia, Spain: A Descriptive Study. / Tratamiento sistémico de la psoriasis moderada-grave en edad pediátrica en Galicia: estudio descriptivo.

BACKGROUND AND OBJECTIVE: Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. RESULTS: Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n=40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n=63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. CONCLUSIONS: Phototherapy, followed by methotrexate, was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only).

Tratamiento sistémico de la psoriasis moderada-grave en edad pediátrica en Galicia: estudio descriptivo / Systemic Treatment of Moderate to Severe Psoriasis in Pediatric Patients in Galicia, Spain: A Descriptive Study

ANTECEDENTES Y OBJETIVO: Los trabajos sobre el tratamiento sistémico de la psoriasis en edad pediátrica son escasos. El objetivo principal de este trabajo consistió en describir qué tratamientos sistémicos se emplean en práctica clínica en psoriasis moderada-grave en edad pediátrica. Secundariamente se describió la efectividad y perfil de seguridad de dichos tratamientos. MATERIALES Y MÉTODOS: Estudio descriptivo transversal multicéntrico, de los pacientes con psoriasis moderada-grave, que siendo menores de 18 años estuviesen recibiendo o hubieran recibido tratamiento sistémico (clásico o biológico) o fototerapia. Se recogieron datos clínico-demográficos, tipo de tratamiento recibido, y tolerancia, efectos indeseables y respuesta al mismo. RESULTADOS: Se obtuvieron datos de 40 pacientes (60% sexo femenino, edad media 13 años), que realizaron 63 ciclos de tratamiento. Teniendo en cuenta el primer tratamiento (n = 40), la fototerapia fue la opción más frecuente (68%), seguida de acitretino (15%). Considerando el total de ciclos de tratamiento (n = 63), el tratamiento más frecuentemente empleado fue la fototerapia (57%), seguida de metotrexato (16%). En la semana 12 (incluye evaluación de fototerapia), el 66% y el 22% fueron buenos respondedores o respondedores parciales, respectivamente. En la semana 24 (datos exclusivos sobre fármacos sistémicos), el 36% y el 32% continuaron con respuestas buenas y parciales. Los tratamientos fueron bien tolerados (97%) y los efectos indeseables escasos (11%), sin que en ningún caso motivasen la suspensión del fármaco. CONCLUSIONES: En la población menor de 18 años con psoriasis moderada-grave evaluada la fototerapia fue el tratamiento más utilizado, seguida de metotrexato. Los tratamientos consiguieron porcentajes de buenos respondedores del 66% en la semana 12 (incluida fototerapia), y del 36% en la semana 24 (fármacos sistémicos sin fototerapia), presentando un buen perfil de seguridad

BACKGROUND AND OBJECTIVE: Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. RESULTS: Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n = 40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n =63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. CONCLUSIONS: Phototherapy, followed by methotrexate, was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only)

Plastic flexible films waste management - A state of art review.

Plastic flexible films are increasingly used in many applications due to their lightness and versatility. In 2014, the amount of plastic films represented 34% of total plastic packaging produced in UK. The flexible film waste generation rises according to the increase in number of applications. Currently, in developed countries, about 50% of plastics in domestic waste are films. Moreover, about 615,000 tonnes of agricultural flexible waste are generated in the EU every year. A review of plastic films recycling has been conducted in order to detect the shortcomings and establish guidelines for future research. This paper reviews plastic films waste management technologies from two different sources: post-industrial and post-consumer. Clean and homogeneous post-industrial waste is recycled through closed-loop or open-loop mechanical processes. The main differences between these methods are the quality and the application of the recycled materials. Further research should be focused on closing the loops to obtain the highest environmental benefits of recycling. This could be accomplished through minimizing the material degradation during mechanical processes. Regarding post-consumer waste, flexible films from agricultural and packaging sectors have been assessed. The agricultural films and commercial and industrial flexible packaging are recycled through open-loop mechanical recycling due to existing selective waste collection routes. Nevertheless, the contamination from the use phase adversely affects the quality of recycled plastics. Therefore, upgrading of current washing lines is required. On the other hand, household flexible packaging shows the lowest recycling rates mainly because of inefficient sorting technologies. Delamination and compatibilization methods should be further developed to ensure the recycling of multilayer films. Finally, Life Cycle Assessment (LCA) studies on waste management have been reviewed. A lack of thorough LCA on plastic films waste management systems was identified.

Differences in the kinematics of booster-seated pediatric occupants using two different car seats.

OBJECTIVE: The objective of this article is to compare the performance of forward-facing child restraint systems (CRS) mounted on 2 different seats. METHODS: Two different anthropomorphic test device (ATD) sizes (P3 and P6), using the same child restraint system (a non-ISOFIX high-back booster seat), were exposed to the ECE R44 regulatory deceleration pulse in a deceleration sled. Two different seats (seat A, seat B) were used. Three repetitions per ATD and mounting seat were done, resulting in a total of 12 sled crashes. Dummy sensors measured the head tri-axial acceleration and angular rate and the thorax tri-axial acceleration, all acquired at 10,000 Hz. A high-speed video camera recorded the impact at 1,000 frames per second. The 3D kinematics of the head and torso of the ATDs were captured using a high-speed motion capture system (1,000 Hz). A pair-matched statistical analysis compared the outcomes of the tests using the 2 different seats. RESULTS: Statistically significant differences in the kinematic response of the ATDs associated with the type of seat were observed. The maximum 3 ms peak of the resultant head acceleration was higher on seat A for the P3 dummy (54.5 ± 1.9 g vs. 44.2 ± 0.5 g; P =.012) and for the P6 dummy (56.0 ± 0.8 g vs. 51.7 ± 1.2 g; P =.015). The peak belt force was higher on seat A than on seat B for the P3 dummy (5,488.0 ± 198.0 N vs. 4,160.6 ± 63.6 N; P =.008) and for the P6 dummy (7,014.0 ± 271.0 N vs. 5,719.3 ± 37.4 N; P =.015). The trajectory of the ATD head was different between the 2 seats in the sagittal, transverse, and frontal planes. CONCLUSION: The results suggest that the overall response of the booster-seated occupant exposed to the same impact conditions was different depending on the seat used regardless of the size of the ATD. The differences observed in the response of the occupants between the 2 seats can be attributed to the differences in cushion stiffness, seat pan geometry, and belt geometry. However, these results were obtained for 2 particular seat models and a specific CRS and therefore cannot be directly extrapolated to the generality of vehicle seats and CRS.

Características sociodemográficas y clínicas de pacientes diagnosticados con depresión en Centros Comunitarios de Salud Mental (COSAM) de Santiago, Chile / Sociodemographic and clinical characteristics of patients diagnosed with depression in Community Mental Health Centres (COSAM) in Santiago, Chile

Introduction: The study aimed to characterize a sample of depressive patients who attend to Community Mental Health Centres (COSAM) in Santiago, regarding their sociodemographic and clinical characteristics and the associations among these variables. Method: 88 patients treated at 5 different COSAM in Santiago were assessed with self-report questionnaires regarding sociodemographic variables, severity of depressive symptoms (BDI), general and social functioning (OQ-45) and health-related quality of life (SF-36). Descriptive and correlational analyses were performed to describe sociodemographic and clinical features of the participants, and to address the associations between depressive symptomatology, general functioning and quality of life. Results: Participants were mostly women, with chronic and severe depressive symptoms and high frequency of comorbid physical illnesses, they presented reduced quality of life and impairments in general and social functioning. Female gender and a history of physical illness were significant predictors of the severity of depressive symptoms. The latter, in turn, showed moderate to high correlations with the different dimensions of general functioning and quality of life, especially with lack of vitality, impact of health and emotional problems in social life, work and daily activities and, the perception of an impaired mental health. Conclusion: Depressive disorders in patients treated at COSAM are highly limiting and are associated with low quality of life. The observed profile describes mainly women patients with severe chronic symptoms, in whom physical, emotional and personality vulnerabilities are intertwined, suggesting the need for an articulated approach to physical and mental health and therapeutic resources considering these characteristics.

Este estudio describe características sociodemográficas y clínicas en una muestra de pacientes depresivos atendidos en Centros Comunitarios de Salud Mental (COSAM) en Santiago, y explora asociaciones entre estas variables. 88 pacientes consultantes en 5 COSAM fueron evaluados mediante cuestionarios de auto-reporte, respecto a variables sociodemográficas, severidad de los síntomas depresivos (BDI), funcionamiento general y social (OQ-45) y calidad de vida (SF-36). Se realizaron análisis descriptivos y correlacionales para describir características sociodemográficas y clínicas, y estudiar las asociaciones entre variables sociodemográficas y gravedad de la sintomatología depresiva, y entre esta última y el funcionamiento general y calidad de vida. Los participantes fueron mayoritariamente mujeres, con síntomas depresivos crónicos y severos, y alta frecuencia de comorbilidad médica. Presentaron disminución de su calidad de vida y alteraciones en el funcionamiento general y social. Sexo femenino e historia de enfermedad física fueron predictores significativos de gravedad de los síntomas depresivos. Estos, a su vez, mostraron correlaciones significativas con diferentes dimensiones del funcionamiento general y la calidad de vida, especialmente con la falta de vitalidad, impacto de la salud y problemas emocionales en la vida social, trabajo y actividades cotidianas, y percepción de una salud mental deteriorada. Los trastornos depresivos en pacientes atendidos en COSAM son altamente limitantes y están asociados a una baja calidad de vida. El perfil observado describe principalmente mujeres, con sintomatología severa y crónica, en la que se entrelazan vulnerabilidades físicas, emocionales y de personalidad, lo que sugiere la necesidad de un enfoque articulado de la salud física y mental y recursos terapéuticos que consideren estas características.

Analysis of occupant kinematics and dynamics in nearside oblique impacts.

OBJECTIVE: The objective of this article is to analyze the kinematics and dynamics of restrained postmortem human surrogates (PMHS) exposed to a nearside oblique impact and the injuries that were found after the tests. METHODS: Three male PMHS of similar age (64 ± 4 years) and anthropometry (weight: 61 ± 9.6 kg; stature: 172 ± 2.7 cm) were exposed to a 30° nearside oblique impact at 34 km/h. The test fixture approximated the seating position of a front seat occupant. A rigid seat was designed to match the pelvic displacement in a vehicle seat. Surrogates were restrained by a 3-point seat belt consisting of a 2 kN pretensioner (PT), 4.5 kN force-limiting shoulder belt, and a 3.5 kN PT lap belt. The shoulder belt PT was not fired in one of the tests. Trajectories of the head, shoulder, and hip joint (bilaterally) were recorded at 1,000 Hz by a 3D motion capture system. The 3D acceleration and angular rate of the head, T1, and pelvis, and the 3D acceleration of selected spinal locations was measured at 10,000 Hz. Seat belt load cells measured the belt tension at 4 locations. PMHS donation and handling were performed with the approval of the relevant regional ethics review board. RESULTS: Activation of the shoulder PT reduced substantially the peak forward excursion of the head but did not influence the lateral displacement of the head center of gravity (CG). In all 3 subjects, the lateral excursion of the head CG (291.1, 290, 292.1 mm) was greater than the forward displacement (271.4, 216.7, 171.5 mm). The hip joint excursion of the PMHS that was not exposed to the shoulder PT seat belt was twice the magnitude observed for the other 2 subjects. The 3 PMHS sustained clavicle fractures on the shoulder loaded by the seat belt and 2 of them were diagnosed atlantoaxial subluxation in the radiologist examination. Avulsion fractures of the right lamina of T1, T2, T3, and T4 were found when the PT was not used. The 3 PMHS received multiple fractures spread over both aspects of the rib cage and involving the posterior aspect of it. CONCLUSION: In this study of nearside oblique impact loading, the PMHS exhibited kinematics characterized by reduced torso pitching and increased lateral head excursion as compared to previous frontal impact results. These kinematics resulted in potential cervical and thoracic spinal injuries and in complete, displaced fractures of the lateral and posterior aspects of the rib cage. Though this is a limited number of subjects, it shows the necessity of further understanding of the kinematics of occupants exposed to this loading mode.

[Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool]. / Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool.

INTRODUCTION: The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers¼ in the Global Trigger Tool (GTT). SETTING: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. RESULTS: Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). CONCLUSIONS: The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers¼ for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary.

Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool / Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool

Introducción. La implantación del listado de verificación quirúrgica (LVQ) por la OMS ha permitido mejorar la seguridad de los pacientes. El objetivo ha sido evaluar el grado de cumplimiento del LVQ incorporando los no cumplimientos como triggers o pistas en la herramienta Global Trigger Tool (GTT). Material y métodos. Ámbito: hospital geriátrico de agudos con 200 camas. Estudio retrospectivo. Periodo de estudio: 2011-2014. Se utilizó el formulario del LVQ y la metodología del GTT para el análisis de historias clínicas y el cumplimiento del LVQ desde el año 2011 hasta el año 2014. Para el grado del daño se usaron las categorías del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Resultados. Se analizaron 227 historias de pacientes dados de alta (23,6%) de todas las historias electrónicas (1,7% de las intervenciones en los 4 años). El 100% de las historias contenían el LVQ, el 94,4% de los ítems estaban cubiertos y 28,2% de los LVQ tenían todos los ítems cumplimentados en las 3 fases del proceso. Los efectos adversos quirúrgicos disminuyeron del 16,3% en el año 2011 al 9,4% en el año 2014 (p=0,2838, no significativo) y el cumplimiento de todos los ítems del LVQ aumentó del 18,6 al 39,1% (p=0,0246, significativo). Conclusiones. La herramienta GTT permite sistematizar con un menor coste de tiempo la búsqueda de historias clínicas al azar para evaluar el cumplimiento del LVQ y considerar a los no cumplimientos del LVQ como triggers para su análisis posterior. Esta estrategia no ha sido nunca contemplada en el GTT ni en la sistemática del LVQ (AU)

Introduction. The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers» in the Global Trigger Tool (GTT). Material and methods. Setting: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. Results. Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). Conclusions. The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers» for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary (AU)

Sulfide-oxidizing bacteria establishment in an innovative microaerobic reactor with an internal silicone membrane for sulfur recovery from wastewater.

A novel bioreactor, employing a silicone membrane for microaeration, was studied for partial sulfide oxidation to elemental sulfur. The objective of this study was to assess the feasibility of using an internal silicone membrane reactor (ISMR) to treat dissolved sulfide and to characterize its microbial community. The ISMR is an effective system to eliminate sulfide produced in anaerobic reactors. Sulfide removal efficiencies reached 96 % in a combined anaerobic/microaerobic reactor and significant sulfate production did not occur. The oxygen transfer was strongly influenced by air pressure and flow. Pyrosequencing analysis indicated various sulfide-oxidizing bacteria (SOB) affiliated to the species Acidithiobacillus thiooxidans, Sulfuricurvum kujiense and Pseudomonas stutzeri attached to the membrane and also indicated similarity between the biomass deposited on the membrane wall and the biomass drawn from the material support, supported the establishment of SOB in an anaerobic sludge under microaerobic conditions. Furthermore, these results showed that the reactor configuration can develop SOB under microaerobic conditions and can improve and reestablish the sulfide conversion to elemental sulfur.

A comparison of the performance of two advanced restraint systems in frontal impacts.

OBJECTIVE: The goal of the study is to compare the kinematics and dynamics of the THOR dummy in a frontal impact under the action of 2 state-of-the-art restraint systems. METHODS: Ten frontal sled tests were performed with THOR at 2 different impact speeds (35 and 9 km/h). Two advanced restraint systems were used: a pretensioned force-limiting belt (PT+FL) and a pretensioned belt incorporating an inflatable portion (PT+BB). Dummy measurements included upper and lower neck reactions, multipoint thoracic deflection, and rib deformation. Data were acquired at 10,000 Hz. Three-dimensional motion of relevant dummy landmarks was tracked at 1,000 Hz. RESULTS are reported in a local coordinate system moving with the test buck. RESULTS: Average forward displacement of the head was greater when the PT+FL belt was used (35 km/h: 376.3±16.1 mm [PT+BB] vs. 393.6±26.1 mm [PT+FL]; 9 km/h: 82.1±26.0 mm [PT+BB] vs. 98.8±0.2 mm [PT+FL]). The forward displacement of T1 was greater for the PT+FL belt at 35 km/h but smaller at 9 km/h. The forward motion of the pelvis was greater when the PT+BB was used, exhibiting a difference of 82 mm in the 9 km/h tests and 95.5 mm in the 35 km/h test. At 35 km/h, upper shoulder belt forces were similar (PT+FL: 4,756.8±116.6 N; PT+BB: 4,957.7±116.4 N). At 9 km/h, the PT+BB belt force was significantly greater than the PT+FL one. Lower neck flexion moments were higher for the PT+BB at 35 km/h but lower at 9 km/h (PT+FL: 34.2±3.5 Nm; PT+BB: 26.8±2.1 Nm). Maximum chest deflection occurred at the chest upper left region for both belts and regardless of the speed. CONCLUSION: The comparison of the performance of different restraints requires assessing occupant kinematics and dynamics from a global point of view. Even if the force acting on the chest is similar, kinematics can be substantially different. The 2 advanced belts compared here showed that while the PT+BB significantly reduced peak and resultant chest deflection, the resulting kinematics indicated an increased forward motion of the pelvis and a reduced rotation of the occupant's torso. Further research is needed to understand how these effects can influence the protection of real occupants in more realistic vehicle environments.

The six degrees of freedom motion of the human head, spine, and pelvis in a frontal impact.

OBJECTIVE: The goal of this study is to characterize the in situ 6-degree-of-freedom kinematics of the head, 3 vertebrae (T1, T8, and L2), and the pelvis in a 40 km/h frontal impact. METHODS: Three postmortem human surrogates (PMHS) were exposed to a deceleration of 15 g over 125 ms and the motion of selected anatomical structures (head, T1, T8, L2, and pelvis) was tracked at 1000 Hz using an optoelectric stereophotogrammetric system. Displacements of the analyzed structures are reported in the sagittal and the transverse planes. Rotations of the structures are described using the finite helical axis of the motion. RESULTS: Anterior displacements were 530.5 ± 39.4 mm (head), 434.7 ± 20.0 mm (T1), 353.3 ± 29.6 mm (T8), 219.9 ± 19.3 mm (L2), and 78.9 ± 22.1 mm (pelvis). The ratio between peak anterior and lateral displacement was up to 19 percent (T1) and 26 percent (head). Magnitudes of the rotation of the head (69.9 ± 1.5°), lumbar (66.5 ± 9.1°), and pelvis (63.8 ± 11.8°) were greater than that of the thoracic vertebrae (T1: 49.1 ± 7.8°; T8: 47.7 ± 6.3°). Thoracic vertebrae exhibited a complex rotation behavior caused by the asymmetric loading of the shoulder belt. Rotation of the lumbar vertebra and pelvis occurred primarily within the sagittal plane (flexion). CONCLUSION: Despite the predominance of the sagittal motion of the occupant in a pure (12 o'clock) frontal impact, the asymmetry of belt loading induced other relevant displacements and rotations of the head and thoracic spine. Attempts to model occupant kinematics in a frontal impact should consider these results to biofidelically describe the interaction of the torso with the belt.